BRAC - BANGLADESH

Peri-urban TB control in Banglasesh - A situation analysis

Urbanization and increased slums, multiplicity of providers, mobility and migration have a devastating impact on TB case detection and compliance. Observation and the practical experience of BRAC in peri-urban areas and district towns have revealed that accessibility and acceptability of the Shashto Shebikas (community level care providers) in the community was not as in the rural areas. This is due to the diversified socio-economic status and urban lifestyle. Public Health Watch on TB policy has also showed that the NTP lacks the operational structure in the urban areas. There is a need for exploration to fill the knowledge gap for initiating the development of an operational strategy for urban areas. This study was conducted to document the experiences for developing strategic operational guideline for peri-urban and district town DOTS programme. Qualitative studies were conducted to explore the challenges related to BRAC's community based TB programme in 20 district towns and 6 peri-urban areas. In-depth interviews were conducted among 52 TB patients and their families, and 78 health care providers. Eighteen case studies of patients focused on factors of non-adherence to TB treatment were conducted.

The study explored Shasto Shebikas' experiences and barriers encountered in implementing DOTS, patients' health seeking behaviours, perceptions about tuberculosis and it's treatment, drug compliance and their expectations a community based health care delivery. Family members and TB patients' friends were also assessed about tuberculosis disease, role of treatment, and their knowledge and experiences of the DOTS program. Managers of BRAC's urban DOTS programme were interviewed regarding implementation challenges encountered.