Araştırma Makalesi
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Uganda, Kampala'da Mevcut Tüberküloz Önleme Ve Kontrol Programlarını Sınırlayan Faktörler: Kesitsel Bir Çalışma

Yıl 2026, Cilt: 9 Sayı: 1 , 62 - 76 , 31.03.2026
https://doi.org/10.55517/mrr.1799829
https://izlik.org/JA42FR94CC

Öz

Amaç: Bu çalışma, Kampala, Uganda’da tüberküloz önleme ve kontrol programlarının uygulanmasını engelleyen zorlukları belirlemeyi amaçlamaktadır. Yöntem: Kampala’da en az iki yıldır yaşayan, 18–65 yaş arası tüberküloz hastalarına sağlık çalışanları tarafından yapılandırılmış anketler uygulanarak kesitsel bir çalışma yürütülmüştür. Katılımcılar (n=413) basit rastgele örnekleme yöntemiyle seçilmiştir. Bulgular: Katılımcıların %63,4’ü tüberküloz tanısını aile üyelerine açıklamamış, %59,6’sı HIV ile koenfekte bulunmuş ve %64,3’ü tüberküloz tedavisi dışında ek ilaçlara ihtiyaç duymuştur. Ayrıca %53,8’i tüberküloz tedavisi hakkında sınırlı bilgiye sahipken, %64,2’si semptomların erken düzelmesi nedeniyle tedaviyi iki ay içinde bırakma eğilimi göstermiştir. Bu faktörler, tüberküloz önleme ve kontrol çabalarının etkinliğini önemli ölçüde zayıflatmıştır. Sonuç: Kampala’daki mevcut tüberküloz önleme ve kontrol programlarının etkinliğini azaltan başlıca engeller; ilaç alımı sırasında gıda yetersizliği, hastaların tüberküloz durumlarını aile üyelerine açıklamaktan kaçınmaları, damgalanma ve ayrımcılık korkusu, tedaviye ilişkin sınırlı bilgi, semptomların erken düzelmesi nedeniyle tedaviyi zamanından önce bırakma, HIV koenfeksiyonu ve verem ilaçlarıyla birlikte ek ilaç kullanma zorunluluğudur.

Etik Beyan

Bu makale bilimsel araştırma ve yayın etiğine uygun olarak hazırlanmıştır. Çalışmada yer alan tüm veriler özgün olup, diğer kaynaklardan alınan bilgiler uygun şekilde alıntılanmıştır.

Destekleyen Kurum

Kampala Kent Konseyi Otoritesi (KCCA)

