Where HIV/AIDS has had its greatest adverse impact is on TB. People with TB that are infected with HIV are at increased risk of dying from TB than HIV. TB is the leading cause of death in HIV individuals in South Africa. HIV is the driving factor that increases the risk of progression from latent TB to active TB. In South Africa no coherent analysis of the risk determinants of HIV and TB has been done at the national level this study seeks to mend that gab. This study is about estimating risk determinants of HIV and TB. This will be done using the national household survey conducted by Human Sciences Research Council in 2005. Since individuals from the same household and enumerator area more likely to be more alike in terms of risk of disease or correlated among each other, the GEEs will be used to correct for this potential intraclass correlation. Disease occurrence and distribution is highly heterogeneous at the population, household and the individual level. In recognition of this fact we propose to model this heterogeneity at community level through GLMMs and Bayesian hierarchical modelling approaches with enumerator area indicating the community e ect. The results showed that HIV is driven by sex, age, race, education, health and condom use at sexual debut. Factors associated with TB are HIV status, sex, education, income and health. Factors that are common to both diseases are sex, education and health. The results showed that ignoring the intraclass correlation can results to biased estimates. Inference drawn from GLMMs and Bayesian approach provides some degree of con dence in the results. The positive correlation found at an enumerator area level for both HIV and TB indicates that interventions should be aimed at an area level rather than at the individual level. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009

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)

BACKGROUND: The prevalence of tuberculosis (TB) has been rapidly on the ascendency in the recent years globally due to its co-infection with HIV/AIDS. TB case finding is one of the technical pillars of the Directly Observed Treatment Short course (DOTS) TB strategy and there has been advocacy for early TB case detection to be the new focus of TB control efforts. PURPOSE: The purpose of this non-experimental study was to assess the determinants of TB case finding among pulmonary TB patients registered for treatment in Makana Municipality METHOD: A quantitative, non-experimental, cross sectional descriptive study among PTB patients registered for treatment at the primary health care clinics in Makana Municipality was done. Data collection was by self-administered questionnaires while sampling was by systematic sampling of PTB patients at five systematically selected clinics. RESULTS: Patient–related delay contributed more to total delay, in this study sample, than health system-related delay. Health system delay was found to be significantly associated with poorer finances, passive smoking history, seeking care from multiple health providers, initially visiting a non- NTCP health provider, TB stigma , overcrowding in the household and having difficulty with breathing as an initial symptom (p<0.05). CONCLUSION: There was a significant delay in TB case finding among PTB patients in this local municipality and patient related determinants contributed more than health system related determinants to this delay. There is need for the municipal TB programme to embark on an aggressive health education programme to furnish the populace with accurate information about TB, improve their health seeking behaviour and help address the issue of stigma associated with TB. / Health Studies

Thesis (MPA)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: The primary purpose of this study is to determine developmental opportunities for the upliftment of the socio-economic conditions of Tuberculosis patients as a non-medical intervention. The aim of the study rests with patients' opinions and life experiences regarding the control of the illness. Owing to the social and economic connotation attached to TB, it is imperative that the conditions be addressed that have a direct influence on the susceptibility of TB in order to minimize the risk of infection and reinfection. These conditions are, amongst other, housing, feeding status, level of education and substance abuse. Since these conditions depend on sufficient income, the issue of unemployment and its consequences are being discussed. For decades already the relation between TB and socioeconomic circumstances is described, but it are still