Health information and its influence on the perception of tuberculosis (TB) patients: Current policies and practices at Brooklyn Chest Hospital

Abstract

HIV and TB are major problems in the South African context and the burden of these diseases is proving detrimental to the development of the country. These diseases have been evident in the country for many years and in recent times the infection rates of TB and HIV has been alarming. The World Health Organization (WHO) classified TB as a problem and the world was to actively implement strategies to combat this epidemic. The issue with TB control strategies is the emergence of HIV which has been the largest contributing factor to the increase in the TB burden in South Africa and many countries like it. South Africa has made great strides in the control of HIV in areas such as mother to child transmission, awareness programs, initiation of ARVs and medical male circumcision which have proven to be successful. In contrast, the TB burden does not share the same fate. The number of deaths caused by TB is continuously rising, as well as the number of new Multi-drug resistant TB cases. Furthermore the emergence of Extreme –drug resistant TB is seen as a sign of a failing health system. Policy makers are now faced with fact that the Directly Observed Therapy Short course (DOTS) program for the prevention of TB is inadequate in an area with a high HIV prevalence, which is what South Africa is faced with. The research objectives are therefore to identify if knowledge from South African TB policies are being disseminated to people who suffer from TB, also to measure if a lack of knowledge may have an impact on treatment success. A policy analysis was done of 5 South African TB policies to identify areas of the policies which are patient specific. The TB policies emphasized a patient-centred approach and the researcher used this concept to motivate that patient-specific areas must be known by the patients. The specific areas identified were: TB specific areas, Treatment specific areas, Adherence specific areas and information/education specific areas. Based on the policy analysis a case study was conducted at Brooklyn Chest Hospital to measure implementation of the policies on the ground. The study found that education was adequate in areas around TB diagnosis, treatment length, signs and symptoms, and family education. The participants lacked knowledge in areas such as TB contacts, monitoring of TB disease, education of TB prior to diagnosis and a high prevalence of non-adherence and multiple cases of TB were found among the participants. Also, the Chi-Square test found no statistical significance between the length of admission to hospital and treatment outcome. The result also shows that of the participants studied, over 30% of the study had not adhered to TB treatment after discharge. The study finds that there are significant shortfalls in the knowledge of participants based on South African TB policies, with a high non-adherence rate before and after discharge. The study shows a lack in the implementation of policy directives on education, following a patient-centred approach, which is evident in the lack of knowledge found in the participants in many facets of the TB disease and the processes to control TB.