Barriers of Multi-drugs resistant Tuberculosis (MDR- TB) detection in National Tuberculosis control Program (NTP) in Bangladesh: The Voice of Community

Flowra, Mahfuza Talukder, Dr. Yodi Mahendradhata, MSc,PhD and Prof. Dr. Ari Probandari, MPH, Ph.D

2020 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Background: Multi-drug-resistant Tuberculosis (MDR-TB) is one of the emerging and global crises worldwide. Though global prevalence and incidence of TB is in declining mode; Bangladesh is still in the list of 30 high Tuberculosis (TB) burden countries. Even having successful DOTs program and National Tuberculosis Control program (NTP), TB is in the top chart of national public health concerns due to MDR-TB as cases are gone under delayed detection and under reported. Thus, the gaps and barriers persisting in the NTP from the community point of view should be unblinded through proper investigations regarding timely diagnosis with the limited resource. This study helped to find out the barriers in the community level to maximize the MDR-TB case detection as well as notify the appropriate authority for designing the NTP more authentic way with best implementation channel. Objectives: This study aimed to assess the community perception about gaps and barrier which suppress the timely MDR-TB case finding under NTP. It has also explored the community knowledge and preference to dig up the needs and query to improve the social support and health care seeking behavior which is one of the lights to the proper implementation way by assessing which one fit most in the NTP in Bangladesh. Method: The research was conducted in two different hospitals and household level from both rural and urban setting in Bangladesh. Study design was mixed method where qualitative part used Focus group discussions (FGDs), In depth Interviews (IDIs) and Key Informants Interviews (KIIs) and quantitative part used semi structured questionnaire. Both simple random and purposive sampling method were used. MDR-TB patients, care giver of them, community health workers, Community leaders and program officer for TB from government and Non-government organizations (NGOs) from the study area were the respondents for this study. Results: All the targeted study population were positive about the NTP, but the barriers were found in coverage and information dissemination of the program. Level of knowledge regarding MDR-TB is very poor among the community people, though who knows about the disease, are enough concern about that and maintain themselves properly to get cured or prevented from further infection; but still importance of timely detection and available facilities are not satisfactory. Stigma induced constrains and economic crisis speaks louder than the priority and consequence of timely detected MDR-TB. So, some major barriers in the way of detection of timely MDR-TB under NTP was low educational rate, least information regarding the issue, unsatisfactory quality of CHWs services, less availability of gene Xpert machine, few manpower in this sector, lack of motivation of the health care provider, insufficient financial support for the patients , social acceptability. Conclusion: This study has explored various community factors which create barriers for timely detection of MDR-TB under NTP with some additional information from the health care providers side. In a nutshell, we can comment that NTP needs to take re-strategic plan focusing on community involvement by removing social stigma related factors, economic supports with intensive follow-up and rewarding approaches for the providers aspects by acknowledging monetary skim for better implementation of the program. Keywords: Barriers, MDR-TB, Delayed Detection, NTP, Community, Bangladesh.

Background: Multi-drug-resistant Tuberculosis (MDR-TB) is one of the emerging and global crises worldwide. Though global prevalence and incidence of TB is in declining mode; Bangladesh is still in the list of 30 high Tuberculosis (TB) burden countries. Even having successful DOTs program and National Tuberculosis Control program (NTP), TB is in the top chart of national public health concerns due to MDR-TB as cases are gone under delayed detection and under reported. Thus, the gaps and barriers persisting in the NTP from the community point of view should be unblinded through proper investigations regarding timely diagnosis with the limited resource. This study helped to find out the barriers in the community level to maximize the MDR-TB case detection as well as notify the appropriate authority for designing the NTP more authentic way with best implementation channel. Objectives: This study aimed to assess the community perception about gaps and barrier which suppress the timely MDR-TB case finding under NTP. It has also explored the community knowledge and preference to dig up the needs and query to improve the social support and health care seeking behavior which is one of the lights to the proper implementation way by assessing which one fit most in the NTP in Bangladesh. Method: The research was conducted in two different hospitals and household level from both rural and urban setting in Bangladesh. Study design was mixed method where qualitative part used Focus group discussions (FGDs), In depth Interviews (IDIs) and Key Informants Interviews (KIIs) and quantitative part used semi structured questionnaire. Both simple random and purposive sampling method were used. MDR-TB patients, care giver of them, community health workers, Community leaders and program officer for TB from government and Non-government organizations (NGOs) from the study area were the respondents for this study. Results: All the targeted study population were positive about the NTP, but the barriers were found in coverage and information dissemination of the program. Level of knowledge regarding MDR-TB is very poor among the community people, though who knows about the disease, are enough concern about that and maintain themselves properly to get cured or prevented from further infection; but still importance of timely detection and available facilities are not satisfactory. Stigma induced constrains and economic crisis speaks louder than the priority and consequence of timely detected MDR-TB. So, some major barriers in the way of detection of timely MDR-TB under NTP was low educational rate, least information regarding the issue, unsatisfactory quality of CHWs services, less availability of gene Xpert machine, few manpower in this sector, lack of motivation of the health care provider, insufficient financial support for the patients , social acceptability. Conclusion: This study has explored various community factors which create barriers for timely detection of MDR-TB under NTP with some additional information from the health care providers side. In a nutshell, we can comment that NTP needs to take re-strategic plan focusing on community involvement by removing social stigma related factors, economic supports with intensive follow-up and rewarding approaches for the providers aspects by acknowledging monetary skim for better implementation of the program.

Kata Kunci : Keywords: Barriers, MDR-TB, Delayed Detection, NTP, Community, Bangladesh.