this very circumstances that stifles the advancement in medical treatment. The opinions and experiences of TB patients are obtained from informal in-depth interviews. It is obvious that TB patients never started to consider solutions for the epidemic themselves. This can be ascribed to the fact that, historically the cure of TB was exclusively the responsibility of the health profession. A great deal of apathy is noticed with regards to problem identification. For this reason the community is not yet ready for the massive developmental task that is still to come. Through a process of social learning and empowerment, a sense of responsibility must be cultivated within the communities. Confidence must be established with regards to their ability to improve the situation with the aid of other role players for example government, the private sector and health services. Recommendations for development are based on the level, the imagination and current abilities of the patients. The distribution of information about the disease, the creation of job opportunities, the encouragement of parents to participate in the education of their children and health education by trained members of the community are some of the most important recommendations of this study. / AFRIKAANSE OPSOMMING: Die primêre doel van die studie is die ondersoek na ontwikkelingsgeleenthede vir die opheffing van die sosio-ekonomiese omstandighede van Tuberkulose pasiënte as 'n nie-mediese tussentrede. Die fokus van die studie berus op die pasiënt se menings en lewenservaring aangaande die bekamping van die siekte. Vanweë die sosiale en ekonomiese konnotasie aan TB is dit van belang dat die toestande wat direk 'n invloed het op die vatbaarheid vir TB, aangespreek word om sodoende die risiko van infeksie en herinfeksie te verminder. Hierdie toestande is onder andere behuising, voedingsstatus, opvoedingspeil en substansmisbruik. Omdat genoemde toestande afhang van gereelde en genoegsame inkomste word werkloosheid en die gevolge daarvan behandel. Reeds vir dekades is die verband tussen TB en sosioekonomiese omstandighede beskryf, maar steeds is dit juis dié omstandighede wat die vooruitgang in die mediese behandeling in die wiele ry. Die menings en ervarings van TB pasiënte is verkry uit informele indiepte onderhoude. Dit is duidelik dat TB pasiënte nog nie self aan oplossings vir die epidemie begin dink het nie. Dit kan toegeskryf word aan die feit dat die genesing van TB histories die uitsluitlike verantwoordelikheid van gesondheidspersoneel was. Daar word ook 'n groot mate van apatie gemerk ten opsigte van probleemidentifiseringen is die gemeenskappe dus nog nie gereed vir die massiewe ontwikkelingstaak wat voorlê nie. Deur 'n proses van sosiale leer en bemagtiging moet 'n verantwoordelikheidsin by gemeenskappe gekweek word. Selfvertroue moet gebou word ten opsigte van hulle vermoë om die situasie te verbeter met die hulp van ander rolspelers soos die regering, die privaatsektor en gesondheidsdienste. Aanbevelings vir ontwikkeling is gebaseer op die vlak, denke en huidige vermoëns van die pasiënte.Van die belangrikste aanbevelings sal wees die uitbreiding van kennis aangaande die siekte, die skepping van werksgeleenthede, die aanmoediging van ouerbetrokkenheid by hulle kinders se opvoeding en voedingsvoorligting deur opgeleide gemeenskapslede.

Thesis (MPhil (Communicable Diseases)) (Dept of Interdisciplinary Health Sciences. Community Health))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Global control of the tuberculosis (TB) epidemic remains one of the greatest health challenges of the 21st century, despite the availability of effective treatment over the past 50 years. The rising incidence of transmitted (primary) drug resistant TB threatens the very fabric of conventional TB control efforts, which are already strained by a rampant human immunodeficiency virus (HIV) epidemic. Ongoing transmission of Mycobacterium tuberculosis is a key factor that sustains the TB epidemic in endemic areas such as the socio-economically deprived townships of Cape Town, South Africa. My research explores the disease context, or social terrain, of TB in this endemic setting. It is primarily concerned with how the social terrain of endemic TB may contribute to ongoing transmission and the potential that it holds for enhancing TB control efforts. Analyses of qualitative data from eight township research sites in and around Cape Town show that pragmatic and novel approaches are required to pierce through the enormity of TB as a political and economic problem. Broadening the current biomedical focus on treating individual patients, to include more holistic community-based interventions, can and should be developed. Data were collected as part of qualitative pre-intervention community surveys conducted in 2005 and 2006 for a public health intervention trial (ZAMSTAR) performed in Zambia and South Africa. Twenty-four communities were selected as research sites and this study draws on the survey data collected in the trial’s eight South African sites. Although the data were collected for the ZAMSTAR trial, the aims and analyses presented in this study - which seek to improve our understanding of how the social terrain is meaningful for TB control - remain independent of ZAMSTAR. Through a retrospective analysis of the South African data, I inductively present three distinctive ways in which the social terrain is meaningful for TB control. First, the interaction between social cohesion and social diversity may be an important variable that predicts community response to public health interventions aimed at reducing the prevalence of TB in these endemic areas. This is demonstrated by triangulating ZAMSTAR’S adaptation of a social systems model with further analysis of the research sites. Second, the study identifies a common discourse running through the sites that stigmatizes TB as both a dirty and HIV-related disease. It is argued that this may be significantly contributing to TB diagnostic delay and I call for more holistic approaches to TB control that can reduce perceived marginalization and TB-HIV stigma. Third, congregate settings emerge as noteworthy visible features of social terrain that clearly have the potential to facilitate TB transmission within communities. The pre-intervention surveys qualitatively described public spaces within each research site and the use thereof. Basic principles of TB transmission are applied to these descriptions, developing a novel method of mapping the relative transmission risk possibly posed. Innovative use of similar approaches could identify likely transmission “hot spots” that may serve as focal points for targeted interventions, such as adjustments that increase ventilation or encourage TB suspects to seek urgent medical diagnosis and treatment. / AFRIKAANSE OPSOMMING: Die beheer van tuberkulose (TB) bly steeds een van die grootste gesondheids uitdagings van die 21ste eeu, ten spyte van die beskikbaarheid van effektiewe behandeling vir die afgelope 50 jaar. Die stygende insidensie van oorgedraagde (primêre) middelweerstandige TB bedreig die wese van konvensionele TB kontrole programme, wat reeds gebuk gaan onder die oorweldigende impak van die menslike immuungebrek virus (MIV) epidemie. Ononderbroke oordrag van Mycobacterium tuberculosis is ‘n kardinale faktor wat die epidemie onderhou in areas soos die sosioekonomies agtergeblewe dele van Kaapstad, Suid-Afrika. My navorsing ondersoek sosiale terrein (konteks) van TB in hierdie hiperendemiese konteks. Dit is primêr gemoeid met die moontlike bydrae van die sosiale terrein tot voortgaande TB oordrag en die potensiaal wat dit mag inhou om TB kontrole te verbeter. Analise van kwalitatiewe data van agt agtergeblewe gemeenskappe in en om Kaapstad wys dat nuwe en pragmatiese benaderings benodig word om die volle omvang van TB as ‘n politieke en ekonomiese problem aan te spreek. Data is versamel as deel van kwalitatiewe pre-intervensie gemeenskapsopnames wat gedoen is gedurende 2005 en 2006 vir ‘n publieke gesondheid intervensie studie (ZAMSTAR) in Zambië en Suid-Afrika. Die studie sou poog om die TB prevalensie betekenisvol te verlaag in gemeenskappe wat erg geaffekteer word deur MIV. Vir navorsings doeleindes is vier-en-twintig gemeenskappe geselekteer, waaronder agt Suid-Afrikaanse gemeenskappe. My studie analiseer kwalitatiewe data wat versamel is in hierdie agt gemeenskappe, wat verskeie observasie en deelnemende tegnieke ingespan het. Die studie poog om algemene begrip te verbeter van hoe die sosiale terrein betekenisvol kan wees in TB kontrole; dit is my eie werk en is totaal onafhanklik van die groter ZAMSTAR studie. Induktiewe retrospektiewe analise van data identifiseer drie voorbeelde wat illustreer hoe die sosiale terrein betekenisvol mag wees vir TB kontrole. Eerstens, die interaksie tusses sosiale kohesie en sosiale diversiteit mag ‘n belangrike verandelike wees wat gemeenskapsrespons tot publieke gesondheidsintervensies voorspel. Dit word geïllustreer deur die toepassing van ‘n sosiale sisteme model (soos aangepas deur ZAMSTAR) en analise van ander aanvullende data. Tweedens, identifiseer die studie ‘n gemeenskaplike diskoers in alle navorsings gemeenskappe