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Mobilization of Cured Patients to Improve TB Control Programme in Sarlahi District of Nepal

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Mobilization of Cured Patients to Improve TB Control Programme in Sarlahi District of Nepal Mobilization of cured patients to improve TB control programme in Sarlahi district of Nepal By: Raj Nandan Mandal (Master of Public Health) Principal Investigator Submitted to : Nepal Health Research Council (NHRC) Ramshah Path, P.O. Box: 7626 Kathmandu, Nepal 2007 TABLE OF CONTENTS Acknowledgement ……………………………………………………………… i Executive Summary……………………………………………………………… ii List of Tables ………………………………………………………………….... iii List of Figures ………………………………………………………………….. iv Abbreviations …………………………………………………………………… v CHAPTER I: INTRODUCTION 1.1 Background of the study ……………………………………………………. 1 1.2 Statement of the problem ………………………………………………… . 2 1.3 Rationale/Justification……………………………………………………… 3 1.4 Research Questions………………………………………………………… 4 CHAPTER II: LITERATURE REVIEW………………………………………. 5 CHAPTER III: METHODOLOGY 3.1 Objective of the study………………………………………………………. 8 3.2 Research hypotheses………………………………………………………... 8 3.3 Research design and methodology…………………………………………… 8 3.4 Study variables ……………………………………………………………… 9 3.5 Conceptual framework…………………………... …………………………. 11 3.6 Selection of cured patients…………………………………………………… 12 3.7 Study site & its justification………………………………………………… 12 3.8 Target Population…………………………………………………………… 12 3.9 sampling Method & Sample Size…………………………………………… 12 3.10 Tools & techniques for data collection…………………………………….. 13 3.11 Validity and Reliability of research………………………………………… 14 3.12 Limitation of the study…………………………………………………….. 14 CHAPTER IV: FINDINGS AND ANALYSES………………………………… 15 CHAPTER V: DISCUSSIONCONCLUSIONS AND RECOMMENDATIONS 35 REFERENCES…………………………………………………………………… 39 ANNEXES ACKNOWLEDGEMENT I am extremely grateful to all those who have encouraged and supported me to make this thesis become a reality. First of all I would like to thank NHRC for providing me research grant. Special thanks to Dr. Rajendra Kumar B.C. (Chief Research Officer, NHRC), Mr. Nirbhay Kumar Sharma (Administrative Officer, NHRC), Mr. Subodh Kumar Karn (Account Officer, NHRC), Mr Chandra Bhushan Yaday (Library Incharge, NHRC) and all other staffs of NHRC for their inspiration, cooperation, guidance and support along the way of beginning to end. At the DPHO Sarlahi, I would like to express my gratitude to Mr. Raj Kishor Pandit-PHA, Md. N.A. Mikrani –DTLA, Mr. Pramod Pandit- A.H.W., Mr. Nageswor Prasad Jaiswal- Public Health Inspector and Rajbir Yadav DTLA for their assistance and support during the period of study. I would like to thank all data collectors and supervisors for their hard workings and continuous support to me. I will never forget the respondents who respond me to give answer to questions, without thei willingness to answer on questions, this study would not have been accomplished. And finally, my appreciation to the cured patients who have helped to make people aware and work hard during six months of intervention period. Raj nandan Mandal Principal Investigator I EXECUTIVE SUMMARY The objectives of this study was to find the effect on CFR, CR, SCR and DR after the mobilization of cured patients and it was conducted in randomly selected Sarlahi district of Central region Nepal. Twelve DOTS centers/Sub centers were randomly selected for intervention and other twelve DOTS centers/Sub centers were selected for control sites. Ten household of the each DOTS center were interviewed to know the knowledge on TB and DOTS and their perception disease. Data was collected using interviews, FGDs, In-depth interviews as well as reviewing the records from the DOTS Centers. Data Collection took place from in Oct. 2006 and in Apr. 2007. Mobilization of the cured patients was effective in increasing CFR, CR and SCR and in decreasing DR in comparison with control sites. Most of the respondents were illiterate (40.4 %) and 34.2 % were involved in agriculture. On average they had 8 family members and immunized children were 88.8 %. Ninety three percent of the respondents had heard TB and nearly 2/3rd of them knew it`s symptoms. Fifty nine percent were known to cause and hundred percent of them were known to main mode of transmission. Nearly 3/4 th of them (72.3 %) thought TB is curable and 92 % thought appropriate place for treatment was government health institutions. Seventy two percent knew it’s preventive measures. Thirty eight percent of them got information from neighbors and 85 % knew that TB is communicable disease. More than half of the respondents (58 %) had heard DOTS and all knew that DOTS can completely cure disease. Almost all cases had been diagnosed by Sputum test and X-ray and most of them were diagnosed in private clinics. Nearly 39 percent knew the treatment course schedule and almost all (97.3 %) knew that medicines were available free of cost in government health institutions. II Similar findings were got from Focus Group Discussions and almost similar results from In-depth interviews. From In-depth interviews they were found very much eager to help to improve TB control program in the rural community and they were found well known to DOTS. III LIST OF TABLES Table.1: CFR, CR, SCR and DR of 12 intervention sites before and after intervention..16 Table.2: Difference of Mean, Standard Deviation and `t` value of CFR, CR, SCR and DR of intervention sites…………………………………………………………… 16 Table.3: CFR, CR, SCR and DR of 12 non-intervention sites without intervention….. 