| Summary: | A dissertation submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in fulfilment of the requirements for the degree of Doctor of 'Philosophy
Johannesburg 1998 === This study is divided into two phases, an historical record review and an intervention study.
In the period 1992. to mid-1994, tuberculosis management and treatment outcomes were
reviewed in the Tintswalo district of the Northern province, South Africa. Bacteriological
coverage, diagnostic criteria and treatment outcomes for the 514 patier, ~..t this period were
less than the internationally recommended goals, a record review giving a best estimate of
treatment completion of 67% for new smear positive patients.
An intervention study was set up from mid 1994 until January 1996. Twelve district clinics
were randornised to either "treatment" or "control .rlepending on whether tuberculosis followup
was at the hospital or clinics. Treatment clinic staff were trained, treatment supporters were
organised, and the logistic needs of a good tuberculosis control programe (transport to the
laboratory and drugs supplies) were provided by the researchers, who collected data On
patients, disease management and outcomes. A higher proportion of patients were diagnosed
bacteriologically, the majority had supporters, and treatment outcomes for all new smear
positive patients who lived in the district improved significantly to 81%. There was no change
in outcomes for those living outside 'ne boundaries of the study district. Successful treatment
outcomes Were more likely in supported patients, in new, as opposed to re-treatment patients,
and in those with at least a minimum level of formal education. Patients were interviewed at
different stages of their treatment. The results, together with those of focus group interviews
on patients and other community members, provind insights into the problems experienced
by patients, and their preferences, and into local beliefs and attitudes about this disease. It was
concluded that good tuberculosis management in this rural district was possible, despite a
number of constraints. It required commitment, staff training and support, management
supervision, and organisation of a laboratory network and drug supplies. === MT2017
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