Barriers and facilitators of nutrition assessment, counseling and support for Tuberculosis patients: a qualitative study


Identification: Degefa-Meaza


Description

Barriers and facilitators of nutrition assessment, counseling and support for Tuberculosis patients: a qualitative study
Meaza Girma Degefa1*, Afework Mulugeta Bezabih2, Zinabu Hadush Kahsay 2, Abate Bekele Belachew3

1 Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
2 School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
3 School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
*Corresponding author: meazabe3@gmail.com

Background: Nutrition and proper diet has substantial role for prevention, treatment and cure of tuberculosis thus nutrition assessment, counseling and support has become an integral part of tuberculosis treatment. However, proper implementation is crucial to realize its effect and the barriers and facilitators of the implementation has not been yet studied. 
Objective: To explore barriers and facilitators of implementation of Nutrition Assessment, Counseling and Support for tuberculosis patients.  
Methods: An exploratory qualitative study conducted in public health facilities and health bureaus of Mekelle City, Northern Ethiopia. Seventeen purposively selected key informants were interviewed in April 2019. Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach within the multilevel framework.
Results: Barriers were identified at three levels (organization, care provider and patient levels). Suboptimal nutritional supply, lack of supportive supervision, lack of adequate work force, staff turn-over, sudden withdrawal of partners and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling and support services. While training, availability of measurement and educational tools, inclusion of nutrition indicators in the tuberculosis register, and presence of collaborating partners were identified as facilitators at organizational level. Patients’ motivation to know their health status was reported to be a facilitator at patient level.
Conclusion and Implications: Organization, care provider and patient level barriers and facilitators found to influence the implementation. Multifaceted approaches are needed for the health system to successfully implement the program and to gain its potential impact. More importantly, sustained provision of nutrition supply, regular supportive supervision, task sharing, inclusion of tuberculosis patients in social safety nets and income generating activities and strengthening nutrition related capacity and clinical mentorship aimed at boosting the motivation of the care providers are recommended.
 
Key Words: nutrition assessment, nutritional support, Tuberculosis, Ethiopia 

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