Ecological Model of Multidrug-resistant Tuberculosis in Mae Sot Hospital, Tak Province

Abstract

Objective: To study the 5 levels-factors leading to multi-drug resistant tuberculosis within Mae Sot Hospital using the Ecological model including individual, interpersonal, organizational, community and public policy factors. Method: This research was a qualitative study collecting data by in-depth interviewing 10 new multidrug-resistant tuberculosis patients undergoing treatment at Tuberculosis Clinic, Mae Sot Hospital, 7 relatives or their caregivers and 6 health providers at tuberculosis clinics during September to December 2018. The study employed thematic analysis and triangulation of data with multiple sources of information. Results:  Medication non-adherence patients which may lead to multi-drug resistance was peak of the icebergs resulting from many factors including adverse drug reactions interfering with daily life, long duration of treatment leading to patients’ concern that they may not be treated, feeing hopeless, separation from the community, and hiding themselves for fear of social disgust. At the same time, the attitude towards the disease of their relatives affected care giving, and morale of patients. Environment factors and process of providing services that was not systematic and delayed led patients to avoid the use of services. While health professionals had an increased workloads from various tuberculosis policies, but patients and relatives were unaware of such policies. Conclusion: All 5 levels of factors based on the Ecological models are directly or indirectly lead to the development of multiple drug-resistant tuberculosis. Creating understanding of diseases and treatments in patients and their relatives, together with the changing of tuberculosis-related policies to fit the current context with continuity and conducive to practicality may be a key leverage for the problem.