Volunteer's contribution to urban tuberculosis control programme in Kathmandu, Nepal.
Ghimire, Sagar Prasad.
Volunteer's contribution to urban tuberculosis control programme in Kathmandu, Nepal. - c2006. - vii, 62p. :
Thesis Report.
SUMMARY: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Transmission of the tuberculosis occurs by airborne spread of infectious droplets from one person to another. Tuberculosis continues to remain one of the most serious health and developmental problems over the world. The problem is especially severe in Asia, which carries two-thirds of the global burden. Tuberculosis is a major public health challenge in Nepal. About 45% of the total population is infected with TB. Every year 40,000 people develop active TB, of whom 20,000 have infectious pulmonary disease. Introduction of treatment by Directly Observed Treatment Short course (DOTS) has already reduced the numbers of deaths; however 5,000-7,000 people continue to die every year from this disease. To strengthen DOTS in urban area National Tuberculosis Programme has started volunteers' mobilization jointly with municapalities and DPHO. The objective of the study was to identify the contributions of volunteers' in TB control, to identify the factors that facilitates or hinders in making such contribution and to assess the acceptability of the volunteers to service providers and users. This is a cross- sectional study conduced in the urban DOTS clinic of Kathmandu district, under the National Tuberculosis Control Programme (NTP). Altogether 184 TB volunteers, four DOTS clinic incharge and four patients from DOTS clinic were interviewed. Pre-tested semi-structured interview questionnaire for volunteers and in-depth interview guideline for DOTS clinic incharge and patients were administered for required information. Data entry and analysis was done using SPSS 11 for Windows. Content analysis was done for qualitative information. Categorical data were compared by Chi-square, logistic regression analysis was performed to obtain odds ratios for covariates with 95% confidence intervals. Around half of the volunteers were involved in late patient tracing and referral of suspected TB cases. Good number of volunteers (around 40) was found to be involved in direct observation of treatment and health education. More than three fourth volunteers are making contribution at least in one activity among four major activities (Late patient tracing, referral of suspected TB cases, direct observation of treatment and health education). Good perception about disease severity, TB programme, information availability and social consequence were making 2.6 times more contribution in TB control and prevention. Overall knowledge on TB ( cause, symptoms, mode of transmission, methods of diagnosis, treatment) has no significant relationship with any of the volunteers' activities. Level of expenditure had significant association with late patient tracing by volunteers. Nearly half of the volunteers were performing on an average. There was no significant association between type of DOTS clinic and volunteers overall performance. Though there were different selection criteria of the volunteers in Urban Health Clinic, private clinic and NGO DOTS clinics, performance was almost similar in all type of DOTS clinics. Variation in the acceptability of volunteers by DOTS clinic in different activities was observed. In some health facilities volunteers were not accepted for direct observation of the treatment thinking that volunteers were not competent enough to perform the task. The volunteers didn't maintain a direct relationship and communication with the patient and other sectors of community. Lack of incentives (monetary, motivation), social recognition, supervision from District Public Health Office and Metropolitan city, lack of records of volunteers' activities were major hindering factors. The findings of the study suggest for selection of the volunteers covering all sphere of society culturally and geographically regardless of gender bias. Periodical training focusing on perception about disease severity, information availability, social consequence and TB programme, provision for incentives, documentation of volunteers' activities, more health education activities in community through volunteers, effective communication between health system and volunteers are required for effective volunteers' mobilization to foster urban TB control programme.
Eng.
Volunteers' contribution.
Tuberculosis.
Programme.
Kathmandu.
Nepal.
THS-00148
Volunteer's contribution to urban tuberculosis control programme in Kathmandu, Nepal. - c2006. - vii, 62p. :
Thesis Report.
SUMMARY: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Transmission of the tuberculosis occurs by airborne spread of infectious droplets from one person to another. Tuberculosis continues to remain one of the most serious health and developmental problems over the world. The problem is especially severe in Asia, which carries two-thirds of the global burden. Tuberculosis is a major public health challenge in Nepal. About 45% of the total population is infected with TB. Every year 40,000 people develop active TB, of whom 20,000 have infectious pulmonary disease. Introduction of treatment by Directly Observed Treatment Short course (DOTS) has already reduced the numbers of deaths; however 5,000-7,000 people continue to die every year from this disease. To strengthen DOTS in urban area National Tuberculosis Programme has started volunteers' mobilization jointly with municapalities and DPHO. The objective of the study was to identify the contributions of volunteers' in TB control, to identify the factors that facilitates or hinders in making such contribution and to assess the acceptability of the volunteers to service providers and users. This is a cross- sectional study conduced in the urban DOTS clinic of Kathmandu district, under the National Tuberculosis Control Programme (NTP). Altogether 184 TB volunteers, four DOTS clinic incharge and four patients from DOTS clinic were interviewed. Pre-tested semi-structured interview questionnaire for volunteers and in-depth interview guideline for DOTS clinic incharge and patients were administered for required information. Data entry and analysis was done using SPSS 11 for Windows. Content analysis was done for qualitative information. Categorical data were compared by Chi-square, logistic regression analysis was performed to obtain odds ratios for covariates with 95% confidence intervals. Around half of the volunteers were involved in late patient tracing and referral of suspected TB cases. Good number of volunteers (around 40) was found to be involved in direct observation of treatment and health education. More than three fourth volunteers are making contribution at least in one activity among four major activities (Late patient tracing, referral of suspected TB cases, direct observation of treatment and health education). Good perception about disease severity, TB programme, information availability and social consequence were making 2.6 times more contribution in TB control and prevention. Overall knowledge on TB ( cause, symptoms, mode of transmission, methods of diagnosis, treatment) has no significant relationship with any of the volunteers' activities. Level of expenditure had significant association with late patient tracing by volunteers. Nearly half of the volunteers were performing on an average. There was no significant association between type of DOTS clinic and volunteers overall performance. Though there were different selection criteria of the volunteers in Urban Health Clinic, private clinic and NGO DOTS clinics, performance was almost similar in all type of DOTS clinics. Variation in the acceptability of volunteers by DOTS clinic in different activities was observed. In some health facilities volunteers were not accepted for direct observation of the treatment thinking that volunteers were not competent enough to perform the task. The volunteers didn't maintain a direct relationship and communication with the patient and other sectors of community. Lack of incentives (monetary, motivation), social recognition, supervision from District Public Health Office and Metropolitan city, lack of records of volunteers' activities were major hindering factors. The findings of the study suggest for selection of the volunteers covering all sphere of society culturally and geographically regardless of gender bias. Periodical training focusing on perception about disease severity, information availability, social consequence and TB programme, provision for incentives, documentation of volunteers' activities, more health education activities in community through volunteers, effective communication between health system and volunteers are required for effective volunteers' mobilization to foster urban TB control programme.
Eng.
Volunteers' contribution.
Tuberculosis.
Programme.
Kathmandu.
Nepal.
THS-00148