Compliance of St. Joseph’s Hospital Roma, Lesotho with the National Tuberculosis Programme of Lesotho, 2007/2008
Thesis (MFamMed)--Stellenbosch University, 2011.
ENGLISH SUMMARY : Background and Objective: Most National Tuberculosis Programmes ( NTPs) have focused their efforts on reaching the short-term internationally recommended TB control targets set in 2005 by the World health assembly;-a case detection of 70% with successful treatment of 85% of the detected cases. The National TB programme of Lesotho registered 3976 sputum smear positive cases for TB treatment in 2008, 73.5% (2834) of which were successfully treated. This falls short of the global target of at least 85% treatment success rates. The national TB programme has lamented over the last 5 years for its inability to meet targets set by the WHO for measuring effective TB programmes, because of the inability of most of the hospitals to fully implement the national TB programmes as recommended. Most of the hospitals running TB programmes in the country still have difficulty blending the clinical and programmatic components of TB treatment together, hence explained the poor treatment outcome seen over the past years. In view of this perceived gap, an investigation into programme compliance by the hospitals serving as TB roll out centres is warranted. The aim of the study was to evaluate the implementation of the national TB program in St. Joseph’s hospital Roma, Lesotho (which happens to be one of the district hospitals in Lesotho providing TB service delivery), and also to come up with recommendations that will improve TB treatment outcome where gaps are identified and subsequently improve the TB programme in the hospital and contribute towards improving the overall TB programme for Lesotho. Methods: A retrospective cohort study design was used. The study was carried out on the records of TB patients who were treated at St. Joseph’s hospital Roma, Lesotho in 2007 and 2008. All patients treated for TB within the specified period were consecutively selected for the study, except for those who did not meet the inclusion criteria. Nine hundred and ninety three (993) TB patients’ records were evaluated, for 2007 (509 records were evaluated) and for 2008 (484 records were evaluated). Results: There was a marginal improvement in the case detection of smear positive patients, sputum conversion rate, TB treatment outcome such as cure rate, mortality, treatment failure, defaulters, transferred outcome and TB/HIV collaborative activities such as HIV testing among TB patients, cotrimoxazole and antiretoviral uptake among TB/HIV co-infected. In terms of comparison of the targets achieved with the targets set by the national TB programme of Lesotho, targets were met in defaulter and treatment failure rates, but were not met in case detection of smear positive pulmonary TB, sputum conversion rate, cure rate, mortality rate, treatment success rate, HIV testing uptake among TB patients, cotrimoxazole uptake among TB/HIV positive patients and ARVs uptake among TB/HIV positive patients. Conclusions: Although the national TB programme has got good monitoring and evaluation tools, these are mainly reporting tools. In- house result analysis, individual case studies and overall programme management evaluation are invaluable assets to control and improve programmes. There was a significant improvement in St. Joseph’s TB programme, especially in the case detection of smear positive PTB, defaulter and treatment failure rates, TB/HIV co-infection detection and ARVs uptake among eligible patients, in 2008. However, meeting targets in sputum conversion, treatment outcome is still a big challenge, hence the need for implementation of the recommendations made in this document to close the identified gaps and Improve TB service delivery in the hospital.
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