wat TB stigmatiseer as beide ‘n vuil en MIV-verwante siekte. Dit word geargumenteer dat hierdie verskynsel moontlik betekenisvol bydra tot vertraging van TB diagnose en die nodigheid vir meer holistiese benaderings wat marginalisasie en TB-HIV stigma kan verminder word uitgewys. Derdens blyk dit dat openbare vergaderplekke ‘n belangrike deel van die sosiale terrein vorm en duidelik die potensiaal het om TB oordrag binne gemeenskappe te fasiliteer. Die pre-intervensie opnames het alle openbare vergaderplekke sorgvuldig beskryf en basiese beginsels van TB oordrag is gebruik om vergaderplekke geografies te kaart volgens die moontlike transmissie risiko wat dit mag inhou. Innoverende gebruik van GIS-gebasseerde benaderings, soortgelyk aan die metode wat gebruik is om potensiële “transmission hot spots” te kaart, mag bydra om intervensies beter te fokus, deur bv. verbeterde ventilasie te verskaf of mense met simptome van TB aan te moedig om dringend mediese hulp te soek.

This thesis is an investigation into the socio-economic constraints that influence the decisions of tuberculosis sufferers in the health seeking process and therapeutic management of tuberculosis in Grahamstown, the Eastern Cape. It is shown that structural violence influences experiences and perceptions of tuberculosis at all levels. Management of tuberculosis in the formal health sector is explored at local levels and related to national and global strategies of health care. The role of health workers, and particularly voluntary health workers, is explored and it is shown that they work within a context of growing burden of sickness and co-infections and a lack of government commitment to deal with increasing TB and HIV incidences. Kleinman’s notion of explanatory models is explored and it is evident that although knowledge of the aetiology of tuberculosis is well-known to patients and general members of the communities, they are nevertheless victims of increased stigmatisation and marginalisation as a result of illness. The importance of social support in curing tuberculosis is explored using Janzen’s concept of therapy managing groups. Social capital is a fundamental component in adhering to biomedical therapy, but is commonly weak among the structurally poor. The availability of temporary social grants for people living with TB influences health seeking behaviour. In a context of structural poverty the sick are faced with what Nattrass terms “perverse incentives”, having to choose between the right to health and the right to social security, both guaranteed in the South African Constitution, for him/herself and dependants. Although adherence to biomedical therapy is essential in curing tuberculosis, it is shown throughout this thesis that ignoring wider structural causes of disease limits the patient’s ability to get well. The ethnography shows that the right to health is a social and economic right which is not the reality for most South Africans.

BACKGROUND: The prevalence of tuberculosis (TB) has been rapidly on the ascendency in the recent years globally due to its co-infection with HIV/AIDS. TB case finding is one of the technical pillars of the Directly Observed Treatment Short course (DOTS) TB strategy and there has been advocacy for early TB case detection to be the new focus of TB control efforts. PURPOSE: The purpose of this non-experimental study was to assess the determinants of TB case finding among pulmonary TB patients registered for treatment in Makana Municipality METHOD: A quantitative, non-experimental, cross sectional descriptive study among PTB patients registered for treatment at the primary health care clinics in Makana Municipality was done. Data collection was by self-administered questionnaires while sampling was by systematic sampling of PTB patients at five systematically selected clinics. RESULTS: Patient–related delay contributed more to total delay, in this study sample, than health system-related delay. Health system delay was found to be significantly associated with poorer finances, passive smoking history, seeking care from multiple health providers, initially visiting a non- NTCP health provider, TB stigma , overcrowding in the household and having difficulty with breathing as an initial symptom (p<0.05). CONCLUSION: There was a significant delay in TB case finding among PTB patients in this local municipality and patient related determinants contributed more than health system related determinants to this delay. There is need for the municipal TB programme to embark on an aggressive health education programme to furnish the populace with accurate information about TB, improve their health seeking behaviour and help address the issue of stigma associated with TB. / Health Studies

