Assessment of Tuberculosis Treatment and Quality of Anti-Tb Drug Management in Health Facilities in Gambella Regional State, Ethiopia

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Addis Ababa University


Introduction: Tuberculosis is among the chronic infectious diseases in the world which is responsible for a great number of global mortality and morbidity. Its prevalence is highest in developing countries among which the Sub-Saharan Africa is in the front line. Effectiveness of tuberculosis treatment is measured by the level of treatment success and cure rates achieved. The main factors contributing to low tuberculosis cure rate are prevalence of multi-drug resistant tuberculosis, high level of TB/HIV co-infection, inappropriate prescribing practices by service providers, low quality of DOTS, low level of knowledge among TB patients about their treatment and infrequent and poor quality drug supply to TB patients. This study is, therefore, intended to assess tuberculosis treatment in health facilities in the region in general and the factors which may influence tuberculosis cure rate in particular in order to conclude whether these factors are really contributing to the problem at hand or not. This will greatly help in taking appropriate measures against tuberculosis and the associated factors. Objective: To assess tuberculosis treatment and quality of anti-TB drug management in health facilities in Gambella Regional State, Ethiopia. Methodology: A cross-sectional health institution based survey was conducted from 10th July to 20th Results: The results of this study showed that total TB/HIV co-infection level in the region was 46.7%, above the national level (31%). There was no significant difference in HIV positivity among female and male tuberculosis patients. Extra pulmonary tuberculosis patients were 1.95 times at a higher risk of contracting HIV than pulmonary tuberculosis patients. August, 2009 in six health institutions, where records were reviewed for 823 patients, exit interviews were done among 113 outpatients, key informant interview were done among six tuberculosis care providers and six pharmacy personnel. Observation was made to the store and dispensary units of the respective health institutions. Data was entered using Epi Info version 2002 and analysed using SPSS version 15 statistical soft wares. Qualitative data was manually processed and analysed. ix Similarly, re-treatment tuberculosis patients were 2.63 times at a higher risk of contracting HIV than new cases. Non-adherence to the treatment guide lines was one major prescribing problem among prescribers in all weight categories of patients. Among the anti-TB drugs, Isoniazid, Rifampicin and Pyrazinamide were the most common drugs prescribed in either under doses or over doses. Around forty-eight percent (47.8%) of the total patients interviewed reported to have been directly observed during the intensive phase and 50.6% of new cases, 39.3% of re-treatment cases, 48.1% of male and 46.7% of female tuberculosis patients said that they were directly observed during the first two months of their treatment. About seventy five percent (75.5%) of the total respondents confirmed that they were informed about the duration of their treatment. But this was 69% among new cases, 75%, 68.75% and 73.3% among re-treatment, male and female TB patients, respectively. Nearly fifty percent (49.6%) of the interviewees reported that the disease would relapse and 46.9% said that they would die of the disease if they failed to take their anti-TB drugs as prescribed. There was poor drug storage conditions in two out of the six health facilities and moderately adequate in the regional store. Some facilities in support of TB care like water, sputum cups and slides were not available, some in all health facilities and others in certain health facilities. There was staffing problem in the TB clinics and the stores of the health facilities. Conclusion and Recommendations: The study concluded that the level of TB/HIV co-infection was high in Gambella Regional State. Non-adherence of prescribers to national guide lines and low degree of DOT implementation were prevalent problems in health facilities in the region. It can also be inferred from the study that inadequate storage conditions, staffing and unavailability of facilities in support of TB care were problems in health facilities in the region. Hence, it is recommended that mechanisms should be devised to tackle TB and HIV in a coordinated manner, enforce prescribers to follow national guide lines, facilitate provision of facilities to improve anti-TB drug storage condition and facilities in support of TB care and solve staffing problems.



Tuberculosis Treatment ;Quality of Anti-Tb Drug