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<b>Introduction:</b> Almost 90% of chronic obstructive pulmonary disease (COPD) deaths
occur in low- and
middle-income countries (LMICs), where there are large rural populations and access
to health care for COPD is poor. The purpose of this study was to compare urban-rural
provider experiences regarding systemic facilitators and barriers to COPD management
and treatment access.
<b>Methods:</b> We conducted a qualitative study using direct observations and in-depth
interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke,
Uganda, respectively. We analyzed interviews by performing inductive coding using
generated topical codes.
<b>Results:</b> In both urban and rural districts, exposure to evidence-based practices
diagnosis and treatment was limited. The biomedical definition of COPD is not well
distinguished in rural communities and was commonly confused with asthma and other
respiratory diseases. Urban and rural participants alike described low availability
of medications, limited access to diagnostic tools, poor awareness of the disease,
and lack of financial means for medical care as common barriers to seeking and receiving
care for COPD. While there was greater access to COPD treatment in urban areas, rural
populations faced more pronounced barriers in access to diagnostic equipment, following
standard treatment guidelines, and training medical personnel in non-communicable
disease (NCD) management and treatment.
<b>Conclusion:</b> Our results suggest that health system challenges for the treatment
of COPD may disproportionately
affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines
and training health professionals in COPD, with a special emphasis on rural communities,
will assist in addressing these barriers.