The purpose of the study was to investigate the problem of defaulting of tuberculosis (TB) treatment in the Khomas region of Namibia. A quantitative, descriptive research approach was used to investigate the reasons for defaulting of TB treatment under the DOTS strategy in Khomas Region of Namibia. Data was collected by using a structured interview schedule with 54 participants who were on DOTS strategy and defaulted. Data were analysed by using the Epi info computer program. The major findings from the data obtained, revealed that the respondents did not have an in-depth knowledge of TB and the health education was not successful. This contributed to the defaulting of their treatment. Based on the study findings nurses should improve health education to TB patients on DOTS and also educate members of the community to address the stigmatisation of TB. Recommendations for further improvement in the compliance of TB treatment were made. / Public Health / M.A. (Public Health)

The purpose of the study was to investigate the problem of defaulting of tuberculosis (TB) treatment in the Khomas region of Namibia. A quantitative, descriptive research approach was used to investigate the reasons for defaulting of TB treatment under the DOTS strategy in Khomas Region of Namibia. Data was collected by using a structured interview schedule with 54 participants who were on DOTS strategy and defaulted. Data were analysed by using the Epi info computer program. The major findings from the data obtained, revealed that the respondents did not have an in-depth knowledge of TB and the health education was not successful. This contributed to the defaulting of their treatment. Based on the study findings nurses should improve health education to TB patients on DOTS and also educate members of the community to address the stigmatisation of TB. Recommendations for further improvement in the compliance of TB treatment were made. / Public Health / M.A. (Public Health)

The purpose of this study was to describe the factors contributing to high default of DOTS implementation in the Kwaebibrim district of Ghana. A quantitative, descriptive study was conducted to determine personal, health service, community and treatment factors contributing to high default of DOTS implementation in the district. Data collection was done using a structured questionnaire. Purposive sampling was done. The sample comprised of one hundred and thirty TB patients who were on DOTS implementation at the district chest clinic. The study highlighted TB patients’ knowledge about TB, socio-economic characteristics, organisation of care as well as community perceptions about the disease. The findings revealed that default to treatment is a complex behavioural issue involving multiple factors, an interaction of personal, social and health care factors as well as side effects of medication and duration of treatment. It is therefore recommended that interventions to prevent default of DOTS implementation should be designed with these factors in mind.

The purpose of this study was to describe the factors contributing to high default of DOTS implementation in the Kwaebibrim district of Ghana. A quantitative, descriptive study was conducted to determine personal, health service, community and treatment factors contributing to high default of DOTS implementation in the district. Data collection was done using a structured questionnaire. Purposive sampling was done. The sample comprised of one hundred and thirty TB patients who were on DOTS implementation at the district chest clinic. The study highlighted TB patients’ knowledge about TB, socio-economic characteristics, organisation of care as well as community perceptions about the disease. The findings revealed that default to treatment is a complex behavioural issue involving multiple factors, an interaction of personal, social and health care factors as well as side effects of medication and duration of treatment. It is therefore recommended that interventions to prevent default of DOTS implementation should be designed with these factors in mind.

Text in English with questionnaire in Amharic / Purpose: The purpose of the study was to evaluate the effectiveness of the tuberculosis directly observed treatment, short-course (DOTS) strategy with respect to patient centeredness and satisfaction, and propose a model in support of the DOTS strategy in Addis Ababa, Ethiopia. Method: The study was conducted in Addis Ababa, Ethiopia using a mixed-method approach. An interviewer-administered questionnaire was used to collect quantitative data from 601 randomly selected TB patients who were on TB treatment followup in 30 health facilities.Three focus group discussions were conducted with 23 TB experts purposefully selected from 10 sub-city health offices and health bureau. Moreover, telephonic interviews were conducted with 25 defaulted TB patients who had been attending TB treatment in the health facilities. The quantitative data were described using mean, median, percentage and frequencies. Logistic regression and exploratory factor analysis were used to extract associated factors using SPSS version 21 software. Thematic analysis was used for qualitative data analysis. Deductive and inductive reasoning was used to propose a descriptive model with substantiating literatures. Findings: Of the 601 TB patients included, 40% of them perceived they had not received a patient-centred TB care (PC-TB care) with DOTS strategy. Gender (AOR=0.45, 95%CI 0.3, 0.7), good communication (AOR=3.2, 95%CI 1.6, 6.1), treatment supporter (AOR=3.4, 95%CI 2.1, 5.5) were associated with the perceived PC-TB care. Thirty-seven percent of TB patients were following their TB treatment with feeling of dissatisfaction with DOTS strategy. Gender (AOR=2.2; 95%CI 1.3, 3.57), place of residence (AOR=3.4; 95%CI 1.6, 7.6), presence of symptoms (AOR=0.6, 95%CI 0.40, 0.94) and treatment-supporter (AOR=4.3, 95%CI 2.7, 6.8) were associated with satisfaction of TB patients. TB experts and defaulted TB patients pointed out that DOTS strategy is not providing comprehensive PC-TB care except the provision of facility choice where to follow during initiation of the treatment. DOTS delivery system inflexibility, loose integration, HCPs’ characteristic, communication skill and motivation and the community awareness were explored factor with patient centeredness of DOTS. DOTS delivery system, incompatible of diagnosis and patient beliefs were the identified categories to default. The proposed PC-TB care model core constructs are patient, community, health care providers, health care organisation and TB care delivery system. The core constructs are directed by policy and monitoring and evaluation components. Conclusion: DOTS strategy is limited to provide fully integrated PC-TB care and did not provide full satisfaction to TB patients. Therefore, a support that makes the TB care patient-centred are important and the proposed PC-TB care model needs to be tested, practiced and evaluated for its performance toward increments of patient centeredness of TB care. / Health Studies / D.Litt. et Phil. (Health Studies)