Research Publications (Health Sciences)
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Item Challenges of Directly Observed Treatment Strategy implementation in eThekwini Municipality, South Africa(AFAHPER-SD, 2014-06) Rajagopaul, Althea; Reddy, Poovendhree; Kistnasamy, Emilie JoyEThekwini Municipality in Kwazulu-Natal, South Africa has a high prevalence of Tuberculosis (TB) and reported a defaulter rate of 18.9% in 2007, in spite of the Directly Observed Treatment Short Course (DOTS) which was adopted in 1996. While numerous quantitative studies have evaluated aspects of the DOTS programme in South Africa, there are limited qualitative data on this issue. The aim of this study was to determine the challenges associated with the implementation of the DOTS programme in the eThekwini Municipality. Five participants, who were all involved in TB management and control within the municipality, were interviewed. Textual data were content analysed. Three themes relating to healthcare personnels’ reports on the challenges associated with implementing DOTS in the municipality emerged from the inductive analysis of transcripts namely; inadequate follow up and tracing of patients, training of health care personnel and choice of DOTS supporters and DOTS sites. In spite of the eThekwini Municipality’s commitment to TB control and management, problems with implementation of DOTS persist. Communication, reporting and co-ordination between the different levels of the TB programme are essential to optimise patient benefit from both the TB programme and community or home based care.Item Predictors of tuberculosis treatment defaulting in informal dwellers within the eThekwini Municipality, KwaZulu-Natal(FIDSSA, 2014) Rajagopaul, Althea; Reddy, Poovendhree; Kistnasamy, Emilie JoyGlobally, tuberculosis causes more than 2-million deaths annually. Despite the implementation of the directly observed treatment strategy (DOTS) in South Africa, cure and defaulter rates have not reached World Health Organization (WHO) target rates. This causes concern as it may increase the risks of the development of multiple drug-resistant tuberculosis. Prior to commencement of this study, the eThekwini Municipality reported a defaulter rate of 18.9% in 2007 and 29% in 2009, which is higher than the WHO guideline of 5%. In 2011, eThekwini reported a defaulter rate of 24.3%. Given these statistics and the impact that these high rates may have on susceptible populations and an already overburdened health system, this study aimed to investigate predictors of defaulting in informal dwellers of eThekwini Municipality, KwaZulu-Natal. The study population comprised 102 defaulters and 102 non-defaulters from informal settlements within eThekwini. It was a cross-sectional descriptive study. The Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register was used to trace defaulters who were interviewed from informal settlements. Demographic data for non-defaulters were matched from the Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register, but were not physically traced. A questionnaire was administered to all defaulters and retrospective data were obtained from the Prince Cyril Zulu Communicable Disease Centre register for non-defaulters. Multivariate logistic analysis found smoking, alcohol use and having a family member with tuberculosis to be statistically significant predictors of defaulting. Smoking [odds ratio (OR): 2.79, 95% confidence interval (CI): 1.15, 6.77, p-value ≤ 0.005], alcohol consumption (OR: 7.04, 95% CI: 2.96, 16.71, p-value ≤ 0.005), and having a family history of tuberculosis (OR: 4.60, 95% CI: 2.34, 9.04, p-value = 0.01), were all significantly associated with defaulting in informal dwellers. Smoking, alcohol use and having a family member with tuberculosis were predictors that informal dwellers would default from their treatment. These factors should be included in tuberculosis management programmes.