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Table 2 Assessment of effectiveness parameters

From: The impact of pastoralist mobility on tuberculosis control in Ethiopia: a systematic review and meta-synthesis

Effectiveness parameter Description Quantitative assessment Qualitative assessment Analysis
Efficacy An estimate of the ability of anti-TB drugs to cure the disease - Results from clinical trials - A biological feature of the drugs  
Targeting accuracy How well were the cases identified - A 10-year trend analysis study in SRS reported average case detection rate (CDR) of 19.1% [18]
- Another 10-year trend study in Afar region showed 34% CDR
- Calculated CDR of 69.1%, from 2017 WHO Global TB Report [2]
  In pastoralist areas 19.1–34.0% of TB cases were detected, while at national level 69.1% of cases were detected
Availability Service meets patient’s needs - As of 2016, 53% of the available facilities in SRS had TB microscopy and 88% had all first-line anti-TB drugs [35]
- A study conducted in Afar region reported 28.7% of participants were dissatisfied with service provision [28]
- 84% of health facilities in Ethiopia had all first-line anti-TB drugs [35]
- Shortage of trained staff and intermittent stock outs of drugs and laboratory supplies
- Available services are concentrated in major towns
For effectiveness estimation: at national level 84% of the required drugs were available while 53–88% of the required services were available in pastoralist areas.
Accessibility Health service delivery sites are accessible to the community without significant physical or social barriers - Travel distance was too far for 60% of participants [27]
- More than 84% of pastoralists in SRS lacked access to TB care [24]
- At national level, 9% of the population did not use services because health facilities were too far away
- Lack of transport infrastructure (roads), long travel distances to health facilities 16–40% of health facilities were accessible to pastoralists, while national level accessibility was reported as 91%
Affordability Willingness and ability to pay cost of TB service - In SRS 8.2% delayed treatment due to lack of money [27]
- In Bale zone of Oromia 34.2% of pastoralists delayed treatment due to lack of money [26]
- At national level 41% reported inability to pay for the service [30]
- The economic burden of TB was the most important concern for pastoralists in SRS [24] 65.8–91.8% of pastoralists could afford the cost of the service, while at national level 41% could not afford it
Adequacy The TB service organisation meets the community’s expectations - 9.3% of participants in a pastoralist zone of Oromia region delayed treatment because of long waiting time [26]
- Dissatisfaction rate in waiting time (70%) and in open hours (63.6%) was reported in Afar region [28]
- 77% of the outpatient health provision was from public health services [23]
- Limited supervision and in-service training of staff, poor staffing quality
- Insufficient decentralisation of DOTs and inadequate health infrastructure
30.0–97.7% of pastoralists were satisfied with the service, while at national 77% of the population utilised public health services
Acceptability Provider’s characteristics match those of the community - 87% of pastoralists in SRS preferred traditional medicine [23]
- 31.7% of participants reported their symptoms as self-resolving [27]
- Health care seeking at national level was 62% [30]
- Lack of trust in health extension workers
- Preference for traditional medicine and other informal health services
13.0–68.3% of patients felt comfor\ with the conventional service providers. In contrast, at national level 62% sought health care
Compliance How well provider initiates correct procedure for intervention- How well health care providers conform to standards of TB treatment - Despite availability of services, only two of six (33.3%) health facilities studied in Afar region followed strict DOTs during the intensive phase [28]
- 44% of Ethiopian health facilities had diagnostic and treatment guidelines
- Absence of professionals during working hours 33.3% of health facilities in pastoral area followed strict DOTs, while at national level 44% of health facilities followed standard guidelines
Adherence How well recipient follows medical advice given - In SRS 4.2% of patients enrolled for TB treatment defaulted over the period 2003–2012 [18]. Default rate was 2.9% in Afar region [19] - High default rate due to pastoralist mobility versus stationary health facility 95.8% of patients adhered to treatment in pastoral settings