Challenges TB control program

Tuberculosis causes more than 70 thousand death each year in Bangladesh. The TB control program is decentralized to all levels of healthcare where the primary healthcare setting provides service to the majority of TB patients in the country. This mixed-method study was designed to identify recent challenges in controlling TB at primary healthcare centers in Bangladesh. Data were collected from six primary healthcare centers with a low TB case detection rate. For qualitative data, Key informant interview (KII) was conducted with six government and six non-government organization (NGO) health officials who were responsible for the coordination of the TB program at the Upazila level. The government officials were Upazila Health and Family Planning Officers (UHFPO). NGO officials were three TB-Leprosy Control Officers (TLCO) and three Upazilla Managers (UM). Interview guidelines for IDI focused on patient's early symptoms, care-seeking behavior, treatment initiation and continuation, and hygiene practice to prevent infection transmission. Interview guideline for KII was comprised of questions regarding the challenges faced in case finding and ensuring proper treatment, and administrative challenges. All interviews were audio-taped and transcribed verbatim. Initial key concepts (barriers in case finding, treatment initiation and continuation, and infection control measures) of qualitative data were derived from the literature review, which served as analytic categories or "master codes". A line-by-line analysis of the interview transcripts and observations was done to generate codes under analytic categories. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. Health system delay in case finding was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence.

孟加拉国每年因结核病（Tuberculosis, TB）导致的死亡病例超过7万例。该国结核病防控项目已下沉至各级医疗卫生机构，其中基层医疗卫生机构为绝大多数结核病患者提供诊疗服务。本研究为混合方法研究设计，旨在识别孟加拉国基层医疗卫生机构在结核病防控工作中面临的最新挑战。研究数据来源于6家结核病检出率较低的基层医疗卫生机构。针对定性数据，研究对6名政府及6名非政府组织（Non-Governmental Organization, NGO）的医疗卫生官员开展了关键知情人访谈（Key Informant Interview, KII），这些官员均负责乌帕齐拉（Upazila）层面的结核病防控项目协调工作。其中政府官员为乌帕齐拉卫生与家庭规划官员（Upazila Health and Family Planning Officers, UHFPO）；非政府组织官员则包括3名结核病-麻风病防控官员（TB-Leprosy Control Officers, TLCO）与3名乌帕齐拉管理人员（Upazilla Managers, UM）。针对患者的深度访谈（In-depth Interview, IDI）指南聚焦于患者早期症状、就医行为、治疗启动与依从情况，以及预防感染传播的卫生习惯等内容；而关键知情人访谈指南则涵盖了病例发现、规范治疗保障以及行政管理层面所面临的挑战相关问题。所有访谈均进行了录音，并逐字转录。定性数据的初始核心概念（包括病例发现障碍、治疗启动与依从障碍以及感染防控措施）源自文献综述，这些概念将作为分析类别或"主编码"使用。研究对访谈转录文本与观测记录进行了逐行分析，以在分析类别下生成具体编码。研究发现，患者延迟就医与就医行为不当、对结核病症状认知不足以及医疗卫生设施可及性差相关；病例发现环节的卫生系统延迟则与人力配置不足、人员技能不足以及诊断设施有限相关。每两名患者中就有1名报告未遵循短程督导化疗（Directly Observed Treatment Short-Course, DOTS）指南。DOTS服务提供者可及性差、激励机制不足以及患者不合理需求均会导致治疗不依从。