Tuberculosis (TB) is a bacterial infection caused by mycobacterium tuberculosis. The bacteria most often attack the lungs but can also affect other parts of the body including the brain, spinal cord and kidneys. TB is spread through the air from person to person. The bacteria are released into the air when a person with pulmonary TB coughs or sneezes. People within close proximity may inhale these bacteria and become infected. About 10% of people who are exposed develop active TB, and others develop latent TB. However, the chances of developing active TB increases dramatically in those whose immune system is not fully functional, such as persons afflicted with HIV.

Tuberculosis is ancient bacterial disease for which there are effective diagnostic and treatment methods. Yet the disease is neglected in countries like Ethiopia and TB continues to be a major killer around the world. Each year there are 9 million new cases of TB with 2 million deaths and 85% of cases occur in Africa. (WHO Global Update Report, 2011) Ethiopia is 7th among the 22 high burden TB countries in the world. In 2011, the TB prevalence rates were 560 per 100,000 population with a total of 148,688 cases of all forms of TB. (Ethiopia, health and health related indicators 2011). HIV exacerbates the problem by affecting both the clinical and epidemiological course of TB. The problem is worse in rural areas of Ethiopia such as Debre Tabor.

Debre Tabor town is located in Amhara region of Ethiopia about 100 km from the capital city of the region, Gondar. Recently, Gondar University teaching hospital established a multi-drug resistant (MDR-TB) diagnostic and treatment center. Amhara has the third highest number of estimated sputum smear positive TB cases of 29,514, but only 26.2% are confirmed cases. (Health and Health Related Indicators, 2011) Hospitals are typically staffed by health officers, physicians and nurses, pharmacists and equipped with laboratories. Health Centers are closer to the community and are usually staffed by health officers, nurses and midwives. The primary health care unit consists of 1 health center that supervises 5 satellite health posts. Health posts are staffed by health extension workers (HEWs), one of the target populations for this project and services offered are preventive and educational in nature.

There are 2.3 million people, including approximately 39,000 residents living in the town of Debre Tabor, who seek services from Debre Tabor Hospital. It is the only hospital with surrounding health centers and health posts, (Ethiopian Central Statistics Authority, 2010). As a regional hospital, it provides services to all surrounding communities and the hospital is overcrowded and has no separate rooms for active TB patients to be treated until they are no longer infectious. Triaging clients who have signs of TB in the outpatient department is also in need of improvement. Due to the high volume of patients in the hospital, doctors and nurses don’t have time to counsel patients about the disease and a treatment plan that requires multiple medications for a minimum of six months. Patients often stop taking their medications due to barriers such as poor awareness about the disease, improper treatment monitoring, misinformation about the disease, distance from home to health facility/hospital, long wait times, high stigma around TB, and unavailability of daily TB care in their communities. They are then at risk of developing multiple drug-resistant TB (MDR-TB). If one develops extensively drug-resistant TB (XDR), it is potentially untreatable. Treatment for MDR-TB drug resistant TB is highly expensive and currently very difficult to find in Ethiopia. However, with the newly launched MDR-TB diagnostic and treatment facilities in Gondar and Bahir Dar, patients who could potentially develop MDR-TB have some hope of treatment. However, the goal of UHA is to support patients to comply and adhere to medications to prevent the development of MDR-TB.
In addition, many Ethiopians in rural areas don’t understand how the disease is transmitted and treated. The result is either stopping or never start seeking medical help and die without any medical treatment. Delay in treatment is also very common in this region. Patients don’t go to seek medical help unless they’re very sick and they can’t work. By that time, they may have potentially spread TB to others due to tight living conditions and close contact with others.

In sum, UHA aims to empower communities to prevent the spread of TB and encourage high adherence to TB treatment to prevent the development of MDR-TB. UHA also aims to build the capacity of the hospital, in collaboration with the government and other partners, to ensure high quality TB care are offered to those in need.
TB is one of the major causes of morbidity and mortality in Ethiopia and the problem is more severe in the rural areas including Debre Tabor where low access to health facilities is presenting additional challenge to control TB. Therefore UHA’s planned intervention is critical.