Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea

Authors: Tanya Diefenbach-Elstob, David Plummer, Robert Dowi, Sinba Wamagi, Bisato Gula, Keyanato Siwaeya, Daniel Pelowa, Peter Siba, Jeffrey Warner

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

Papua New Guinea (PNG) is a diverse and culturally-rich country with severe infrastructural and health problems. Tuberculosis (TB) is widespread, and the number of cases with drug resistance is rising. Treatment adherence is known to be important for both effective treatment and limiting the emergence of drug resistance. The aim of this study was to construct a matrix of the factors that act as facilitators or barriers to TB treatment adherence in a remote region of PNG.

Methods

The study was based in the Balimo region of the Western Province. People known to have undergone TB treatment, as well as staff involved in managing people with TB, were asked to participate in an in-depth interview about their experiences. Purposive sampling was used to identify a diverse range of participants, from different geographic locations, social backgrounds, and with successful and unsuccessful treatment outcomes. The interview data was analysed based on grounded theory methodology.

Results

The study identified a range of factors that influence TB treatment adherence, with these being classified as personal, systems, and sociocultural. These factors are presented along with suggested recommendations for adaptations to DOTS-based treatment in this region. Barriers included the challenges associated with travel to treatment sites, and the difficulties of undertaking treatment alongside the daily need to maintain subsistence food production. However, facilitators were also identified, including the positive influence of religious beliefs, and high confidence in the ability of DOTS-based treatment to cure TB.

