Community perspectives on tuberculosis care in rural South Africa

Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa

BACKGROUND

Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment.

METHODS

Focus group discussions (FGDs) were conducted with 34 participants who had previous or current drug-susceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa.

RESULTS

In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FGD participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints, while FGD participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FGD participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services.

CONCLUSION

Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.

Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa

Background

Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment.

Methods

Focus groups (FGs) were conducted with 34 participants who had previous or current drugsusceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa.

Results

In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FG participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints while FG participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FG participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use as well and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services.

Conclusion

Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.

Community members and healthcare workers' priorities for the control and prevention of snakebite envenoming in Ghana

INTRODUCTION

Snakebite is one of the most neglected tropical diseases. In Ghana, there has been a limited interest in snakebite envenoming research despite evidence of high human-snake conflicts. In an effort to meet the World Health Organisation's (WHO) 2030 snakebite targets, the need for research evidence to guide policy interventions is evident. However, in setting the research agenda, community and healthcare workers' priorities are rarely considered.

METHODS

Three categories of focus groups were formed in the Ashanti and Upper West regions of Ghana, comprising of community members with and without a history of snakebite and healthcare workers who manage snakebite patients. Two separate focus group discussions were conducted with each group in each region. Using the thematic content analysis approach, the framework method was adopted for the data analysis. A predefined 15-item list of potential snakebite-associated difficulties and the WHO's 2030 snakebite strategic key activities were ranked in order of priority based on the participants' individual assessment.

RESULTS

Both acute and chronic effects of snakebite such as bite site management, rehabilitation and mental health were prioritised by the community members. Health system challenges including training, local standard treatment protocols and clinical investigations on the efficacy of available antivenoms were identified as priorities by the healthcare workers. Notably, all the participant groups highlighted the need for research into the efficacy of traditional medicines and how to promote collaborative strategies between traditional and allopathic treatment practices.

CONCLUSION

The prioritisation of chronic snakebite envenoming challenges by community members and how to live and cope with such conditions accentuate the lack of post-hospital treatment follow-ups for both mental and physical rehabilitation. To improve the quality of life of patients, it is essential to involve grassroots stakeholders in the process of developing and prioritising future research agenda.

Experiences with Tuberculosis Management among Community-Based Care Providers in Indonesia: A Qualitative Study

To explore experiences with TB management among community-based care providers. Descriptive qualitative study. A total of 25 care providers were selected using purposive sampling. Data were collected by semi-structured interviews and analyzed using content analysis. Six themes emerged from this study: "various dissemination channels," "compassionate religious volunteerism," "shortage of resources," "keeping TB cases hidden," "patient impediments to care," and "perceived economic burdens of patients." The findings can provide an understanding that the management of tuberculosis in the community requires collaboration between various institutions as well as patients. Building a sustainable TB system would be beneficial. A TB care model can be established between government and other institutions.

Factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty: a systematic review

OBJECTIVE

to analyze factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty.

METHOD

systematic review, carried out in March 2021 in seven databases, with no delimitation of period of publication. The selection process of publications and data extraction was carried out by two independent reviewers.

RESULTS

a total of 1,448 publications was identified and nine were included in the study. Unfavorable outcome was higher among those who were men; had low level of education; were living in a rural area before detention; had longer prison time; received occasional visits; had been transferred between prisons; with no sputum smear microscopy or with a positive result at the diagnosis; with no follow-up sputum smear microscopy, previous history of tuberculosis; having both clinical forms of the disease, HIV/AIDS; alcoholics; smokers; low body weight; and self-administered treatment. Treatment default was associated with young people and death with older people.

CONCLUSION

prison health managers and professionals are expected to establish mechanisms of surveillance and health actions innovation aimed at the population deprived of liberty, making efforts to reduce the unfavorable outcomes of tuberculosis treatment.

"I was always struggling": Caregivers' experiences of transitioning a child from oral to long-term non-oral feeding at an out-patient hospital clinic in South Africa

BACKGROUND

As the prevalence of paediatric dysphagia increases, the need for long-term non-oral feeding has also increased. Despite these developments, little is known about caregiver experiences of transitioning a child onto long-term non-oral feeds, and the factors which influence the process of decision-making and the provision of consent to do so. This paper aims to explore these factors.

METHODS

Semi-structured interviews were conducted with nine participants recruited from the multidisciplinary out-patient non-oral feeding clinic at a hospital. Interviews explored caregiver experiences of decision-making and the process of providing consent when transitioning their child to non-oral feeds, as well as the support structures available to the caregivers. Interviews were audio recorded and transcribed, then analyzed using thematic analysis (Braun & Clarke, 2013) and content analysis (Neuendorf, 2016).

