title: A qualitative assessment of challenges to tuberculosis management and prevention in Northern Ethiopia.
abstract: OBJECTIVE
  To elicit Ethiopian health care providers' understanding of challenges to effectively preventing, diagnosing and treating tuberculosis (TB).
  
  
  METHODS
  Qualitative data were collected via in-depth interviews and focus group discussions with 73 providers, including physicians, nurses, pharmacists and laboratory technicians, in five hospitals in the Northern Ethiopian regions of Amhara and Tigray. There was no intervention.
  
  
  RESULTS
  Focus groups and interviews shared a number of prominent common themes. Respondents identified numerous challenges associated with active case identification, infection control practices, diagnostics, including the absence of TB culture and drug susceptibility testing capacity, and the lack of infrastructure for diagnosing and treating multidrug-resistant TB. Pharmacists noted a need for improved procurement practices and pediatric dosages for TB medications. Providers shared concerns regarding isoniazid preventive therapy, health workforce challenges and the risk of contracting TB in the workplace.
  
  
  CONCLUSIONS
  Health care providers in the Northern Ethiopian regions of Tigray and Amhara identified many challenges to effectively preventing, diagnosing and treating TB. These challenges are complicated by severe resource constraints and challenges in attracting and retaining providers in government hospitals in centers outside Addis Ababa.
authors.affiliation: Department of Infectious Disease, The University of Washington, Seattle, Washington 98195, USA. jcowan22@uw.edu
authors.forename: J
authors.initials: J
authors.lastname: Cowan
authors.forename: J
authors.initials: J
authors.lastname: Greenberg Cowan
authors.forename: S
authors.initials: S
authors.lastname: Barnhart
authors.forename: S
authors.initials: S
authors.lastname: Demamu
authors.forename: D
authors.initials: D
authors.lastname: Fiseha
authors.forename: W
authors.initials: W
authors.lastname: Graham
authors.forename: E
authors.initials: E
authors.lastname: Melese
authors.forename: L
authors.initials: L
authors.lastname: Reason
authors.forename: F
authors.initials: F
authors.lastname: Tefera Asfaw
authors.forename: G
authors.initials: G
authors.lastname: Feleke
authors.forename: B
authors.initials: B
authors.lastname: Feleke
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D004305:Dose-Response Relationship, Drug; D005002:Ethiopia / Q000453:epidemiology; D017144:Focus Groups; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D009784:Occupational Diseases / Q000382:microbiology / Q000517:prevention & control; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D017132:Workplace
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid