Introduction: World Health Organization recommends screening of household contact as a key to improve detection of tuberculosis cases. Ethiopia’s current tuberculosis household contact investigation strategies rely on symptomatic contacts attending health facilities for investigation. This approach has not led to the detection of additional tuberculosis (TB) cases; alternative approaches have to be considered. The purpose of the research was to develop guidelines in endorsing the implementation of a community based household contact investigation program in Addis Ababa. Methods: A mixed method research using sequential exploratory design was conducted in Addis Ababa. In the first phase, qualitative data collection and analysis methods were used to formulate intervention approach and in the second phase, a quantitative random controlled trial was conducted, with the purpose of comparing the proposed intervention measures with routine household contact tuberculosis investigation. Frequencies and logistic regression analyses were used to determine the relative risk and associated factors. Thematic analysis was used for qualitative data analysis. Results: The in-depth interview and focus group discussion findings identified themes namely household contact investigation (HHCI) implementation, misconceptions on HHCI, challenges with HHCI Approaches, opportunities for HHCI provision, contributing factors associated with household involvement, strategies for effective HHCI service and partnerships with health bureau. In phase two, the study reported that the prevalence of TB was 7.1% among the intervention group compared to 1.9% in the control groups at the end of first year follow-up. Nine guidelines were developed to support the household contact investigation system. Conclusion: The passive case detection strategy of contact investigation did not find more cases, and tuberculosis patients and their family contacts were not satisfied with this method. However, the proposed community-based strategy shows that more TB cases can be detected by using existing medical staff. Therefore, an approach that makes the service more accessible is significant and the recommended community based TB household contact tracing approaches needs to be scaled up for its performance towards identified missed cases and enhance patient and their household contacts involvement. / Health Studies / D. Litt. et Phil. (Public Health)

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)

This study investigated factors influencing the quality of data for the Tuberculosis (TB) control programme in Oshakati District in Namibia. A quantitative, cross-sectional descriptive survey was conducted using 50 nurses who were sampled from five departments in Oshakati State Hospital. Data was collected by means of a self-administered questionnaire. The results indicated that the majority (90%) of the respondents agreed that TB training improved correct recording and reporting. Sixty percent of the respondents agreed that TB trainings influenced the rate of incomplete records in the unit, while 26% of the respondents disagreed with this statement. This indicates that TB trainings influence the quality of data reported in the TB programme as it influences correct recording and completeness of data at operational level. Participants’ knowledge on TB control guidelines, in particular the use of TB records to, used to capture the core TB indicators influenced the quality of data in the programme. The attitudes and practises of respondents affected implementation of TB guidelines hence, influencing the quality of data in the programme. The findings related to the influence of the quality of data in the TB programme and its effect to decision-making demonstrated a positive relationship (p=0.0023) between the attitudes of study participant on the use of data collected for decision-making. Knowledge, attitudes and practice are the main factors influencing the quality of data in the TB control programme in Oshakati District. / Health Studies / M.A. (Public Health)

The purpose of this study was to explore and describe the personal experiences of enrolled nurses while caring for patients infected with multidrug-resistant tuberculosis (MDR-TB) in an urban tuberculosis hospital in KwaZulu-Natal province, South Africa. Generic qualitative research was conducted with a sample of purposively selected enrolled nurses who cared for MDR-TB patients. Data was collected through in-depth individual interviews and analysed using Colaizzi’s (1978) method of data analysis. The research findings revealed six major themes: the working context, fear of contracting the disease, problems that have an impact on the quality of nursing care, nurses' perceptions of the patients, support structures and nurses' expressed needs. The findings of this study indicate that the nurses work in a challenging environment and need to be supported, as they experience more negative than positive feelings while caring for these patients. / Health Studies / (M.A. (Health Studies))

Submitted in compliance with the requirements for the Master's Degree in Technology: Nursing, Durban University of Technology, 2014. / Background : Tuberculosis (TB) is a global public health concern and is identified as the leading cause of morbidity and mortality in the population infected with Human Immune Deficiency Virus (HIV). South Africa (SA), particularly the KwaZulu-Natal Province, is burdened with persistently high rates of both TB and HIV infections. In an attempt to improve TB and HIV co-infection outcomes the South African health care system has adopted the World Health Organisation (WHO) guidelines for intensified TB case findings in all HIV positive individuals for regular screening of TB symptoms in order to promptly diagnose and treat active TB disease or to exclude TB for initiation Isoniazid Prophylactic Therapy (IPT). IPT has proven effective in preventing TB disease in People Living with HIV or AIDS (PLWHA). This critical first step of TB symptom screening is regarded as the intervention that could significantly reduce the challenge currently faced with TB-HIV co-infection. The study was conducted in selected eThekwini Municipality Primary Health Care (PHC) facilities with the focus on an investigation to determine the extent of the implementation of the TB symptom screening tool in HIV infected individuals, in addition to identifying treatment initiation or further investigations based on the tool implementation. It has been found during the literature review, that there is a lack of research in SA to show that this critical first step in TB identification has been investigated, yet one in six South African’s is HIV positive and the incidence of TB-HIV co-infection is not declining. Methodology : A quantitative, descriptive approach was utilised to conduct a retrospective patient chart review. A multistage cluster sampling technique comprising three stages was implemented to identify the sample. There was a random selection of clinics, and the required number of client records was obtained through convenience sampling from the selected clinics. Results : The findings of this study revealed there is inadequate implementation of the current national and provincial TB protocols. The study provides varied levels of information about TB symptom screening in HIV infected individuals in the PHC clinics of eThekwini Municipality. It was observed that Health Care Worker’s (HCW) in some facilities carried out TB symptom screening to an extent. However, the inconsistent and partial application of this screening tool warrants improvement to facilitate the broad success of TB-HIV care strategies.

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)

There is a very limited literature examining transport and access to health care, especially in the South African context. The existing literature does not provide an analysis of the influence of transport on access to health care and the utilisation of referrals by the patients. In the context of the HIV/AIDS and Tuberculosis epidemics which have already increased the demand for health care and utilisation of referrals, transport is a critical issue to take into account with regard to access to health care. The case study presented in this dissertation examines the influence of transport (either public or private) on patient's access to health care facilities, particularly the referrals and Emergency Medical services (EMS). The findings are based on a sample of 30 EMS providers, 15 clinic and hospital nurses, doctors and senior administrators, as well as 200 patients (clients) seeking health care in the three clinics which were chosen as study sites. Using qualitative and quantitative methods, this study focuses on patients seeking health care as well as those who provide health care routinely at clinics and hospitals and in emergencies. The focus of interest was transport needs and services and its role in patient access in the context of HIV/AIDS and TB epidemics. Findings of this study confirm research undertaken in other developing contexts. They show that in rural and some remote urban settlements, transport is a serious barrier to equitable access to health care. Race and locality combine to generate a hierarchy of access to care in South Africa. The study concludes that there is a need to reallocate resources in the health sector in order to increase access. Transport needs have to be taken into account when access to services is planned. And alternative models of health care provision in the context of the epidemics have to be conceived, emphasising the provision of well-equipped and resourced primary health care facilities. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Text in English / Botswana has witnessed highest TB rates in the southern African countries, ranking the fourth after South Africa, Swaziland and Zimbabwe. In 2012, the TB rate was on average 531/100 000 population. About 2 380 contacts out of a possible 8 110 (amounting to 29.30%) were traced nationally (Botswana 2011:8), indicating a possible gap of 5 730 which was yet to be traced in 2011. The TBCT strategies might be inadequate leading to absence of screening and treating TB contacts and reducing PTB related deaths. The purpose of this study was to describe utilisation of current TBCT and develop a strategy for a more effective TBCT in Botswana. Data was collected through a quantitative cross-sectional research design. The study further described the association between TBCT strategies and practices and determined the gaps, challenges and needs in the TBCT. Results revealed under-tracing of contacts in the number of registered and enumerated TB contacts. The results further established the risk of mixing TB contacts and the general patients. The differences in the perceptions and knowledge of the cause of TB as well as poor utilisation of the current programmes by the PTB patients denotes the need for aggressive awareness raising and health promotion strategies. The results were used to develop an alternative strategy, the IC-TBCT, which has a potential to trace all TB contacts. The strategy encourages participation, effective accountability and involvement of the beneficiaries in all efforts aiming at early contact identification and reducing the incidence of PTB. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore factors related to poor adherence to TB treatment in Keetmanshoop municipal area in Namibia. A qualitative, exploratory design was used to explore basic information about the study. Participants were using purposive sampling technique. The researcher-implemented triangulation, based on three different categories of participants, namely Field Promoters (preferred). DOT supporters (more preferred), and TB patients (most preferred). Participants were chosen in a ratio of preference. 1:2:3 respectively. The transcripts and audio tapes from interviews were analysed using the thematic content analysis. Five main themes emerged. In order of descending prominence, these themes included: factors leading to lack of adherence to TB treatment, support to enhance adherence to treatment, existing behaviours determining adherence, suggestions to promote adherence to treatment and practices to promote adherence to treatment. / Health Studies / M.A. (Public Health)

In this thesis, a mathematical model for HIV and TB co-infection with TB treatment among populations of Ethiopia is developed and analyzed. The TB model includes an age of infection. We compute the basic reproduction numbers RTB and RH for TB and HIV respectively, and the overall repro- duction number R for the system. We find that if R < 1 and R > 1; then the disease-free and the endemic equilibria are locally asymptotically stable, respectively. Otherwise these equilibria are unstable. The TB-only endemic equilibrium is locally asymptotically stable if RTB > 1, and RH < 1. How- ever, the symmetric condition, RTB < 1 and RH > 1, does not necessarily guarantee the stability of the HIV-only equilibrium, but it is possible that TB can coexist with HIV when RH > 1: As a result, we assess the impact of TB treatment on the prevalence of TB and HIV co-infection. To derive and formulate the nonlinear differential equations models for HIV and TB co-infection that accounts for treatment, we formulate and analyze the HIV only sub models, the TB-only sub models and the full models of HIV and TB combined. The TB-only sub model includes both ODEs and PDEs in order to describe the variable infectiousness and e ect of TB treatment during the infectious period. To analyse and solve the three models, we construct robust methods, namely the numerical nonstandard definite difference methods (NSFDMs). Moreover, we improve the order of convergence of these methods in their applications to solve the model of HIV and TB co-infection with TB treatment at the population level in Ethiopia. The methods developed in this thesis work and show convergence, especially for individuals with small tolerance either to the disease free or the endemic equilibria for first order mixed ODE and PDE as we observed in our models. / Mathematical Sciences / Ph. D. (Applied Mathematics)