RESULTS

Challenges to care and quality of life, access to information and culturally relevant counselling, and the involvement of family members and significant others emerged as prominent themes. Findings suggest that quality of life was the most common motivating factor for transitioning a child to non-oral feeding methods. Several participants suggested that support and information sharing via digital platforms were both useful and effective.

IMPLICATIONS

The findings highlight caregivers' needs for improved access to information and social support. The findings hold implications for training of healthcare providers working in similar contexts and for models of service delivery which ensure that family-centred intervention can be delivered in culturally and contextually relevant ways. With widespread access to smartphones, counselling should include digital messaging as a way of providing support and information sharing. Future research should focus on the complexities of counselling and the process of informed consent in settings impacted by diverse cultural, contextual and linguistic barriers, as well as the potential value of mobile health (mhealth) in ensuring improved health outcomes.

Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study

OBJECTIVES

Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice.

SETTING

Secondary and tertiary level healthcare facilities (HCFs) in three East African countries. Level of HCF was selected based on the WHO recommendation for implantation of tuberculosis (TB) molecular diagnostics.

PARTICIPANTS

Using implementation of TB diagnostics as a model, we purposively selected participants (TB patients, carers, survivors, healthcare practitioners, community members, opinion leaders and policy-makers) based on their role as stakeholders. In-depth interviews, key informant interviews and focus group discussions were held to collect the data between 2016 and 2018. The data were transcribed, translated, coded and analysed by thematic-content analysis.

RESULTS

A total of 712 individuals participated in the study. Socioeconomic and cultural factors such as poverty, stigma and inadequate knowledge about causes of disease and available remedies, cultural beliefs were associated with low access and utilisation of diagnostic and treatment tools for TB. Poverty made people hesitate to seek formal healthcare resulting in delayed diagnosis and resorting to self-medication and cheap herbal alternatives. Fear of stigma made people hide their sickness and avoid reporting for follow-up treatment visits. Inadequate knowledge and beliefs were fertile ground for aggravated stigma and believing that diseases like TB are caused by spirits and thus cured by spiritual rituals or religious prayers. Cultural norms were also the basis of gender-based imbalance in accessing care, 'I could not go to hospital without my husband's permission', TB survivor.

CONCLUSION

Our findings show that socioeconomic and cultural factors are substantial 'roadblocks' to accelerating the uptake and utilisation of diagnostic and treatment tools. Resolving these barriers should be given equal attention as is to health system barriers.

Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: A scoping review protocol

Introduction: Arterial hypertension (aHT) is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality. Life-long aHT service delivery models in the region remain mostly anchored to health facilities and are provided by physicians or nurses, thus limiting access to care. Over the past years, decentralized community-based aHT care models have been piloted, aiming to improve access to prevention, diagnosis, and treatment. Although individual studies suggest that community-based care is well-received and potentially efficacious, a synthesized overview of such care models is missing. Hence, the aim of this scoping review is to map out and summarize existing interventions for community-based aHT diagnosis and care in non-pregnant adults in SSA. Additionally, we will describe outcomes in terms of acceptability, blood pressure control, patient engagement in care, and occurrence of aHT caused end-organ damage. Methods and analysis: We will apply the Arksey and O’Malley scoping review methodology and best practice, as outlined by Levac and the Joanna Briggs Institute scoping review guidelines. The research questions have been identified through a literature review and expert consultation. A systematic literature search will be conducted in four databases using a tailored search strategy, including a supplemental search through backward and forward citation. Abstracts and full text screening as well as the extraction of data will be conducted by two independent reviewers. Discrepancies will be resolved by a third reviewer. Information will be presented in both tabular and narrative form. Ethics and dissemination: This scoping review will summarize findings from existing publications, rather than primary data, and as such, does not require ethics review. Findings will be disseminated through stakeholder meetings, conference presentations, websites, and a peer-reviewed publication.

Elucidating the Antimycobacterial Mechanism of Action of Decoquinate Derivative RMB041 Using Metabolomics

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), still remains one of the leading causes of death from a single infectious agent worldwide. The high prevalence of this disease is mostly ascribed to the rapid development of drug resistance to the current anti-TB drugs, exacerbated by lack of patient adherence due to drug toxicity. The aforementioned highlights the urgent need for new anti-TB compounds with different antimycobacterial mechanisms of action to those currently being used. An N-alkyl quinolone; decoquinate derivative RMB041, has recently shown promising antimicrobial activity against Mtb, while also exhibiting low cytotoxicity and excellent pharmacokinetic characteristics. Its exact mechanism of action, however, is still unknown. Considering this, we used GCxGC-TOFMS and well described metabolomic approaches to analyze and compare the metabolic alterations of Mtb treated with decoquinate derivative RMB041 by comparison to non-treated Mtb controls. The most significantly altered pathways in Mtb treated with this drug include fatty acid metabolism, amino acid metabolism, glycerol metabolism, and the urea cycle. These changes support previous findings suggesting this drug acts primarily on the cell wall and secondarily on the DNA metabolism of Mtb. Additionally, we identified metabolic changes suggesting inhibition of protein synthesis and a state of dormancy.

