Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient's perspective

BACKGROUND

Despite having an effective community-based Directly Observed Therapy Short-course (DOTS) strategy for tuberculosis (TB) care, treatment adherence has been a major challenge in many developing countries including Ghana. Poor adherence results in discontinuity of treatment and leads to adverse treatment outcomes which pose an increased risk of drug resistance. This study explored barriers to TB treatment adherence and recommended potential patient-centered strategies to improve treatment adherence in two high-burden TB settings in the Ashanti region of Ghana.

METHODS

The study was conducted among TB patients who defaulted on treatment in the Obuasi Municipal and Obuasi East districts in the Ashanti region. A qualitative phenomenology approach was used to explore the barriers to TB treatment adherence. Purposive sampling was adopted to select study participants with different sociodemographic backgrounds and experiences with TB care. Eligible participants were selected by reviewing the medical records of patients from health facility TB registers (2019-2021). Sixty-one (61) TB patients met the eligibility criteria and were contacted via phone call. Out of the 61 patients, 20 were successfully reached and consented to participate. In-depth interviews were conducted with participants using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. The transcripts were imported into Atlas.ti version 8.4 software and analyzed using thematic content analysis.

RESULTS

Food insecurity, cost of transportation to the treatment center, lack of family support, income insecurity, long distance to the treatment center, insufficient knowledge about TB, side effect of drugs, improvement in health after the intensive phase of the treatment regimen, and difficulty in accessing public transportation were the main co-occurring barriers to treatment adherence among the TB patients.

CONCLUSION

The main barriers to TB treatment adherence identified in this study reveal major implementation gaps in the TB programme including gaps related to social support, food security, income security, knowledge, and proximity to treatment centers. Hence, to improve treatment adherence there is a need for the government and the National Tuberculosis Programme (NTP) to collaborate with different sectors to provide comprehensive health education, social and financial support as well as food aid to TB patients.

Prevalence and associated factors influencing stunting and wasting among children aged 1 to 5 years in Nkwanta South Municipality, Ghana

Childhood undernutrition continues to be a major public health problem and one of the most common causes of morbidity and mortality in developing countries. The risk factors of child undernutrition are diverse and change with time, place, and season.This study aimed to assess the prevalence and associated factors influencing stunting and wasting among children 1 to 5 years of age in the Nkwanta South Municipality, Ghana. This was a health facility-based descriptive cross-sectional study that used a multistage sampling technique to select 240 children 1 to 5 years of age from April to June 2019. Data were collected using a structured questionnaire and anthropometric measurements. The data were analyzed using ENA software 2011, and Stata version 15. Binary logistic regression was used to find the adjusted estimates and associations between undernutrition (stunting and wasting) and the exposure variables. P ≤ 0.05 was considered statistically significant at a 95% confidence interval. The prevalence of stunting and wasting among the children was 12.5% and 27.5%, respectively. Factors influencing stunting were parents' working status, number of children in the household, child's age, birth interval, exclusive breastfeeding, child's vaccination status, and recurrent diarrhea. Furthermore, factors influencing wasting were parents' educational level, parents' working status, child's age, birth interval, exclusive breastfeeding, poor appetite, child's vaccination status, and recurrent diarrhea. The results showed a high prevalence of stunting and wasting among children 1 to 5 years in the Nkwanta South Municipality. This finding indicates the degree to which nutritional screening for children is very crucial, and thus recommends government and health authorities to adapt or promote nutrition-related interventions such as educational awareness on the utilization of family planning services for birth spacing, exclusive breastfeeding practices, and vaccination to prevent undernutrition among young children.