Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up

Abstract

Objective: Providing effective medical care for non-communicable diseases (NCD) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). As the reasons are poorly understood, we have investigated LTFU in a rural Ethiopian community among patients with two contrasting, but common NCDs.

Method: The study was based in five health centres in southern Ethiopia providing services for surrounding rural populations where NCD clinics run by nurses and health officers were initiated in 1998. Samples of LTFU patients with epilepsy and hypertension were identified and traced through health extension workers. A questionnaire enquiring about the reasons for LTFU was administered to LTFU patients and non-LTFU, comparison patients.

Results: Of 268 LTFU patients, the current status of 147(54.9%) was ascertained. Of these 62 had died, moved away or were continuing medical care at other facilities. The remaining patients (48 with epilepsy and 37 with hypertension) were compared with 113 non-LFTU patients with epilepsy and 98 with hypertension attending the same clinics. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments together with misunderstanding as to the nature of NCD management.

Conclusions: We conclude that the delivery of low cost, affordable care closer to the patients’ homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

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