Identifying barriers to effective tuberculosis control in Senegal: an anthropological approach.

SETTING: Low tuberculosis (TB) cure rates (average 53%) and high treatment default rates (average 28%) were reported in Senegal between 1999 and 2001.
OBJECTIVE: To qualitatively evaluate the ability of TB patients to access and complete treatment in Senegal, with a view to helping to develop suitable strategies to improve TB control.
METHODS: Anthropological study conducted in a series of public and private, urban and rural health facilities in 2001 and 2002. The qualitative methods used included semi-structured and in-depth interviews of health staff, patients and relatives, focus group discussions, and observations carried in health facilities.
RESULTS: Problems were identified at several levels of health care. The main impediments to successful patient outcomes identified were: limited access to TB diagnosis and treatment facilities, poor communication between health personnel and patients, poor quality information provided to patients, poorly applied directly observed treatment, lack of a strategy to trace defaulting patients and limited supervision of the treatment units by the district leadership team.
CONCLUSION: The anthropological analysis of patient care is an appropriate means of addressing complex public health problems in disease control and identifying solutions that are acceptable, sustainable and adapted to the local context.