Factors contributing to poor performance of Directly Observed Treatment Short-course (DOTS) in Mopani District, Limpopo Province, South Africa

The purpose of the study was to assess factors contributing to poor performance of Directly Observed Treatment Short-Course (DOTS) in Mopani district of Limpopo Province, South Africa. An exploratory qualitative approach was used to investigate the factors that contribute to poor performance of the DOTS Strategy. Four focus group discussions were conducted, two with Directly Observed Therapy (DOT) Supporters and two with patients on treatment for more than 6 months. The focus groups (4) discussions were tape-recorded. Data collected were descriptively analyzed using thematic methods. The patients generally found supervision of TB treatment helpful as they were motivated and encouraged to continue treatment. Some of the aspects identified as being unhelpful were the inconvenient times for treatment support and stigma due TB supporters’ visit to patients home. Patients often preferred family members as supporters, whereas health workers favoured trained volunteers as DOT supporters. Other factors affecting DOTS were poverty, food shortage, cultural beliefs, and side-effects of the medication. Patients receiving disability grants prefer to remain uncured so as to continue receiving the grant. Behavioural factors seem to play a major role in noncompliance with TB treatment. The findings of the study support the importance of initial counseling and motivation of patients in improving adherence in the programme. Self-motivation was mentioned rather than the motivation from the DOT supporters. Further exploration of alternative DOTS supporters other than trained volunteer demands further investigation

Development implementation and process evaluation of an adapted tuberculosis directly observed treatment programme in Limpopo Province

PhDDepartment of Public HealthSee the attached abstrac

Knowledge, Beliefs, and Perceptions of TB and Its Treatment amongst TB Patients in the Limpopo Province, South Africa

Despite the implementation of global plans to end tuberculosis (TB), this disease remains a major cause of ill-health and is the second leading cause of death. In 2019, globally, an estimated 10.0 million people fell ill and about 1.4 million died of TB. During the same year, South Africa was among the eight countries with the highest tuberculosis burden, contributing to two-thirds of the world’s total. Due to the high burden of the human immunodeficiency virus (HIV) epidemic, TB in South Africa is a major public health problem. Limpopo is amongst the provinces that are hardest hit by TB and HIV in South Africa. Therefore, using a quantitative descriptive design, this study assessed the knowledge, beliefs, and perceptions of TB and TB treatment amongst TB patients in the Limpopo Province. A systematic random sampling method was used to sample 207 TB patients who agreed in writing to be part of the study. Data were collected using a self-administered questionnaire, however, about 3.9% of participants who could not read were assisted by the main researcher and health professional. About 33% of the participants with primary education were also assisted to clarify any questions that were not clear to them. Data were analyzed using the Statistical Package for Social Sciences® version 26.0. Validity and reliability of the instrument was ensured, and ethical considerations were observed in this study. The research findings revealed that about 93.25% respondents only came to know they had TB after diagnosis. About 75% indicated that they had visited faith healers and only 2% acknowledged that they had visited traditional healers after diagnosis. A total of 76% of the respondents stated that they strongly believed in their culture and religion. These findings highlight the need for health education efforts to strengthen accurate information to improve TB knowledge and correct misconceptions about TB among patients within the community

Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

Background: Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. Aim: To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. Setting: This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Methods: Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. Results: A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Conclusion: Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community. Keywords: Health seeking, Adherence, Community based participatory research, Tuberculosi