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A study to determine the predictors of tuberculosis defaulting and the evaluation of the DOTS programme within the eThekwini Municipality

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dc.contributor.advisor Kistnasamy, Emilie J.
dc.contributor.advisor Reddy, Poovendhree Rajagopaul, Althea 2011-06-03T11:31:22Z 2013-04-01T22:20:08Z 2011
dc.identifier.other 333865
dc.description Submitted in fulfilment of the requirements of the Degree of Master of Technology: Environmental Health, Durban University of Technology, 2011. en_US
dc.description.abstract Worldwide Tuberculosis (TB) is a major public health concern. The Directly Observed Treatment Strategy (DOTS) has been used widely internationally and in South Africa (SA) to control the disease yet defaulting on treatment has still not achieved its World Health Organization (WHO) guideline of 5.0%. The eThekwini Municipality reported a defaulter rate of 18.9% in 2007 even with the adoption of DOTS in 1996. This study aimed to investigate the predictors of default amongst informal dwellers of eThekwini and to evaluate the implementation and the efficiency of the DOTS programme within the eThekwini Municipality, KwaZulu-Natal (KZN), and SA. The study population comprised of 102 defaulters from informal settlement, 16 nurses and 5 health personnel that are involved in TB management and control. The study was a mixed method cross sectional descriptive study that generated both quantitative and qualitative data. The Cyril Zulu Communicable Disease Centre (CDC) Electronic TB Register was used to trace the defaulters from the informal settlements that were interviewed. Non-defaulters were matched from the CDC Electronic TB Register but could not be traced due to accessibility and financial issues. Due to the low response from nurses 16(53%), semi structured qualitative interviews were conducted with health personnel. The three sets of data generated were analysed using descriptive statistics and content analysis. Multivariate logistic regression models found smoking, drinking and having a family member with TB as statistical significant predictors of default. Based on the multivariate model with a 95% confidence interval (CI), smoking (OR: 11.23, CI: 5.79, 21.78; p<0.005), alcohol consumption (OR: 15.22; CI: 7.66, 30.25; p<0.005) and had family member with TB (OR: 4.60, CI: 2.34, 9.04; p<0.005) were all significantly associated with defaulting. It was apparent that DOTS implementation was partly implemented due to lack of human resources. Tracing of defaulters, DOTS supporters, DOTS sites and incentives to patients and volunteers were major challenges hindering the iv effective implementation of the DOTS programme in eThekwini. Defaulting occurs as a result of an association between patient and health care characteristics. This study provides useful information specific to predictors of default amongst informal dwellers and the implementation and efficiency of the DOTS programme specific to informal settlements. The results from this study could be used to improve TB control and management specifically in informal settlements addressing factors that predict default and tracing and supporting patients to ensure adherence to TB treatment. en_US
dc.description.sponsorship DUT Finance en_US
dc.format.extent 211 p en_US
dc.language.iso en en_US
dc.subject.lcsh Tuberculosis--South Africa--Durban--Prevention en_US
dc.subject.lcsh Tuberculosis--Treatment--South Africa--Durban en_US
dc.subject.lcsh Directly Observed Therapy (Program) en_US
dc.title A study to determine the predictors of tuberculosis defaulting and the evaluation of the DOTS programme within the eThekwini Municipality en_US
dc.type Thesis en_US
dc.dut-rims.pubnum DUT-000599

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