Me. Edginton, Tuberculosis patient care decentralised to district clinics with community-based directly observed treatment in a rural district of South Africa, INT J TUBE, 3(5), 1999, pp. 445-450
Citations number
25
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
SETTING: A rural district of the Northern Province, South Africa.
OBJECTIVES: To measure the effect of decentralisation of a tuberculosis ser
vice in a rural area on treatment outcomes.
DESIGN: An intervention study that measured treatment outcomes of patients
attending district clinics for tuberculosis treatment and compared these wi
th outcomes of patients attending the district hospital.
RESULTS: Over the ii-year period 1992-1995, 928 patients were admitted to t
he tuberculosis unit of the district hospital. In the initial pre-intervent
ion phase, the best estimate of completed treatment for all 503 cases was 6
1%, and for 206 new smear-positive patients it was 67%. The intervention pr
ocess established a tuberculosis control programme with directly observed t
reatment for all patients, and training and supervision of clinic staff. Ni
nety per cent of all patients had community-based supporters. For most pati
ents, cure was not proven, but assuming success from completion of and prov
en adherence to treatment, successful outcomes for new smear-positive cases
rose to 82% for decentralised (clinic) treatment, and 88% for those patien
ts who lived in the district but attended the hospital for treatment.
CONCLUSIONS: These findings suggest that district clinics can achieve the s
ame good results as the hospital. It is recommended that tuberculosis contr
ol needs a dedicated co-ordinator at district level to manage the necessary
infrastructural and staff resources.