Conclusions

Documenting the wide range of factors that influence treatment adherence in a severely affected remote population will assist in improving TB control. These results provide impetus for further community-based efforts aimed at improving access to TB diagnosis and treatment, and maintaining successful treatment outcomes in the face of emerging drug resistance.
Appendix
Available only for authorised users
Literature
1.
2.
Carroll K, Malefoasi G. Comparison of outcomes from a district tuberculosis control programme in the Pacific: before and after the implementation of DOTS. Trop Doct. 2004;34:11–4.CrossRefPubMed
3.
Shargie E, Lindtjorn B. DOTS improves treatment outcomes and service coverage for tuberculosis in South Ethiopia: a retrospective trend analysis. BMC Public Health. 2005;5:62.CrossRefPubMedPubMedCentral
4.
5.
Cross GB, Coles K, Nikpour M, Moore OA, Denholm J, McBryde ES, Eisen DP, Warigi B, Carter R, Pandey S, Harino P, Siba P, Coulter C, Mueller I, Phuanukoonnon S, Pellegrini M. TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study. BMC Infect Dis. 2014;14:93.CrossRefPubMedPubMedCentral
6.
7.
Gilpin CM, Simpson G, Vincent S, O’Brien TP, Knight TA, Globan M, Coulter C, Konstantinos A. Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea. Med J Aust. 2008;188:148–52.PubMed
8.
Simpson G, Coulter C, Weston J, Knight T, Carter R, Vincent S, Robertus L, Konstantinos A. Resistance patterns of multidrug-resistant tuberculosis in Western Province, Papua New Guinea. Int J Tuberc Lung Dis. 2011;15:551–2.CrossRefPubMed
9.
Luke L, Phuanukoonnon S, Suarkia D, Pangoa H, Gilpin C, Coulter C, McCarthy J, Usurup J, Siba P. Distribution of pulmonary tuberculosis and TB drug resistance in a hospital setting in Papua New Guinea. Int J Infect Dis. 2008;12:e336.CrossRef
10.
Ballif M, Harino P, Ley S, Coscolla M, Niemann S, Carter R, Coulter C, Borrell S, Siba P, Phuanukoonnon S, Gagneux S, Beck H-P. Drug resistance-conferring mutations in Mycobacterium tuberculosis from Madang, Papua New Guinea. BMC Microbiol. 2012;12:191.CrossRefPubMedPubMedCentral
11.
Macfarlane J. Common themes in the literature on traditional medicine in Papua New Guinea. P N G Med J. 2009;52:44–53.PubMed
12.
Ongugo K, Hall J, Attia J. Implementing tuberculosis control in Papua New Guinea: a clash of culture and science? J Community Health. 2011;36:423–30.CrossRefPubMed
13.
14.
15.
Saldaña J. The coding manual for qualitative researchers. 2nd ed. London: SAGE Publications Ltd; 2013.
16.
Layder D. New strategies in social research: an introduction and guide. London: Polity; 1993.
17.
Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New Brunswick: AldineTransaction; 2008.
18.
Adane AA, Alene KA, Koye DN, Zeleke BM. Non-adherence to anti-tuberculosis treatment and determinant factors among patients with tuberculosis in northwest Ethiopia. PLoS ONE. 2013;8:e78791.CrossRefPubMedPubMedCentral
19.
Widjanarko B, Gompelman M, Dijkers M, van der Werf MJ. Factors that influence treatment adherence of tuberculosis patients living in Java, Indonesia. Patient Prefer Adherence. 2009;3:231–8.PubMedPubMedCentral
20.
Martins N, Grace J, Kelly PM. An ethnographic study of barriers to and enabling factors for tuberculosis treatment adherence in Timor Leste. Int J Tuberc Lung Dis. 2008;12:532–7.PubMed
21.
Gebremariam MK, Bjune GA, Frich JC. Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health. 2010;10:651.CrossRefPubMedPubMedCentral
22.
Kagee A, Delport T. Barriers to adherence to antiretroviral treatment: the perspectives of patient advocates. J Health Psychol. 2010;15:1001–11.CrossRefPubMed
23.
Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, Kglatwane J, Kinsman J, Kwasa R, Maridadi J, Moroka TM, Moyo S, Nakiyemba A, Nsimba S, Ogenyi R, Oyabba T, Temu F, Laing R. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19:658–65.CrossRefPubMed
24.
Anaam MS, Ibrahim MIM, Serouri AWA, Aldobhani A. Factors affecting patients’ compliance to anti-tuberculosis treatment in Yemen. J Pharm Health Serv Res. 2013;4:115–22.CrossRef
25.
Tadesse T, Demissie M, Berhane Y, Kebede Y, Abebe M. Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study. BMC Public Health. 2013;13:424.CrossRefPubMedPubMedCentral
26.
Buregyeya E, Kulane A, Colebunders R, Wajja A, Kiguli J, Mayanja H, Musoke P, Pariyo G, Mitchell EMH. Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda. Int J Tuberc Lung Dis. 2011;15:938–42.CrossRefPubMed
27.
World Vision TB DOTS Project. TB Owera - Quarterly News: April - June 2013, Issue #2. Boroko: World Vision TB DOTS Project; 2013.
28.
Wilde C. From racing to rugby: all work and no play for Gogodala men of Western Province, Papua New Guinea. Aust J Anthropol. 2004;15:286–302.CrossRef
29.
Dundon A. Warrior women, the Holy Spirit and HIV/AIDS in rural Papua New Guinea. Oceania. 2007;77:29–42.CrossRef
30.
Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, Munly K, Igonya EK, Hunt-Glassman J. Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. Am J Prev Med. 2010;39:78–80.CrossRefPubMed
31.
Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376:1838–45.CrossRefPubMed
Metadata
Title
The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea
Authors
Tanya Diefenbach-Elstob
David Plummer
Robert Dowi
Sinba Wamagi
Bisato Gula
Keyanato Siwaeya
Daniel Pelowa
Peter Siba
Jeffrey Warner
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3935-7

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Research article

Healthcare waste management practices and safety indicators in Nigeria

Research article

The unhealthy food environment does not modify the association between obesity and participation in the Supplemental Nutrition Assistance Program (SNAP) in Los Angeles County

Study protocol

An intervention strategy for improving residential environment and positive mental health among public housing tenants: rationale, design and methods of Flash on my neighborhood!

Research article

Psychological, social, and mechanical work exposures and disability retirement: a prospective registry study

Research article

Temporal distribution of gastroenteritis viruses in Ouagadougou, Burkina Faso: seasonality of rotavirus

Research article

Risk, reassurance and routine: a qualitative study of narrative understandings of the potential for HIV self-testing among men who have sex with men in England