This study examined healthcare providers’ adherence to the national Tuberculosis guidelines (NTG) during the diagnosis and treatment of TB in Addis Ababa, Ethiopia using a descriptive, cross-sectional study design. Data were collected from 233 medical records using checklists. Adherence of healthcare providers to the NTG during the diagnosis of TB was 60.9% (n=67) for female and 56.1% (n=69) for male TB patients. However, 91.8% (n=101) female and 90.2% (n=111) male TB patients had been prescribed the correct numbers of anti-TB pills, complying with the NTG recommendations. There was an over-diagnosis of smear negative pulmonary Tuberculosis (PTB) as only 2.6% (n=2) of the 76 smear negative PTB patients were diagnosed correctly. Healthcare providers’ compliance with the NTG could be enhanced by providing appropriate in-service education, maintaining accurate records of all TB patients and providing supportive supervision to identify and address shortcomings.

The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This thesis focused on the provision of economic support to improve the outcomes of patients on TB treatment. Although the association between poverty and tuberculosis is generally acknowledged, there is little evidence to guide the use of economic interventions to improve tuberculosis control. In South Africa, a high burden country with extensive poverty, such evidence is particularly important. The first part of this thesis is a Cochrane systematic review of evidence from randomized controlled trials regarding the effectiveness of economic support among patients with tuberculosis. Eleven trials were included: ten conducted among marginalised groups in the United States on economic support for people on prophylactic treatment for latent TB; and one from Timor-Leste on economic support for patients with active TB. The review found that the use of economic interventions in patients with latent TB may increase the return rate for reading tuberculin skin test results, probably improves clinic re-attendance for initiation or continuation of prophylaxis and may improve completion of prophylaxis, compared to normal care. However, it is uncertain if economic support improves treatment completion in patients with active TB (low quality evidence). The second part of the thesis reports the findings of a pragmatic, cluster randomized controlled trial to evaluate the feasibility and effectiveness of delivering economic support to patients on treatment for active TB in South Africa. Patients with drug sensitive pulmonary TB were offered a monthly voucher valued at ZAR120 until completion of treatment or a maximum of eight months. Patients in control clinics received usual TB care. A parallel process evaluation provided contextual information to explain the trial findings. The qualitative component of this evaluation consisted of in-depth interviews with a sample of trial participants, including patients, nurses and health managers, to assess responses to the voucher and its administration. The quantitative component included a survey of patients’ household expenditure to assess patients’ levels of poverty and the effects of the voucher on these, and an analysis of the goods on which patients spent their vouchers. 4091 patients were included in the trial: 1984 in the control arm (10 clinics) and 2107 in the intervention arm (10 clinics). Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (-1.2; 12.3%), p = 0.107). Fidelity to the intervention was low, partly because nurses preferred to issue vouchers based on perceived financial need, rather than on eligibility. Logistical difficulties in delivering vouchers to clinics also undermined fidelity. The vouchers did not significantly increase patients’ household expenditure, but were experienced by patients as helpful, especially in providing more food with which to take their tablets. Factors related to the administration of economic support may undermine its effectiveness in improving TB treatment outcomes. Further research is needed to explore how best to deliver such economic support to those eligible to receive it, particularly in low and middle income countries where the burden of tuberculosis is highest. / AFRIKAANSE OPSOMMING: Hierdie tesis was toegespits op die verlening van ekonomiese steun om die uitkomste van pasiënte op tuberkulose- (TB-) behandeling te verbeter. Hoewel die verband tussen armoede en TB in die algemeen erken word, is daar nie veel bewyse om die gebruik van ekonomiese intervensies ter verbetering van TB-beheer te staaf nie. In Suid-Afrika – ’n land met ’n hoë TB-las en wydverspreide armoede – is sulke bewyse veral belangrik. Die eerste deel van hierdie tesis behels ’n sistematiese Cochrane-oorweging van bewysmateriaal afkomstig van verewekansigde, gekontroleerde proewe oor die doeltreffendheid van ekonomiese steun aan pasiënte met tuberkulose. Altesame 11 proewe is ingesluit: Tien is gedoen onder gemarginaliseerde groepe in die Verenigde State met die fokus op ekonomiese ondersteuning aan mense wat profilaktiese behandeling vir latente TB ontvang het. Een, van Timor-Leste, was gefokus op ekonomiese ondersteuning aan pasiënte met aktiewe tuberkulose. Die ondersoek het aan die lig gebring dat, vergeleke met normale sorg, die gebruik van ekonomiese intervensies by pasiënte met latente tuberkulose tog die omdraaikoers vir die lees van tuberkulien-veltoetsresultate kan verhoog, waarskynlik hertoelating tot klinieke vir die inisiëring of voortsetting van profilakse verbeter, en die voltooiing van profilakse kan verbeter. Die tweede gedeelte van die tesis behels ’n verslag oor die bevindings van ’n pragmatiese, trosverewekansigde gekontroleerde proef, om te bepaal hoe doenlik en doeltreffend dit sou wees om ekonomiese steun te verleen aan pasiënte wat in Suid-Afrika vir aktiewe tuberkulose behandel word. Pasiënte met middelsensitiewe pulmonêre tuberkulose het tot en met die voltooiing van hul behandeling, of tot ’n maksimum van agt maande, ’n maandelikse koopbewys ter waarde van ZAR120 ontvang. Pasiënte in kontroleklinieke het die gewone TB-sorg ontvang. ’n Parallelle prosesevaluering het kontekstuele inligting voorsien ter verklaring van die bevindinge van die proef. Die kwalitatiewe komponent van hierdie evaluering het bestaan uit diepte-onderhoude met ’n steekproef van alle deelnemers aan die proefneming, insluitend pasiënte, verpleegpersoneel en gesondheidsbestuurders, om hul reaksies te bepaal op die koopbewys self sowel as op die administrasie daarvan. Die kwantitatiewe komponent het ’n opname oor pasiënte se huishoudelike besteding ingesluit, ter vasstelling van hul armoedevlak en die moontlike uitwerking van die koopbewys daarop, asook ’n ontleding van die goedere waarop pasiënte hul koopbewyse bestee het. Altesame 4 091 pasiënte is by die proef ingesluit – 1 984 in die kontrole-afdeling (10 klinieke) en 2 107 in die intervensie-afdeling (10 klinieke). ’n Voorneme-om-te-behandel- (ITT-) ontleding toon ’n klein dog nie-betekenisvolle verbetering in behandelingsuksessyfers in intervensieklinieke (intervensie 76,2%; kontrole 70,7%; risikoverskil 5,6% (-1,2; 12,3%), p = 0.107). Getrouheid aan die intervensie was laag – deels omdat verpleegkundiges verkies het om die koopbewyse op grond van veronderstelde finansiële behoeftigheid eerder as volgens die studiekriteria uit te deel. Die koopbewyse het nie pasiënte se huishoudelike besteding beduidend verhoog nie, maar pasiënte het dit wél as nuttig ervaar, veral omdat hulle daarmee meer kos kon koop om saam met hul pille in te neem. Faktore wat verband hou met die administrasie van ekonomiese ondersteuning kan die doeltreffendheid van sodanige steun in die verbetering van TB-behandelingsuitkomste ondermyn. Verdere navorsing word vereis om te verken wat die beste manier sou wees om sodanige ekonomiese steun te bied aan diegene wat daarvoor in aanmerking kom, veral in lae- en middel-inkomstelande, waar die TB-las die hoogste is.

Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2017. / According to the Namibia National Tuberculosis Control Programme (NTCP) report of 2008, Namibia has one of the highest TB infection rates in the world with a case notification rate of 748/100,000. Rapid, specific and sensitive diagnosis of Mycobacterium tuberculosis (MTB) is needed for correct TB patient management. One of the aims of this study was thus to compare direct microscopy with two rapid molecular diagnostic tools (viz. GeneXpert MTB/RIF and Hain Genotype® MTBDR plus assay) for the identification of MTB from samples collected from the Khomas Region, Windhoek, Namibia. Only patients with positive TB sputum collected at the clinics and health facilities in the Khomas Region, Windhoek were eligible for the study. Three hundred and eighty-four samples were confirmed acid-fast positive by utilising the auramine staining method. The rifampicin (RIF) resistance profile detected by both molecular techniques was then compared for characterisation of the samples as drug resistant. Lastly, participants completed a survey, which included questions related to demographic and epidemiological data. Demographic data included patient age, gender, region of residence and history of treatment. The data was collected using a structured questionnaire and was captured in an Excel spreadsheet. It was then imported into Statistical Package for Social Sciences (SPSS) Version 25 for data analysis. A memorandum of understanding was also signed with the Namibia Institute of Pathology (NIP) to obtain permission to use their samples and the equipment at their site.

