D. Maher et al., TUBERCULOSIS CARE IN COMMUNITY CARE ORGANIZATIONS IN SUB-SAHARAN AFRICA - PRACTICE AND POTENTIAL, The international journal of tuberculosis and lung disease, 1(3), 1997, pp. 276-283
SETTING: Community care organizations in sub-Saharan Africa. OBJECTIVE
S: To evaluate current tuberculosis (TB) care in community health care
organizations in sub-Saharan Africa, to assess their potential contri
bution to tuberculosis care, and to develop a model for expanded commu
nity participation in effective TB control. DESIGN: Quantitative asses
sment of tuberculosis care and cross-sectional assessment of qualitati
ve measures in 14 community care organizations in Uganda, Zambia, Sout
h Africa and Malawi. RESULTS: The community care organizations assesse
d mainly provided care for human immunodeficiency virus (HIV) and aqui
red immune deficiency syndrome (AIDS) patients, and received funding f
rom non-governmental organizations. Shortcomings in tuberculosis care
included delays in diagnosis (which was often not based on sputum exam
ination), drug shortages, low completion rates, high default rates, in
adequate recording, little interaction with government tuberculosis pr
ogrammes, and inadequate training of staff. However, one organization
that provided primarily tuberculosis care and collaborated closely wit
h the district tuberculosis programme and hospital attained a high tre
atment completion rate. The strong points of the community care organi
zations that favour a potential role of community participation in tub
erculosis care were accessibility and staff motivation. CONCLUSION: De
spite most community care organizations' shortcomings in tuberculosis
care, they do have the potential to improve the care of tuberculosis p
atients, thus reducing the load on overstretched health facilities. Th
eir potential impact on tuberculosis control depends on their populati
on coverage and sustainability. HIV/AIDS community care organizations
with strengthened management of tuberculosis care could serve as a mod
el for expanded community participation in tuberculosis control. Opera
tional research is needed to assess the feasibility and cost-effective
ness of community-based TB care.