Tuberculosis contact tracing in primary health care facilities in Francistown, Botswana.
Thesis (MFamMed)--Stellenbosch University, 2014.
ENGLISH SUMMARY : Background: Tuberculosis (TB) is a big health concern in Botswana. High numbers of new and retreatment tuberculosis cases are still being recorded every year. This calls for implementation of more effective ways of investigating and managing tuberculosis to control its spread. Methods: This descriptive study was conducted in four clinics in Francistown, Botswana where a high number of cases were recorded in previous years. The objectives of the study were to determine the frequency and adequacy of tuberculosis contact tracing conduction in Francistown primary health care facilities and to describe factors contributing to the failure to implement TB contact tracing. The study design was a descriptive study using the data that was collected at the four clinics where direct observational therapy was administered. The information on how TB contact tracing was done and factors contributing to lack of adherence to TB programme guidelines was collected over a 5 months period. In one part of the study, sputum positive patients on anti-tuberculosis treatment (ATT) were asked questions as stated in the questionnaire, while in the second part health care workers conducting contact tracing were interviewed at Directly Observed Therapy (DOT) administration points. The findings were compared to the national guidelines on tuberculosis contacts tracing recommendations. Results: A total of 61 sputum positive subjects were identified. A total of 51 (84%) patients had some contact tracing done. Of the 51 patients, 44 (86%) had inadequate contact tracing and only 7 (14%) had adequate contact tracing done. Of the 51 that had contact tracing done, 6 (12%) were identified to have contacts with signs and symptoms of TB. Of the 61 subjects who were AFB positive and currently treated for TB, 12 (20%) of them were previously treated for TB. Patients’ movement, insufficient transport, confidentiality and privacy were noted to be factors hindering effective tuberculosis contact tracing in primary healthcare facilities in Francistown. Conclusion: This study highlights the large number of sputum positive TB patients whose contacts are not effectively investigated and therefore remain untreated. Adequate assessment of contacts may identify active TB cases which could otherwise go unnoticed. Successful tuberculosis contact tracing at Francistown primary healthcare facilities is hindered by a number of challenges which include, highly mobile contacts, transport issues, confidentiality and privacy, limited health care workers communication and counselling skills, homelessness and patients’ refusal to produce sputum. The effective evaluation of TB contacts may therefore contribute to the successful implementation of TB prevention programmes in this area
AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar.