Table 2 Summary of reasons for DTT in children

“Let me say again that the working space is very small -the buildings … they are not enough. And when you’re counseling for HIV, you don’t have separate rooms … we sit here in this room. The same room, we are using for clinical, other clinical services … No privacy”. (KII, Health worker)

No privacy at the healthcare facility to people with TB and their treatment supporters

“We see over a hundred patients a day. So, in bad weather like this, they have nowhere to sit. So, you see them scattered there … to crowd on that veranda” and: “There is no privacy there. If you put a counselor there, no, it doesn’t work because everybody enters there”. “(KII, Health worker)

“Getting well and disappearance of symptoms is major cause of interruption or default from treatment also the inconvenience caused by busy working caregivers in formal and informal setting” (FGD, Treatment supporters).

The disappearance or reduction in symptoms of TB makes most persons with TB discontinue treatment

“TB patients are supposed to be supported at home, that is DOTS- he is supposed to be observed by his treatment supporter when swallowing tablets daily and then the health worker is supposed to go and take the medicines every 2 weeks. But actually, the coverage [of DOTS] is low because of lack of resources. (KII, Health worker)

Poor implementation of community-based DOTS hinders treatment continuation

We have no funds to support people to go down there [to the residence/villages/zones]. The Ministry of Health doesn’t actually have money to give [to the National TB Program] to support DOTS. The divisions receive Primary Health Care funds, but they are not adequate to support [DOTS] they [the government] are not prioritizing TB DOTS strategy.” (KII, Health worker)

“Often clinic appointment may come when you don’t have money for transport and if the child is feeling ok, you may not be bothered to pick medicines” also lack of support and proper counselling from the health workers may lead to treatment discontinuation” (FGD, Treatment supporters).

Insufficient funding prevents the follow-up of lost patients to continue TB treatment by health workers and prevents patient’s returns to per clinic appointment.

“Without the capacity to follow up with patients when they don’t visit to the health center to collect their drugs, health care workers are not able to determine whether TB patients have dropped off, defaulted, died, or transferred to another health center. It is not uncommon for patients to decide to be treated at a different health center, because of the way health centers are located, however no mechanism is in place to track those patients.” (KII, Health worker)

“Sometimes there’s frustrations. There are no medications. It’s just very difficult to have to work. It’s difficult, even when you want to support a patient, sometimes you don’t have … it’s a bit difficult, but we try to improvise sometimes and make ends meet but this usually disappoints our patients and may not come back [meaning that people with TB do not continue with treatment]” . (KII, Health worker)

Frequent stock-out of TB drugs frustrates people with TB from continuing with treatment.

“Sometimes we run short of drugs here.... When we run short of drugs, you put requests in time, these drugs come late, and I mean, it interrupts treatment [meaning discontinuation of TB treatment]. You find somebody missing out on treatment for a month. It’s a very big challenge”.(KII, Health worker)