An evaluative study on DOTS implementation, as an effective strategy for TB treatment and control, in Kabompo District
Nyambanza, LLoyd Kankinda
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A low cure percentage rate of the sputum positive patients a® not in the making of one person or a few people but involve many aspects of individuals concerned and the factors in their working environment, both internal and external ones. The case of Kabompo District cannot be pin pointed as a separate entity, like what is happening elsewhere, can be an example among many other places that may be facing similar situations in the face of new conceptions of TB, once regarded as a vertical programme, now an integrated health care programme whose particular importance as a public health threat, diminishes as the distance from the central control office increases, with diminishing interests and priority settings among workers and their managements. The study report for Kabompo District brings to light a few of the many problems facing the TB programmes and in particular the DOTS implementation. The report is a sum of the facts found to be causing the low output in the cure rate of the TB patients. The factors range from the recruitment of officers who are given responsibilities to shoulder as contact persons, their dealings with patients, the among of time spent on their tasks, the coordination of tasks and responsibilities, the relations with fellow workers and the management and the codification, storage and interpretation of data. What has come out shows clearly that not much was put in to seek better than what the current results show. The focal persons were hurried in their uptake of tasks. They were further loaded with many other tasks so that there was little time used to take complete control over the programme's management; worse still not supported psychological to fit in, on the new responsibility. The management has its share of lapses too. Like a hen that lays an egg and lets it to hatch itself, the focal persons have been regarded as all knowing and let to function in their own ways, without support and motivation and only to desire of them good results later. Fellow workers and the community assets, which includes collaborating partners have not been mobilised and made use to any advantage of the TB programmes. Fellow workers are either not made use of or only when demand exists. So that all have become too complacent to show and advise when things were not well, because to them the main actor was there. The public and government workers in the District do not even know how and when they can be useful to the TB programmes apart from being called to attend TB health day celebrations. The problem of sputum examination at the end of 8 months resulting in some patients being labled as having completed treatment and others to have been cured raises a question about the validity of the terms used and the interest of the originators of the analytical tools. Many patients are no longer able to produce sputum at the end of their treatment because sputum production would have been curtailed before the end of the therapy itself. The fact that they do not give their last sputum for examinations, even after successfully completing treatment, even when visibly cured, are termed as having completed treatment and not cured.These and many more, have come out and would need critical thinking towards positive solutions, in order that there will be a change of air on how the cure rate can be raised and the concept of what should be an acceptable definition of a cure, and a subsequent cure rate.
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