This quantitative, descriptive study investigated factors that contributed to TB patients registered in four Tembisa clinics in 2001, defaulting treatment. An interview schedule with closed and open-ended questions was used for 30 patients who could be traced who had interrupted treatment. The reasons for treatment interruption were related to socio-economic, TB policy-related and health care worker-related factors. The findings illustrate that TB management requires a multi-sectoral approach and joint efforts to tackle the disease that continues to kill people even though it is curable. / Health Studies / M.A. (Health Studies)

The study investigated the knowledge levels of clients on long-term tuberculosis (TB) treatment at Kwekwe General Hospital, Zimbabwe. A quantitative, descriptive research design was chosen and data was collected using a structured questionnaire with a convenience sample of 60 clients on TB treatment and 10 professional nurses. The major findings of the study were that although clients had some knowledge about their condition, there was a lack of knowledge regarding critical aspects such as information on drug-resistant TB and the Directly Observed Therapy Short Course. The professional nurses experienced constraints such as insufficient time for appropriate health education and home visits. Based on the study findings and conclusions, several recommendations were made. / Health Studies / Thesis(M.A(Health Studies))

no abstract available / Health Studies / M.A. (Health Studies)

This study examined healthcare providers’ adherence to the national Tuberculosis guidelines (NTG) during the diagnosis and treatment of TB in Addis Ababa, Ethiopia using a descriptive, cross-sectional study design. Data were collected from 233 medical records using checklists. Adherence of healthcare providers to the NTG during the diagnosis of TB was 60.9% (n=67) for female and 56.1% (n=69) for male TB patients. However, 91.8% (n=101) female and 90.2% (n=111) male TB patients had been prescribed the correct numbers of anti-TB pills, complying with the NTG recommendations. There was an over-diagnosis of smear negative pulmonary Tuberculosis (PTB) as only 2.6% (n=2) of the 76 smear negative PTB patients were diagnosed correctly. Healthcare providers’ compliance with the NTG could be enhanced by providing appropriate in-service education, maintaining accurate records of all TB patients and providing supportive supervision to identify and address shortcomings.

The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

Magister Public Health - MPH / Background: The incidence of tuberculosis in South Africa last measured at 834 in 2015 as reported by the World Bank. Out of these cases, only 54% cured and 13% of patients stop taking treatment. In Pretoria, Gauteng, comprehensive TB services are available in 87% of clinics and all these clinics offer the Directly Observed Treatment Short-course (DOTS) programme and help to diagnose TB and trace contacts. However, the average Pretoria district DOTS coverage has decreased from 88.8% to 84.7% in the last few years. The health district's cure rate as at 2012 is 61%, and its average rate of successful treatment of all new smear positive cases is 66% since 2005. Certain factors that determine patients' adherence towards TB treatment have been identified to include demographic, psychosocial and health system related factors. However, the WHO identified factors responsible for or predisposing patients to discontinue the DOTS programme have not been investigated in the study setting. Aim: The aim of this study was to assess the determinants of adherence to DOTS therapy amongst TB patients who commenced TB treatment at the TB clinic of a district hospital during April – June 2014. Methodology: A quantitative study was conducted using a descriptive cross-sectional design. An inclusive sample was drawn from adults in the DOTS programme receiving first line treatment during the 6-month period prior to commencement of the research. The calculated sample size was 234 individuals. The data collection tools included a questionnaire, 2-day recall and 30-day recall instruments and pill counts. Data were analysed using EPI info version 7 which included descriptive statistics to measure level of adherence. Associations between identified factors and adherence to TB treatment were also determined. Results: The final sample size was 80 participants of which 76% were male. The mean composite adherence rate was found to be 94% while the proportion of the patients who achieved adherence of 95% and above was 75%. Identified barriers to adherence include forgetfulness, lack of transport fare on clinic appointment days, patients not feeling well and so were not strong enough to attend clinic appointments. On the other hand, the role of treatment supporters and counseling were found to have a positive impact on adherence to DOT in this setting. The use of reminders such as cell phones and alarm-radios were also identified as facilitators to adherence. Patients' knowledge of consequences for not taking medications as prescribed, which is closely linked with counseling, was found to be significantly associated with adherence in this study. Education status of participants was found to be significantly associated with adherence to DOTS (p = 0.01), when considering the pharmacy refill pill count as the adherence measure. Significant association was found between DOTS treatment regimens and 30-day recall adherence measures (p = 0.002). Significant association was also found for medication side effects and the adherence measures of 2-day recall, 30-day recall and pill count with p = 0.04; p = 0.03; p = 0.05 respectively There were significant associations between age and adherence with two of the adherence measures (30-day recall and pill count) at p = 0.002 and p = 0.003 level of significance respectively. Significant association was observed between duration of DOTS treatment when dichotomised using the mean treatment period (17 weeks) as the cut-off point and any of the adherence measures. Conclusion: The factors identified in this study can be classified into patient related factors, economic factors, social factors and health care workers and health system related factors. Furthermore, the factors at these different levels impact on one another and their improvements need to be made at all these levels to address the challenges facing TB patients to achieve optimal treatment adherence. This study is the first study of its kind in the study location and the findings have provided useful baseline data on the adherence rates and some insights into the major factors that affect adherence among patients on DOTS at a Pretoria West District Hospital. However further qualitative and quantitative studies are required to explore the factors influencing adherence further.