Tuberculosis patient care decentralised to district clinics with community-based directly observed treatment in a rural district of South Africa.
METHODS
A rural district of the Northern Province, South Africa.


OBJECTIVE
To measure the effect of decentralisation of a tuberculosis service in a rural area on treatment outcomes.


METHODS
An intervention study that measured treatment outcomes of patients attending district clinics for tuberculosis treatment and compared these with outcomes of patients attending the district hospital.


RESULTS
Over the 4-year period 1992-1995, 928 patients were admitted to the tuberculosis unit of the district hospital. In the initial pre-intervention phase, the best estimate of completed treatment for all 503 cases was 61%, and for 206 new smear-positive patients it was 67%. The intervention process established a tuberculosis control programme with directly observed treatment for all patients, and training and supervision of clinic staff. Ninety per cent of all patients had community-based supporters. For most patients, cure was not proven, but assuming success from completion of and proven adherence to treatment, successful outcomes for new smear-positive cases rose to 82% for decentralised (clinic) treatment, and 88% for those patients who lived in the district but attended the hospital for treatment.


CONCLUSIONS
These findings suggest that district clinics can achieve the same good results as the hospital. It is recommended that tuberculosis control needs a dedicated co-ordinator at district level to manage the necessary infrastructural and staff resources.
Edginton
M E
ME
Department of Community Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa. 081mee@chiron.wits.ac.za
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000517:prevention & control
D000995:Antitubercular Agents