Cette thèse en anthropologie fait suite à des travaux réalisés dans le cadre d’un programme de santé publique mis en œuvre au Burkina Faso. Celui-ci concernait la prise en charge de la tuberculose dans la région sanitaire du plateau central. Le travail dont je me suis occupé, porte sur les aspects anthropologiques de la tuberculose en se focalisant sur les représentations de la maladie, ainsi que la nature des relations et processus thérapeutiques. Il rend compte d’une mise en perspective de la dynamique de prise en charge des malades soufrant de la tuberculose dans les familles et les centres de soins. L’analyse est principalement orientée vers une approche critique sur la place qu’occupent les sciences sociales dans la mise en œuvre de projets de santé et de développement dans une perspective interdisciplinaire. L’anthropologue convié dans un programme de santé publique s'invertie dans le but d’identifier et analyser les perceptions locales, ainsi que les attitudes et pratiques des populations, en indiquant les modalités de leur prise en compte pour faire face aux besoins de santé. Ceci permet de définir des orientations dans la réalisation des programmes de santé qui prennent en compte les réalités locales et les caractéristiques des acteurs. Par ailleurs, l’appropriation et la mise en application des connaissances produites par une démarche anthropologique suscitent bien des interrogations. Par une approche réflexive qui prend racine dans de multiples contributions d’anthropologues impliqués dans des programmes de santé et de développement, je me suis interrogé de savoir dans quelle mesure l’implication de l’anthropologue dans des actions de développement tient lieu d’un corpus qui soulève des questionnements d’ordre méthodologique et théorique. Ces questions ont ouvert des perspectives pour l’élaboration de nouvelles connaissances au travers d’une anthropologie du changement social. A partir de mes propres expériences, j’ai donc essayé d’examiner la pratique de l’anthropologie et les modalités de ses apports au fonctionnement des services de santé et la réalisation des projets de santé publique au Burkina Faso. / Doctorat en Sciences politiques et sociales / info:eu-repo/semantics/nonPublished

Tuberculosis (TB) has become a serious South African health problem because it is the most common opportunistic disease that leads to death in people with HIV/AIDS. Due to the airborne nature of the disease it can easily be spread to anyone including healthy people. A lack of compliance to treatment by TB patients explains why prevalence rates of the disease are high and why there is an emergence of drug resistant strains such as XDR-TB and MDR-TB. Information on existing knowledge, attitudes and perceptions regarding TB can provide a crucial foundation for the development of educational programmes and interventions aimed at reducing the further spread of the disease. This study aimed at understanding the knowledge, attitudes and perceptions towards TB and relating these to the current prevalence of HIV/AIDS. A face-to-face interview survey was conducted among adult Grahamstown East residents (n=1020). The Health Belief Model (Rosenstock et al., 1994) and Bandura’s (1986) Social Cognitive Theory formed the theoretical framework of the data collection and analysis. The data generated from the field work was first descriptively analysed providing frequency tables. Thereafter cross tabulations were calculated for relevant items using independent variables, namely gender, level of education, and experience of dealing with TB. The results of the study show that, in general, knowledge concerning TB was sufficient to provide a foundation for the adoption of healthier behaviours in the female respondents. Few of the respondents reported feeling personally susceptible although the majority of the respondents acknowledged the severity of the disease. The cues to action lacked the influence to persuade people to adopt positive health related behaviours. The perceived benefits of adopting preventative behaviour were not very influential in the adoption of healthier behavioural changes in the respondents. Disease stigma regarding the dual association of TB and HIV/AIDS was the main barrier for the adoption of healthier behavioural attitudes. Perceived self-efficacy in preventative behaviours was generally low in the less educated respondents. Recommendations regarding areas for future research and change interventions are provided.