Factors affecting use of community based tuberculosis care in kampala district, uganda.
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A Dissertation submitted in partial fulfillment of the requirements for the award of a degree of Master of Public Health of Makerere University
Tuberculosis(T.B)is among the leading causes of mortality and affects one third of the population in the developing countries. Community based tuberculosis short course therapy(CBDOTS) is the most effective strategy available for controlling TB. CBDOTS was operationalized in kampala district in 1999 but until recently only 8% of TB patients chose to use it. OBJECTIVES OF STUDY: The objective of study was to identify factors affecting use of CBDOTS in order to provide the district health team(DHT) and ministry of health(MOH) with information for scaling up use of CBDOTS in kampala district. METHODS: The study was a facility based matched case control study. A sampla size of 346 was calculated according to schlesselman(1982) formula for case control studies. A case was defined as any person diagnosed with TB within six months prior to the study and using CBDOTS. A control had the same definition but used the facility or self-administered approach. Bivariate and multivariate analysis using Epi-info VERSION 3.2.2 and SPSS version 11.5 was done for quantitative data while qualitative data was analysed using the master sheet technique. Outcome measures of interest for quantitative data included odds ratios and 95% confidence interval. Data was presented as texts, tables, bar charts and quatations from qualitative data were used to supplement quantitative data. RESULTS: At bivariate analysis significant findings included; cases were more likely than controls to be less than 24 years(OR=1.95%,95%CI:1.22-3.12)have heard about CBDOTS from health workers(OR=5.42,95%CI:3.42-8.59), live within a 5 kilometer radius of a health facility offering CBDOTS(OR=2.99,95%CI:1.90-4.70), use herbs for treating TB disease(OR=5.52,95%CI:1.85-16.52),cite lack of incentive pay(OR=4.13,95%CI:1.98-8.65) and lack of awareness (OR=3.28,95%CI:2.10-5.11), as factors affecting use of CBDOTS in kampala district. At multivariate analysis; the influence on use of CBDOTS was reduced and significant factors included; Cases were more likely than controls to live within a five kiolmeter radius of a health facility offering CBDOTS(OR=1.181,95%CI:1.055-1.321),to have heard about CBDOTS from health workers(OR=3.300,95%CI:1.908-5.707) and use herbs for treating TB disease(OR=4.807,95%CI:1.329-17.381).No association was found between socio demographic characteristics such as; sex, occupation, marital staus, level of education and use of CBDOTS at bivariate and multivariate analysis. CONCLUSION/RECOMMENDATIONS: Results were in agreement with findings from previous studies but also revealed that use of herbs influenced use of CBDOTS. In order to scale up use of CBDOTS, It is recommended that the DHT and MOH embark on raising awreness about availability of CBDOTS, bring DBDOTS services closure to the community and motivate health workers to effectively deliver and monitor use of CBDOTS.
Tuberculosis(T.B)is among the leading causes of mortality and affects one third of the population in the developing countries. Community based tuberculosis short course therapy(CBDOTS) is the most effective strategy available for controlling TB. CBDOTS was operationalized in kampala district in 1999 but until recently only 8% of TB patients chose to use it. OBJECTIVES OF STUDY: The objective of study was to identify factors affecting use of CBDOTS in order to provide the district health team(DHT) and ministry of health(MOH) with information for scaling up use of CBDOTS in kampala district. METHODS: The study was a facility based matched case control study. A sampla size of 346 was calculated according to schlesselman(1982) formula for case control studies. A case was defined as any person diagnosed with TB within six months prior to the study and using CBDOTS. A control had the same definition but used the facility or self-administered approach. Bivariate and multivariate analysis using Epi-info VERSION 3.2.2 and SPSS version 11.5 was done for quantitative data while qualitative data was analysed using the master sheet technique. Outcome measures of interest for quantitative data included odds ratios and 95% confidence interval. Data was presented as texts, tables, bar charts and quatations from qualitative data were used to supplement quantitative data. RESULTS: At bivariate analysis significant findings included; cases were more likely than controls to be less than 24 years(OR=1.95%,95%CI:1.22-3.12)have heard about CBDOTS from health workers(OR=5.42,95%CI:3.42-8.59), live within a 5 kilometer radius of a health facility offering CBDOTS(OR=2.99,95%CI:1.90-4.70), use herbs for treating TB disease(OR=5.52,95%CI:1.85-16.52),cite lack of incentive pay(OR=4.13,95%CI:1.98-8.65) and lack of awareness (OR=3.28,95%CI:2.10-5.11), as factors affecting use of CBDOTS in kampala district. At multivariate analysis; the influence on use of CBDOTS was reduced and significant factors included; Cases were more likely than controls to live within a five kiolmeter radius of a health facility offering CBDOTS(OR=1.181,95%CI:1.055-1.321),to have heard about CBDOTS from health workers(OR=3.300,95%CI:1.908-5.707) and use herbs for treating TB disease(OR=4.807,95%CI:1.329-17.381).No association was found between socio demographic characteristics such as; sex, occupation, marital staus, level of education and use of CBDOTS at bivariate and multivariate analysis. CONCLUSION/RECOMMENDATIONS: Results were in agreement with findings from previous studies but also revealed that use of herbs influenced use of CBDOTS. In order to scale up use of CBDOTS, It is recommended that the DHT and MOH embark on raising awreness about availability of CBDOTS, bring DBDOTS services closure to the community and motivate health workers to effectively deliver and monitor use of CBDOTS.
Keywords
Tuberculosis, Kampala district Uganda, T.B patients, Community based health care