Implementation Evaluation of Tuberculosis Directly Observed Treatment Short-Course Strategy in Jimma Town Public Health Facilities

Abstract

Background: The national TB control program has currently achieved 100 percent geographical coverage and 92% of public hospitals and health centers offer tuberculosis directly observed short-course treatment. Despite this Ethiopia is ranked 10th from the world’s 22 high-burden countries for TB, and 4th from sub-Saharan Africa. The burden of multi-drug resistance tuberculosis is also remaining high in Ethiopian settings, especially in previously treated TB cases. Previous TB treatment was the most powerful predictor for multi-drug resistance mycobacterium tuberculosis infection with inadequate TB treatment. Thus this study aimed to generate relevant information on the implementation of TB DOTS strategy to improve quality of service. Objective: To explore the implementation level of tuberculosis directly observed treatment short-course strategy in Jimma town public health facilities in 2019 G.C. Method:The study was conducted in Jimma town public health facilities, which is located 355KM to Addis Abeba in the southwest direction. A case study design using a qualitative and quantitative method was employed. Two years of records of 384 TB patients were selected using simple random sampling and proportionally allocated for six health facilities. Moreover, provider-patient interaction was observed and exit interview was conducted. Quantitative data was analyzed using SPSS 23.0 software and the finding was presented using descriptive statistics. The key informant interview result was summarized and analyzed in major thematic areas and supplement the quantitative finding. The overall implementation status of TB DOTS strategy was determined based on judgment criteria. Result: The evaluation finding shows that the availability of resource was 70.8%. There were only two facilities have full time trained DOTS provider. Standardized regimen for existing adult TB patients and pediatric dose drugs were not fulfilled in three health facilities. Information education communication materials and TB posters were not available in all studied facilities. Compliance of TB DOTS providers toward national guideline score was 77.3%. From 384/353 (91.7%) of the patients on intensive phase were treated to the DOTS recommended drug regimen and during the continuation phase269/340 (79.1 %) of patients were treated according to DOTS drug regimen. From total 156 on intensive and 150 on continuation phase smear-positive PTB patients, 73.7%, 50%, and 52.7% have smear follow up test at the end of the 2nd, 5th and 6thmonths of treatment, respectively. The overall patient satisfaction was 80.1 %( satisfied) according to judgment criteria. About 105(75%) patients were satisfied with the convenience of TB clinic working hours, 60.7% of patients satisfied with daily visit and 85.7% TB patients satisfied with waiting time. In addition to this, 25.7% and 19.3% were not satisfied with the competency & knowledge of providers and adequacy of explanation about the treatment respectively. Conclusion and recommendation: The overall status of TB DOTS implementation was partially implemented in Jimma town public health facilities based on judgment criteria. Attention should be given how to assign responsible and trained full-time HWs who could provide TB DOTS service as standard and availability of necessary drugs and IEC/BCC materials should be ensured.