Table 1 TB control challenges

a) Adequacy

-  Limited experience [26], lack of supervision [28] and in-service training [27] for the staff on duty.

-  Poor staffing quality [28]

-  Incomplete record keeping [28]

-  Insufficient level of decentralisation [18, 24]

-  Inadequate health infrastructure [24]

-  Absence of professionals during working hours [28]

-  Long waiting time [26, 28]

b) Adherence

-  High default rate due to pastoral mobility contrasted with static health facilities [28]

c) Availability

-  Shortage of trained staff [18, 24]

-  Intermittent shortages/stock outs of drugs and laboratory supplies [26, 28]

d) Targeting accuracy

-  Inadequate Acid-Fast Bacilli (AFB) microscopy follow-up [28]

-  Very low detection rate [18, 32] and low sensitivity of diagnosis (microscopy) [18]

e) Acceptability

-  Lack of trust of health extension workers [27]

-  Preference of traditional medicinal practices [24, 26]

-  Perceived symptoms as self-limiting [27]

f) Accessibility

-  Services are only available in major towns and villages along main roads [24]

-  Inaccessibility of service [27], including lack of transport infrastructure [24]

-  Long distance to travel for service [16, 23, 24, 27]

g) Affordability

-  Higher expenses incurred during the first two months of treatment [24]

-  Cost of transportation and housing during the intensive phase [16, 24, 26, 27]