Research Article: Satisfaction of patients with directly observed treatment strategy in Addis Ababa, Ethiopia: A mixed-methods study

Date Published: February 9, 2017

Publisher: Public Library of Science

Author(s): Belete Getahun, Zethu Zerish Nkosi, Madhukar Pai.


Directly observed treatment, short course (DOTS) strategy has been a cornerstone for Tuberculosis (TB) control programs in developing countries. However, in Ethiopia satisfaction level of patients’ with TB with the this strategy is not well understood. Therefore, the study aimed to assess the satisfaction level of patients with TB with the DOTS.

Explanatory sequential mixed method design was carried out in Addis Ababa, Ethiopia. Interviewer-administered questionnaire with 601 patients with TB who were on follow-up was employed in the quantitative approach. In the qualitative approach telephonic-interview with 25 persons lost to follow-up and focus group discussions with 23 TB experts were conducted.

Sixty seven percent of respondent was satisfied with the DOTS. Rural residency (AOR = 3.4, 95% CI 1.6, 7.6), having TB symptoms (AOR = 0.6, 95% CI 0.4, 0.94) and treatment supporter (AOR = 4.3, 95%CI 2.7, 6.8) were associated with satisfaction with DOTS.

DOTS is limited to satisfy patients with TB and lacks a consistent system that determines the satisfaction level of patients with TB. Therefore, DOTS strategy needs to have a system to captures patients’ satisfaction level to respond on areas that need progress to improve DOTS service quality.

Partial Text

One third of the world’s population, approximately 2 billion persons, is thought to be latently infected with Mycobacterium tuberculosis (M.tb); 9 million persons develop active disease attributable to M.tb infection annually. In 2015, there were an estimated 10.4 million incident cases of TB and 1.4 million deaths from Tuberculosis (TB) globally [1]. Globally, for the last two hundred years TB has killed more than any other infectious disease [2].

The study was used explanatory sequential mixed method study design from September 2015 to November 2015 in Addis Ababa, Ethiopia.

Our result presented as follows: quantitative study findings: general characteristics of patients with TB, type of TB and the satisfaction level of the patient with TB and logistic regression analysis outcome. Then followed by qualitative study findings.

Although the Ethiopian Federal Ministry of Health (FMOH) has given due attention and priority to the quality of health care service since the first health sector development plan in 1997, a health care quality strategy has been developed recently. The Ethiopia health care quality strategy has included patient satisfaction as one of success indicators for the provision of quality service for the patients at HCO [31]. Even during Ethiopian hospital performance recognition ceremony in Addis Ababa, Ethiopia, in 2016, the Ethiopian FMOH minster stressed that “the next selection of hospital’s award will be mainly based on survey of client satisfaction. Client satisfaction will be the main indicator.” In addition Ethiopia’s 2015–2020 health sector development plans focus on quality health care delivery and equity in health [32].

The study finding shows that patients with TB who were on follow-up of their treatment were following their treatment with dissatisfaction. All of the lost to follow-up patients with TB were dissatisfied with DOTS. Dissatisfaction is one of the causes to deviate from follow-up. DOTS delivery process, general condition of HCO, allied health care services such as nutritional support and transport services are explored factors with satisfaction. Therefore, the DOTS strategy should include a regular mechanism that informs programmer, policy maker and HCPs about patients with TB satisfaction with DOTS. Moreover, the HCPs, TB-experts, Health programmer need to act on the barriers of patients with TB’ dissatisfaction such as unavailability of nutritional support and transport support, inconvenience of HCOs conditions and long waiting time in health facilities.




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