'Kuyendela odwala TB'--visiting TB patients: the widening role of home-based care organisations in the management of tuberculosis patients in Lusaka, Zambia.
OBJECTIVE
To explore the widening role of home-based care (HBC) organisations in the management of TB patients in Lusaka, Zambia, in 1999.


METHODS
In a purposeful sample of eight HBC organisations and 1 hospice in Lusaka, 142 TB patients under HBC, 54 care givers, 42 TB patients not under HBC and 9 managers were interviewed.


RESULTS
At least 50% of TB patients in Lusaka are cared for by HBC. The role of HBC in management of TB patients included food aid, practical and emotional support through the visits of voluntary care givers and, often, medical advice and treatment. TB diagnosis is carried out within the government health facilities. Five HBC organisations supplied anti-tuberculosis drugs, and three tried to carry out direct observation of treatment. The majority of the TB patients said their situation improved under HBC. Management was undermined by poor record keeping, sporadic anti-tuberculosis drug supplies, stigmatising preventive messages, limited supervision of care givers and poor coordination with the District Health Services.


CONCLUSIONS
HBC organisations have become a key partner in TB control, looking after half the TB patients in Lusaka from diagnosis onwards, and complementing the public system. However, the quality of their management of TB and their partnership with government need to improve.
Bond
V A
VA
ZAMBART Project, School of Medicine, University of Zambia, Lusaka, Zambia. gbond@zamsaf.co.zm
Tihon
V
V
Muchimba
M
M
Godfrey-Faussett
P
P
D000328:Adult; D000995:Antitubercular Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000193:education / Q000458:organization & administration; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D011364:Professional Practice / Q000592:standards; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000191:economics / Q000628:therapy*; D015024:Zambia
D000995:Antitubercular Agents