Proje Numarası

2022-924

Teşekkür

Tüm Katılımcılara

Kaynakça

  • World Health Organization. Tuberculosis [Internet]. 2022 [cited 2022 Oct 3]. Available from: https://www.who.int/health-topics/tuberculosis#tab=tab_1
  • World Health Organization. Global tuberculosis report 2024 [Internet]. Geneva: World Health Organization; 2024 [cited 2025 Aug 7]. Available from: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024
  • World Health Organization. Uganda Ministry of Health launches the national coordination committee for tuberculosis [Internet]. [cited 2025 Nov 7]. Available from: https://www.afro.who.int/news/uganda-ministry-health-launches-national-coordination-committee-tuberculosis
  • World Health Organization. Global tuberculosis programme [Internet]. 2021 [cited 2022 Mar 31]. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports
  • Greene JJ. Factors associated with defaults from treatment among tuberculosis patients in Western Sierra Leone [Internet]. 2014 [cited 2022 Oct 3]. Available from: https://ugspace.ug.edu.gh/handle/123456789/7286
  • World Health Organization. Implementing the End TB Strategy [Internet]. 2014 [cited 2022 Apr 2]. Available from: https://www.who.int/westernpacific/activities/implementing-the-end-tb-strategy
  • Oyediran K, Kirenga B, Turyahabwe S, Davis N, Chauffour J, Muttamba W, et al. Quality of tuberculosis services assessment in Uganda: report—MEASURE Evaluation [Internet]. 2020 [cited 2022 Apr 1]. Available from: https://www.measureevaluation.org/resources/publications/tr-20-398.html
  • World Health Organization. WHO global lists of high burden countries for tuberculosis (TB), TB/HIV and multidrug/rifampicin-resistant TB (MDR/RR-TB), 2021–2025: background document [Internet]. 2021 [cited 2022 Apr 2]. Available from: http://apps.who.int/bookorders
  • Maher D. The role of the community in the control of tuberculosis. Tuberculosis (Edinb). 2003;83(1–3):177–82.
  • World Health Organization. Global tuberculosis control [Internet]. 2003 [cited 2022 Apr 2]. Available from: https://apps.who.int/iris/handle/10665/63835
  • World Health Organization. Global tuberculosis control: surveillance, planning, financing: WHO report 2006 [Internet]. 2006 [cited 2022 Apr 2]. Available from: https://www.who.int/publications/i/item/9241563141
  • Godfrey-Faussett P, Kaunda H, Kamanga J, van Beers S, van Cleeff M, Kumwenda-Phiri R, et al. Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach. Int J Tuberc Lung Dis. 2002 Sep;6(9):796-805.
  • Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005 Dec 12;5:112.
  • Shetty N, Shemko M, Abbas A. Knowledge, attitudes and practices regarding tuberculosis among immigrants of Somalian ethnic origin in London: a cross-sectional study. Commun Dis Public Health. 2004 Mar;7(1):77-82.
  • Edginton ME, Sekatane CS, Goldstein SJ. Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002 Dec;6(12):1075-82.
  • Abebe M, Doherty M, Wassie L, Demissie A, Mihret A, Engers H, et al. TB case detection: can we remain passive while the process is active? The Pan African Medical Journal. 2012;11:50.
  • Cochran WG. Sampling Techniques. 3rd ed. New York: John Wiley & Sons; 1977.
  • Kampala Capital City Authority. Kampala Capital City Authority: for a better city [Internet]. 2022 [cited 2022 May 26]. Available from: https://www.kcca.go.ug/
  • Chani K. Factors affecting compliance to tuberculosis treatment in Andara Kavango region Namibia [dissertation]. Pretoria: University of South Africa; 2010 [cited 2022 May 20]. Available from: http://hdl.handle.net/10500/4778
  • Anyiam FE, Gjonaj J, Osango NA, Mugo R, Aber P, Shah J, et al. Mapping social determinants of health data in sub-Saharan Africa: a scoping review protocol. BMJ Open. 2026 Feb;16(2):e105390.
  • Ichoku HE, Mooney G, Ataguba JE. Africanizing the social determinants of health: embedded structural inequalities and current health outcomes in sub-Saharan Africa. International Journal of Health Services. 2013;43(4):745-59.
  • Avelino IC, Van-Dúnem J, Varandas L. Under-five mortality and social determinants in Africa: a systematic review. European Journal of Pediatrics. 2025;184(2):150.
  • Zolowere D, Manda K, Panulo B, Muula AS. Experiences of self-disclosure among tuberculosis patients in rural Southern Malawi. Rural Remote Health. 2008; 8(4):1–9.
  • Dormechele W, Bonsu EO, Boadi C, Adams MO, Hlormenu BA, Addo SK, et al. Determinants of intention to conceal tuberculosis status among family members: an analysis of seven Sub-Saharan African countries. BMC Infect Dis. 2024 Feb;24(1):175.
  • Tekle B, Mariam DH, Ali A. Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002 Jul;6(7):573-9.
  • Mindachew M, Deribew A, Memiah P, Biadgilign S. Perceived barriers to the implementation of isoniazid preventive therapy for people living with HIV in resource-constrained settings: a qualitative study. Pan African Medical Journal. 2014;17:5.
  • Eticha T, Kassa E. Non-adherence to anti-TB drugs and its predictors among TB/HIV co-infected patients in Mekelle, Ethiopia. Journal of Bioanalysis and Biomedicine. 2014;6(6):113.
  • Bergman AJ, Budhathoki C, Relf MV, Ndlovu N, Mthimkhulu N, Lerefolo S, et al. Cognitive dissonance in tuberculosis stigma: a mixed methods analysis of tuberculosis stigma measurement in South Africa. PLOS Global Public Health. 2024;4(11):e0003932.
  • Van der Westhuizen HM, Giddy J, Coetzee R, Makanda G, Tisile P, Galloway M, et al. Strengthening accountability for tuberculosis policy implementation in South Africa: perspectives from policymakers, civil society, and communities. BMC Global Public Health. 2024;2:48.
  • Ronoh AK, Serrem CA, Tumwebaze SB, Were GM. Effect of fortifying sorghum and wheat with Ruspolia differens powder on nutritional composition and consumer acceptability of biscuits. Food Science and Nutrition. 2024;12(5):3492-3507.
  • Hwang TJ, Ottmani S, Uplekar M. A rapid assessment of prevailing policies on tuberculosis contact investigation. International Journal of Tuberculosis and Lung Disease. 2011;15(12):1620-2.
  • Zhang R, Pu J, Zhou J, Wang Q, Zhang T, Liu S, et al. Factors predicting self-report adherence behaviours among DS-TB patients under the “integrated model”: a survey in Southwest China. BMC Infectious Diseases. 2022;22(1):201.
  • Huq KATM, Moriyama M, Zaman K, Chisti MJ, Long J, Islam A, et al. Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh. BMC Infectious Diseases. 2018;18(1):515.
  • Lawal A, Hussein A, Tiberi S, Kunst H. Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed-method systematic review. BMC Public Health. 2025;26(1):39.
  • Mave V, Paradkar M, Conradie F, Gupta A, Avihingsanon A, Meintjes G, et al. Tuberculosis disease among people with HIV: therapeutic advances. Lancet HIV. 2025 May;12(5):e367-81.
  • Nortey AN, Adjoda A, Alhassan A, Scott GY. Adherence patterns, risk factors and complications among patients with tuberculosis: a cross-sectional study at Nsawam Government Hospital. BMJ Public Health. 2024;2(1):e000618.
  • Appiah MA, Arthur JA, Gborgblorvor D, Asampong E, Kye-Duodu G, Kamau EM, et al. Barriers to tuberculosis treatment adherence in high burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective. BMC Public Health. 2023;23:1317.
  • Troop P, Keam B, Mullen C, Odhiambo JN. Barriers and facilitators of tuberculosis treatment adherence among nomadic populations in sub-Saharan Africa: a scoping review protocol. PLOS ONE. 2026;21(1):e0340307.
  • Li S, Mensah E, Liu M, Pan L, Lu W, Zhou S, et al. The burden of tuberculosis and drug resistance in 22 sub-Saharan African countries, 1990–2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050. Frontiers in Microbiology. 2025;16:1695592.

