Process evaluation of direct observation therapy of tuberculosis strategy in West Gojjam Zone selected public health facilities, Northwest Ethiopia, 2021

Abstract

Abstract: Background: Direct observation therapy is the most effective tuberculosis control strategy available for controlling tuberculosis epidemics both worldwide and in Ethiopia. However, evidence shows that tuberculosis related mortality, morbidity, Human Immunodeficiency Virus co-infection and multi-drug resistance are not reduced significantly, which is associated with the process and implementation status of the direct observation therapy strategy in drugsusceptible

tuberculosis. Moreover, no evaluation study is found on the process of the direct observation therapy strategy. Therefore, the aim of this evaluation is to assess the process of tuberculosis direct observation therapy strategy. Objective: To evaluate the process of tuberculosis direct observation therapy strategy in West Gojjam Zone health facilities, northwest Ethiopia, 2021. Methods: Facility-based single case study design with formative evaluation approach involving concurrent nested method was implemented from April 2021 to May 2021. Interviewer administered questionnaire was used to assess patients satisfaction. Documents were reviewed for about 256 patients and nine key informant interviews were conducted. Quantitative data was cleaned, coded, entered using Epi data, and exported to SPSS software for analysis. Qualitative data were transcribed, translated, coded, and analyzed thematically using open code software. Result: The overall implementation of the process of tuberculosis direct observation therapy strategy was found to be 73.1%. Structure dimension was 90% measured by the availability of resources, compliance of health care provider to the national tuberculosis prevention and control program guideline and satisfaction level of patient was 55.7% and 71.1% respectively. Tuberculosis symptom (AOR = 2.55, 95% CI 1.09, 5.97), Being a daily laborer (AOR = 8.02, 95% CI 1.40, 45.94), tuberculosis type (AOR = 2.14, 95% CI 1.1, 4.17), tuberculosis category (AOR = 3.06, 95% CI 1.07, 8.76), the distance of the Patient's home (AOR= 0.28, 95% CI 0.09, 0.85) were factors significantly associated with patient satisfaction. Conclusion: The process of tuberculosis direct observation therapy was fairly implemented but it needs urgent improvement. Even though there were required resources, compliance of health care providers to the national tuberculosis prevention and control program guideline was poor. The satisfaction of patients was fair but the effort to address areas of dissatisfaction is needed. Follow the national tuberculosis prevention, and control program guideline. Is better to have strong supportive supervision and pay attention to make service accessible to all patient. Keywords: TB, Direct Observation Therapy Strategy, Process evaluation, West Gojjam Zone, Ethiopia