Analysis of Implementation barriers of Directly Observed Treatment Short course therapy (DOTS) program: Case of TB patient care in Machakos County, Kenya

Abstract

Despite the success of the implementation of the Directly Observed Treatment Short Course (DOTS) programme to control and prevent tuberculosis (TB) in Kenya since the year 1996, new TB cases continue to emerge in communities, a significance of the disease transmission. The success of the DOTS programne require total adherence to TB treatment for those infected and appropriate control measures as stipulated in the WHO TB treatment guidelines to include trained manpower to manage the TB patients, adequate treatment facilities and surveillance. The main objective of this study was to examine the implementation of the DOTS programme and TB patient care in Machakos County. A pre-tested self administered questionnaire was used to collect data from health workers and 3 Focus Group Discussions were held with TB patients, health workers and patient care takers. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. For qualitative data, notes taken during Focus Group Discussions was summarized to what was agreed on and presented in narrative. Finally the findings are discussed and appropriate interpretation made. The results of this study reveal a majority (90.9%) of health workers in TB treatment facilities are not trained on TB management posing challenges to drug dose administration and advice in continuity of patient care. In addition (45.5%) of workers reported patient abseentism, (18.2%), refusal of treatment, (18.2%) staff shortage and drug shortage which are preliquisites to TB transmission, drug resistance, relapse and subsequent death. Training of health workers, additional staff, facility infrastructures improvement and diagnostic facilities which are in poor state were reported as urgent for DOTS programme implementation. The study community strongly belief once you have TB you are infected with HIV/AIDS which causes fear that results to secrecy of status. Additionally the community members practice secrecy of their member’s illness posing challenge to TB prevention and control efforts. The study recommends health education dissemination on best practices of TB and treatment adherence by the Ministry of health and to demystify the disease in communities.

Key words: Implementation of DOTS programme, TB patient care in Machakos County