Factors Limiting Current Tuberculosis Prevention and Control Programs in Kampala, Uganda: A Cross-Sectional Study

Yıl 2026, Cilt: 9 Sayı: 1 , 62 - 76 , 31.03.2026
https://doi.org/10.55517/mrr.1799829
https://izlik.org/JA42FR94CC

Öz

Aim: This study aimed to identify challenges hindering the implementation of tuberculosis prevention and control programs in Kampala, Uganda. Methods: A cross-sectional study was conducted using structured questionnaires administered to tuberculosis patients aged 18–65 who had lived in Kampala for at least two years. Participants (n=413) were selected through simple random sampling. Results: Among respondents, 63.4% had not disclosed their tuberculosis diagnosis to household members, 59.6% were co-infected with HIV, and 64.3% required additional medications. Limited understanding of tuberculosis therapy was reported by 53.8%, while 64.2% were inclined to discontinue treatment prematurely due to perceived recovery. These factors significantly undermined tuberculosis prevention and control efforts. Conclusion: Key barriers include food insecurity during medication intake, reluctance to disclose tuberculosis status, stigma and discrimination, poor understanding of treatment, premature cessation of therapy, HIV co-infection, and the burden of multiple medications.

Etik Beyan

This article has been prepared in accordance with scientific research and publication ethics. All data contained in the study is original, and information from other sources has been cited appropriately.

Destekleyen Kurum

Kampala City Council Authority (KCCA)

