Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up.
Background
Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood.


Objective
To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres.


Method
The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU.


Results
Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management.


Conclusions
The delivery of 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.
['Mamo|Y|Y|', 'Dukessa|T|T|', 'Mortimore|A|A|', 'Dee|D|D|', 'Luintel|A|A|', 'Fordham|I|I|', 'Phillips|D I W|DIW|', 'Parry|E H O|EHO|', 'Levene|D|D|']
rural Ethiopia LTFU NCD clinics epilepsy hypertension