An Australian study on the benefits of pastoral care to aged care residents in Christian affiliated homes

This study aimed to understand the experience of pastoral care (PC), that is, the provision of support, comfort and spiritual counselling, from the perspective of Australian aged care residents. A survey research design captured feedback on participants' PC experience. Outcomes were reported by 575 residents (aged 53-102) across 41 sites. The majority perceived that they received a high quality of care (92%) and benefited from their meeting with the pastoral practitioner (80%), 'often' or 'all of the time'. A few significant differences were found based on participants' gender, spirituality (i.e. connection and meaning), religiosity (i.e. faith beliefs and religious practices) and well-being. Females and participants who identified as both religious and spiritual were more likely to feel that their faiths/beliefs were valued. Those with greater psychological well-being, as defined by the World Health Organisation (1998), were more likely to report receiving a high quality of care and greater benefits from receiving PC than those with poorer well-being. Three overarching themes and eight subthemes were identified from the open-ended responses: 1) personal qualities of the pastoral practitioner; caring, supportive, understanding and empathetic; 2) pastoral practitioner met specific needs; spiritual and religious, friendship and company and assistance, advice and help; and 3) positive impact on the participant; feeling listened to, peaceful and valued, accepted and respected. The qualitative findings resonate with Maslow's Hierarchy of Needs, to feel safe, belong and have self-esteem. There was a synergy between what participants desire in the care they receive, as expressed in the open-ended questions, and what the pastoral practitioners provide, as indicated in the quantitative findings. A study strength was its mixed-method, multi-site and cross-organisational context, enabling PC to be explored across a diverse sample. Future research should consider a pre- and post-test survey to more comprehensively capture the impact and benefits of PC.

Bench, bed and beyond: Communication and responsibility in decentralised tuberculosis care

Background

South Africa faces one of the world’s worst drug-resistant tuberculosis epidemics. Implementing successful care in this context has proven challenging for a number of reasons. Communication is an essential yet neglected feature of care and research in the field of tuberculosis.

Aim

The primary aim of this qualitative study was to explore communication facilitators and barriers at several tuberculosis care sites. In this article, we focus on communication practices across the chain of diagnosis, treatment, discharge and follow-up in decentralised care approaches and present evidence of gaps in communication.

Setting

The study was conducted at three tuberculosis care sites in two South African provinces.

Methods

Participants included healthcare workers, patients, community members and home-based carers. Data included 79 interviews, 4 video-recorded interactions between patients and healthcare workers, and ethnographic observations at each site. We analysed the data using thematic analysis and a qualitative sociolinguistic framework.

Results

Communication in decentralised care contexts is complex because of multiple sites and role players. Responsibility for communication seems to be unduly placed on patients, treatment guidelines are not implemented consistently across sites and assumptions are made about the role of others in the chain. Patient and healthcare worker reports suggest confusion and frustration.

Conclusion

Communication in the South African tuberculosis care context appears fragile and current mechanisms for detecting flaws in the care chain are not sensitive to communication issues. We make recommendations for strengthening home-based care resources, providing team training and focusing on communication processes in monitoring and evaluating systems.

Improvement of Nutritional Status among Tuberculosis Patients by Channa striata Supplementation: A True Experimental Study in Indonesia

OBJECTIVE

To analyze the effect of Channa striata supplementation on body mass index among tuberculosis patients, in which their health status is also investigated.

METHODS

This study employed a true experiment. The study was designed randomized pretest-posttest with a control group, in which 200 respondents were enrolled. Body mass index (BMI), used as a nutritional status indicator, was measured every week for a month. Chi-square test was used to analyze the data with a significance level of 5% by STATA 13.

RESULTS

The mean BMI of all groups increases during the month, in which rapid alteration occurs in the treatment group. The mean BMI (kg/m2) in the treatment group at weeks 0-4 was reported to be 17.43, 17.65, 17.90, 18.04, and 18.22, respectively. Meanwhile, the mean BMI (kg/m2) at weeks 0-4 in the control group was reported to be 17.20, 17.36, 17.57, 17.71, and 17.96, respectively. Furthermore, the alteration from severe thinness to higher BMI level in the treatment group is the highest. Based on the statistical test, there were no differences in BMI between the treatment and control groups (p > 0.05). However, the alteration of nutritional status in the treatment group is faster than that in the control group. In addition, there is no difference in their health status between the treatment and control groups (p > 0.05), except vomiting (p < 0.05).

CONCLUSION

The BMI among tuberculosis patients with Channa striata supplementation is increasing faster than that in the control group within a month with a minimum potential negative effect.