Proje Numarası

2022-924

Teşekkür

Thanks to all participants

Kaynakça

  • World Health Organization. Tuberculosis [Internet]. 2022 [cited 2022 Oct 3]. Available from: https://www.who.int/health-topics/tuberculosis#tab=tab_1
  • World Health Organization. Global tuberculosis report 2024 [Internet]. Geneva: World Health Organization; 2024 [cited 2025 Aug 7]. Available from: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024
  • World Health Organization. Uganda Ministry of Health launches the national coordination committee for tuberculosis [Internet]. [cited 2025 Nov 7]. Available from: https://www.afro.who.int/news/uganda-ministry-health-launches-national-coordination-committee-tuberculosis
  • World Health Organization. Global tuberculosis programme [Internet]. 2021 [cited 2022 Mar 31]. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports
  • Greene JJ. Factors associated with defaults from treatment among tuberculosis patients in Western Sierra Leone [Internet]. 2014 [cited 2022 Oct 3]. Available from: https://ugspace.ug.edu.gh/handle/123456789/7286
  • World Health Organization. Implementing the End TB Strategy [Internet]. 2014 [cited 2022 Apr 2]. Available from: https://www.who.int/westernpacific/activities/implementing-the-end-tb-strategy
  • Oyediran K, Kirenga B, Turyahabwe S, Davis N, Chauffour J, Muttamba W, et al. Quality of tuberculosis services assessment in Uganda: report—MEASURE Evaluation [Internet]. 2020 [cited 2022 Apr 1]. Available from: https://www.measureevaluation.org/resources/publications/tr-20-398.html
  • World Health Organization. WHO global lists of high burden countries for tuberculosis (TB), TB/HIV and multidrug/rifampicin-resistant TB (MDR/RR-TB), 2021–2025: background document [Internet]. 2021 [cited 2022 Apr 2]. Available from: http://apps.who.int/bookorders
  • Maher D. The role of the community in the control of tuberculosis. Tuberculosis (Edinb). 2003;83(1–3):177–82.
  • World Health Organization. Global tuberculosis control [Internet]. 2003 [cited 2022 Apr 2]. Available from: https://apps.who.int/iris/handle/10665/63835
  • World Health Organization. Global tuberculosis control: surveillance, planning, financing: WHO report 2006 [Internet]. 2006 [cited 2022 Apr 2]. Available from: https://www.who.int/publications/i/item/9241563141
  • Godfrey-Faussett P, Kaunda H, Kamanga J, van Beers S, van Cleeff M, Kumwenda-Phiri R, et al. Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach. Int J Tuberc Lung Dis. 2002 Sep;6(9):796-805.
  • Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005 Dec 12;5:112.
  • Shetty N, Shemko M, Abbas A. Knowledge, attitudes and practices regarding tuberculosis among immigrants of Somalian ethnic origin in London: a cross-sectional study. Commun Dis Public Health. 2004 Mar;7(1):77-82.
  • Edginton ME, Sekatane CS, Goldstein SJ. Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002 Dec;6(12):1075-82.
  • Abebe M, Doherty M, Wassie L, Demissie A, Mihret A, Engers H, et al. TB case detection: can we remain passive while the process is active? The Pan African Medical Journal. 2012;11:50.
  • Cochran WG. Sampling Techniques. 3rd ed. New York: John Wiley & Sons; 1977.
  • Kampala Capital City Authority. Kampala Capital City Authority: for a better city [Internet]. 2022 [cited 2022 May 26]. Available from: https://www.kcca.go.ug/
  • Chani K. Factors affecting compliance to tuberculosis treatment in Andara Kavango region Namibia [dissertation]. Pretoria: University of South Africa; 2010 [cited 2022 May 20]. Available from: http://hdl.handle.net/10500/4778
  • Anyiam FE, Gjonaj J, Osango NA, Mugo R, Aber P, Shah J, et al. Mapping social determinants of health data in sub-Saharan Africa: a scoping review protocol. BMJ Open. 2026 Feb;16(2):e105390.
  • Ichoku HE, Mooney G, Ataguba JE. Africanizing the social determinants of health: embedded structural inequalities and current health outcomes in sub-Saharan Africa. International Journal of Health Services. 2013;43(4):745-59.
  • Avelino IC, Van-Dúnem J, Varandas L. Under-five mortality and social determinants in Africa: a systematic review. European Journal of Pediatrics. 2025;184(2):150.
