ABSTRACT
Background: One of the challenges of Revised National Tuberculosis Control Programme (RNTCP) has been that it has not been able to impart adequate knowledge, satisfactory attitude and desirable practices among treatment-supporters of rural and tribal communities. Present study was planned to explore the knowledge, attitude, practice and perceived barriers related to Directly Observed treatment (DOT) provision among the treatment-supporters of Shahdol district, Madhya Pradesh in 2018. Methods: Mixed–methods study design of triangulation type was used among 30 community- based treatment-supporters of DOT from Sohagpur tahsil of district Shahdol of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge, attitude and practices and three focus-group discussions were used to explore the perceived barriers related to DOT provision. Results: ‘Adequate knowledge’ related to DOT provision was found in 37% of treatment- supporters, while 40% had “satisfactory attitude” and 60 % had “satisfactory practice” related to DOT. The focus-group discussions revealed, ineffective training, lack of supportive supervision, insecure monetary incentive, distant Public Health Institution/Designated Microscopic Center, language barrier and patient related stigma to TB disease as main perceive challenges related to DOT. Conclusion: Study revealed inadequate knowledge and unsatisfactory attitude and practice related to DOT provision among treatment-supporters. Effective training, making services accessible to patient, making RNTCP form in Hindi language and strengthening of honorarium disbursement mechanism are urgently required.
ABSTRACT
The study has been conducted with the background that DOTS providers are the key persons in the implementation of the program at ground level. Performance at this level maximally affects the outcome of the program. It is a cross-sectional study conducted in the rural and urban population of Meerut District. A multistage random sampling from tuberculosis unit, Microscopy centers and DOTS centers were performed to cover one 8th of the district. Total of 60 DOTS centers and DOT providers were chosen for the study. A modified form of survey has been performed by three visits at each DOT center. A salient observation of the DOT centers and a face to face interview of the DOT providers have been performed by the observer and recorded on a pilot tested performa. The data collected, was coded manually, tabulated and analyzed. One-fifth (20.0%) of the DOT provides were found performing poorly, while the performance of 34 (56.7%) DOT providers was average. Only 12 (20%) and 2 (3.3%) were found to be good, and very good respectively in their performance. The study concluded that quality at DOT center level maximally affects the compliance and satisfaction which in turn affects the treatment and outcome. Increasing the quality at DOT center level will definitely give the desired results of treatment and outcome.