Open Access Research article

Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study

Takele Tadesse1*, Meaza Demissie2, Yemane Berhane2, Yigzaw Kebede1 and Markos Abebe3

Author Affiliations

1 Institute of Public Health, the University of Gondar, Gondar, Ethiopia

2 Addis Continental Institute of Public Health, Addis Ababa, Ethiopia

3 Armauer Hansen Research Institute, Addis Ababa, Ethiopia

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BMC Public Health 2013, 13:424  doi:10.1186/1471-2458-13-424

Published: 1 May 2013



Timely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control program. However, studies to understand patents’ perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. The aim of this study is to attempt to do that in rural Ethiopia.


This qualitative, phenomenological study conducted 26 in-depth interviews with tuberculosis patients. A thematic content analysis of the interviews was performed using the Open Code software version 3.1.


We found that lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments.


This study highlighted complexities surrounding tuberculosis control efforts in Dabat District. Challenges of geographic access to health care facilities and financial burdens were factors that most influenced timely tuberculosis treatment initiation and compliance. Decentralization of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.