  • Zolowere D, Manda K, Panulo B, Muula AS. Experiences of self-disclosure among tuberculosis patients in rural Southern Malawi. Rural Remote Health. 2008; 8(4):1–9.
  • Dormechele W, Bonsu EO, Boadi C, Adams MO, Hlormenu BA, Addo SK, et al. Determinants of intention to conceal tuberculosis status among family members: an analysis of seven Sub-Saharan African countries. BMC Infect Dis. 2024 Feb;24(1):175.
  • Tekle B, Mariam DH, Ali A. Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002 Jul;6(7):573-9.
  • Mindachew M, Deribew A, Memiah P, Biadgilign S. Perceived barriers to the implementation of isoniazid preventive therapy for people living with HIV in resource-constrained settings: a qualitative study. Pan African Medical Journal. 2014;17:5.
  • Eticha T, Kassa E. Non-adherence to anti-TB drugs and its predictors among TB/HIV co-infected patients in Mekelle, Ethiopia. Journal of Bioanalysis and Biomedicine. 2014;6(6):113.
  • Bergman AJ, Budhathoki C, Relf MV, Ndlovu N, Mthimkhulu N, Lerefolo S, et al. Cognitive dissonance in tuberculosis stigma: a mixed methods analysis of tuberculosis stigma measurement in South Africa. PLOS Global Public Health. 2024;4(11):e0003932.
  • Van der Westhuizen HM, Giddy J, Coetzee R, Makanda G, Tisile P, Galloway M, et al. Strengthening accountability for tuberculosis policy implementation in South Africa: perspectives from policymakers, civil society, and communities. BMC Global Public Health. 2024;2:48.
  • Ronoh AK, Serrem CA, Tumwebaze SB, Were GM. Effect of fortifying sorghum and wheat with Ruspolia differens powder on nutritional composition and consumer acceptability of biscuits. Food Science and Nutrition. 2024;12(5):3492-3507.
  • Hwang TJ, Ottmani S, Uplekar M. A rapid assessment of prevailing policies on tuberculosis contact investigation. International Journal of Tuberculosis and Lung Disease. 2011;15(12):1620-2.
  • Zhang R, Pu J, Zhou J, Wang Q, Zhang T, Liu S, et al. Factors predicting self-report adherence behaviours among DS-TB patients under the “integrated model”: a survey in Southwest China. BMC Infectious Diseases. 2022;22(1):201.
  • Huq KATM, Moriyama M, Zaman K, Chisti MJ, Long J, Islam A, et al. Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh. BMC Infectious Diseases. 2018;18(1):515.
  • Lawal A, Hussein A, Tiberi S, Kunst H. Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed-method systematic review. BMC Public Health. 2025;26(1):39.
  • Mave V, Paradkar M, Conradie F, Gupta A, Avihingsanon A, Meintjes G, et al. Tuberculosis disease among people with HIV: therapeutic advances. Lancet HIV. 2025 May;12(5):e367-81.
  • Nortey AN, Adjoda A, Alhassan A, Scott GY. Adherence patterns, risk factors and complications among patients with tuberculosis: a cross-sectional study at Nsawam Government Hospital. BMJ Public Health. 2024;2(1):e000618.
  • Appiah MA, Arthur JA, Gborgblorvor D, Asampong E, Kye-Duodu G, Kamau EM, et al. Barriers to tuberculosis treatment adherence in high burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective. BMC Public Health. 2023;23:1317.
  • Troop P, Keam B, Mullen C, Odhiambo JN. Barriers and facilitators of tuberculosis treatment adherence among nomadic populations in sub-Saharan Africa: a scoping review protocol. PLOS ONE. 2026;21(1):e0340307.
  • Li S, Mensah E, Liu M, Pan L, Lu W, Zhou S, et al. The burden of tuberculosis and drug resistance in 22 sub-Saharan African countries, 1990–2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050. Frontiers in Microbiology. 2025;16:1695592.
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Hastalık Denetimi
Bölüm Araştırma Makalesi
Yazarlar

Hadıjah Mbonde 0000-0002-6693-811X

Dilek Öztaş 0000-0002-8687-7238

Proje Numarası 2022-924
Gönderilme Tarihi 8 Ekim 2025
Kabul Tarihi 26 Mart 2026
Yayımlanma Tarihi 31 Mart 2026
DOI https://doi.org/10.55517/mrr.1799829
IZ https://izlik.org/JA42FR94CC
Yayımlandığı Sayı Yıl 2026 Cilt: 9 Sayı: 1

Kaynak Göster

Vancouver 1.Hadıjah Mbonde, Dilek Öztaş. Uganda, Kampala’da Mevcut Tüberküloz Önleme Ve Kontrol Programlarını Sınırlayan Faktörler: Kesitsel Bir Çalışma. MRR. 01 Mart 2026;9(1):62-76. doi:10.55517/mrr.1799829