The Challenges of Directly Observed Treatment Shortcourse (DOTS) Implementation for Tuberculosis Management in Anambra State, Nigeria: A Comparative Analysis

Abstract

Aim: Several challenges have been hampering the DOTS strategy ranging from a paucity of staff, laboratory consumables and drugs among others. This study, therefore, assessed the challenges facing TB-DOTS implementation in Anambra State, Nigeria. Study Design: A cross-sectional analytic study was carried out. Place and Duration of Study: TB-DOTS accredited facilities in Anambra State, South-East Nigeria, September 2017 - March 2018. Methodology: Using questionnaires on 354 respondents, a checklist on 32 DOTS accredited facilities, and Key In-depth Interview (KII) guide which was administered on 14 focal persons in rural and urban facilities, including the State TBL coordinator, was employed. Data were analysed using Chi-square and Fisher`s exact test with level of significance set at p<0.05, while key themes from KII were thematically analysed. Results: Both urban and rural respondents took nearly the same time to reach a DOTS centre, however, urban respondents spent more money to reach a TB centre and this was statistically significant p≤0.002. Patients stated that the DOTS strategy could be improved by attending to them early, home visiting, having more staff, providing pocket money among others in urban compared to rural areas and these were statistically significant p≤0.003. Checklist revealed that most patients in rural facilities 16/19(84.2%) compared to urban 11/13(84.6%) were not observed taking their medications while 11/19(57.9%) rural compared to 5/13(38.5%) urban had no functional microscope. Both rural and urban facilities specifically had challenges of Genexpert machines, needed more staff and laboratories as well as adequate funds and retraining. Conclusion: Challenges of DOTS may be myriad, however, Focal persons and Health workers should ensure direct observation of patients while the STBL coordinator informs government and policymakers on the need to employ more workers in TB management to help reduce waiting time. Regular training and retraining of health workers are also recommended.