17 Table.4: Difference of Mean, Standard Deviation and `t` value of CFR, CR, SCR and DR of non-intervention sites without intervention……………………………….. 17 Table.5: Socio-demographic characteristics of the respondents……………………… 18 Table.6: Tuberculosis related informations…………………………………………… 20 Table.7: DOTS related informations………………………………………………… 22 IV LIST OF FIGURES Figure.1: Respondents distribution by their known to TB…………………………..23 Figure.2: Respondents distribution by their knowledge on causes of TB………….. 24 Figure.3: Distribution of respondents by their knowledge on curability of TB……..24 Figure.4: Distribution of respondents by their knowledge on treatment course……. 25 Figure.5: Distribution of respondents by their knowledge on DOTS………………. 25 Figure.6: Distribution of respondents by their knowledge on treatment outcomes… 26 Figure.7: Distribution of respondents by their knowledge on problems having TB... 26 Figure.8: Association between literacy status and knowledge on cause of TB…….. 27 Figure.9: Association between literacy status and known to TB…………………… 27 Figure.10: Association between literacy status and DOTS knowledge…………….. 28 V ABBREVIATIONS AIDS Acquired Immuno Deficiency Syndrome CBS Central Bureau of Statistics CFR Case Finding Rate CR Cure Rate DOTS Directly Observed Treatment Short Course DR Defaulter Rate FCHVs Female Community Health Volunteers HIV Human Immunodefiency Virus PHC Primary health Care Center SCR Sputum conversion Rate TB Tuberculosis TOT Training of Trainers VDC Village Development Committee WHO World Health organization VII ACKNOWLEDGEMENT I am extremely grateful to all those who have encouraged and supported me to make this thesis become a reality. First of all I would like to thank NHRC for providing me research grant. Special thanks to Dr. Rajendra Kumar B.C. (Chief Research Officer, NHRC), Mr. Nirbhay Kumar Sharma (Administrative Officer, NHRC), Mr. Subodh Kumar Karn (Account Officer, NHRC), Mr Chandra Bhushan Yaday (Library Incharge, NHRC) and all other staffs of NHRC for their inspiration, cooperation, guidance and support along the way of beginning to end. At the DPHO Sarlahi, I would like to express my gratitude to Mr. Raj Kishor Pandit-PHA, Md. N.A. Mikrani –DTLA, Mr. Pramod Pandit- A.H.W., Mr. Nageswor Prasad Jaiswal- Public Health Inspector and Rajbir Yadav DTLA for their assistance and support during the period of study. I would like to thank all data collectors and supervisors for their hard workings and continuous support to me. I will never forget the respondents who respond me to give answer to questions, without thei willingness to answer on questions, this study would not have been accomplished. And finally, my appreciation to the cured patients who have helped to make people aware and work hard during six months of intervention period. Raj nandan Mandal Principal Investigator i EXECUTIVE SUMMARY The objectives of this study was to find the effect on CFR, CR, SCR and DR after the mobilization of cured patients and it was conducted in randomly selected Sarlahi district of Central region Nepal. Twelve DOTS centers/Sub centers were randomly selected for intervention and other twelve DOTS centers/Sub centers were selected for control sites. Ten household of the each DOTS center were interviewed to know the knowledge on TB and DOTS and their perception disease. Data was collected using interviews, FGDs, In-depth interviews as well as reviewing the records from the DOTS Centers. Data Collection took place from in Oct. 2006 and in Apr. 2007. Mobilization of the cured patients was effective in increasing CFR, CR and SCR and in decreasing DR in comparison with control sites. Most of the respondents were illiterate (40.4 %) and 34.2 % were involved in agriculture. On average they had 8 family members and immunized children were 88.8 %. Ninety three percent of the respondents had heard TB and nearly 2/3rd of them knew it`s symptoms. Fifty nine percent were known to cause and hundred percent of them were known to main mode of transmission. Nearly 3/4 th of them (72.3 %) thought TB is curable and 92 % thought appropriate place for treatment was government health institutions. Seventy two percent knew it’s preventive measures. Thirty eight
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