Barriers to Care Seeking in Directly Observed Therapy Short-Course (DOTS) Clinics and Tuberculosis Control in Southern Nigeria: A Qualitative Analysis

Background: Study explores relationship between depressive disorder and adherence to DOTS (Directly Observed Therapy Short Course) and whether treatment of depressive disorder according to severity of depressive disorder should be an option to improve adherence to DOTS.Methods: Study included 182 newly diagnosed adult cases of tuberculosis who were on anti- tuberculosis therapy (ATT) as per program guidelines and were in third month under DOTS category I and category II therapy. Patients were screened for depressive and anxiety disorder using PHQ-9 and GAD-7. Modified ACTG baseline questionnaire was used to collect data about adherence and reasons for partial adherence.Results: Overall prevalence of depressive disorder amongst participants was found to be 37.9% and that of partial adherence (missed two or more than two doses) was 12.1%. Partial adherence was mostly seen in the first month, followed by third and second month of DOTS. Twenty- two percent patients with depressive disorder were partially adherent to ATT. Odds ratio suggests higher risk being partially adherent to ATT were greater in the participants who had depressive disorder.Conclusions: This study highlights the benefit of screening patients while diagnosing tuberculosis patients for depressive disorder, to improve disease outcome and reduce likelihood of MDR-TB.

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Predictors of pre-hospital delay in Hong Kong Chinese patients with acute myocardial infarction

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117718914 ◽

2017 ◽

Vol 17 (1) ◽

pp. 75-84 ◽

Cited By ~ 4

Author(s):

Polly WC Li ◽

Doris SF Yu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hong Kong ◽

Barriers To Care ◽

Female Gender ◽

Perceived Barriers ◽

Hong Kong Chinese ◽

Chinese Patients ◽

Care Seeking ◽

Symptom Presentation

Background: The pre-hospital delay to seek care remains the most significant barrier for effective management of acute myocardial infarction. Many of the previous studies mainly took place in Western countries. Few data are available about the care-seeking behavior of Hong Kong Chinese. Aim: The purpose of this study was to identify the predictors of pre-hospital delay in care seeking among Hong Kong Chinese patients with acute myocardial infarction. Methods: Adult Chinese patients ( n=301) with a confirmed diagnosis of acute myocardial infarction were recruited from the cardiac units of three regional hospitals in Hong Kong. Various socio-demographic, clinical, symptom presentation characteristics and patient perceptual factors were considered as potential predictors. Multivariate analysis was conducted to identify the independent predictors with pre-hospital delay in care-seeking among acute myocardial infarction patients. Results: Perceived barriers to care seeking constituted the most significant predictor for longer pre-hospital delay in acute myocardial infarction patients. Female gender was also significant in predicting longer delay, whereas a greater extent of symptom congruence and a greater extent of typical symptom presentation were significantly associated with a shorter delay. The final model accounted for 49.6% of the variance in pre-hospital delay as a whole. Conclusion: The most prominent predictors of pre-hospital delay are modifiable in nature, including the perceived barriers to care seeking and symptom congruence. Other sociodemographic and clinical factors also influence patients’ decision. Although these are non-modifiable, our findings provide important insight for educating high-risk individuals.

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ANTHROPOLOGY, DOTS AND UNDERSTANDING TUBERCULOSIS CONTROL IN NEPAL

Journal of Biosocial Science ◽

10.1017/s0021932005000982 ◽

2005 ◽

Vol 38 (1) ◽

pp. 57-67 ◽

Cited By ~ 31

Author(s):

IAN HARPER

Keyword(s):

World Health ◽

Current Debate ◽

Directly Observed Therapy ◽

Short Course ◽

Tuberculosis Programme ◽

History Of ◽

Health Organization ◽

Relationship Of ◽

Research To Policy ◽

The Way

This paper argues for the inclusion of ethnography as a research methodology for understanding the effects of public health policy. To do this, the implementation of DOTS (Directly Observed Therapy, Short-course) – the World Health Organization (WHO) prescribed policy for the control of the infectious disease tuberculosis – is explored in the context of Nepal. A brief history of DOTS and its implementation in Nepal is outlined, and the way it has been represented by those within the Nepal Tuberculosis Programme (NTP) is described. This is followed by an outline of the research done in relation to this, and the ethnographic methods used. These ethnographic data are then interpreted and analysed in relation to two specific areas of concern. Firstly, the effects around the epidemiological uses of ‘cases’ is explored; it is argued that a tightening of the definitional categories so necessary for the programme to be stabilized for comparative purposes has profound material effects in marginalizing some from treatment. Secondly, the paper examines some of the implications and effects relating to the way that the ‘directly observed’ component was implemented. The discussion explores how current debate on DOTS has been played out in some medical journals. It argues for the importance of ethnography as a method for understanding certain questions that cannot be answered by particular, and increasingly dominant, research ideologies informed by randomized controlled trials. This raises important issues about the nature of ‘evidence’ in debates on the relationship of research to policy.

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