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061-PA12 Knowledge, attitudes and practices of lay people about tuberculosis in Cali, Colombia
106
Tubercle and Lung Disease: Supplement 2
widespread stigma associated to TB. Removing these wrong beliefs about TB and negative attitudes toward patients could be a useful intervention to improving the TB Control Program performance.
061-PA12 Knowledge, attitudes and practices of lay people about tuberculosis in Cali, Colombia Jaramillo E.B. Colombian League Against Tuberculosis, Cali, Colombia
Tuberculosis (TB) is the largest cause of death from a single infectious agent in the world. Several factors explain the persistence of TB burden: lack of integration into the primary health care strategy, minimal use of short course chemotherapy, insufficient diagnostic coverage and treatment uncompliance, for instance. Some researchers have emphasized the importance of local beliefs and social stigma associated as an obstacle to the accomplishment of the community role required in order to control TB. A qualitative research about lay beliefs on TB, aimed to design an educational intervention was carried out in Cali. Techniques used consisted of direct observation, key informants interviews, in-depth and informal interviews with patients and health care workers, and focus groups. All observations were uncovered. Inquiry ended when new supplementary information was not observed or obtained. Most of the subjects obtained information from their parents and from people who suffered or had a relative suffering TB. The younger the subjects the more naive they were about TB, and the elder they were the more mythical beliefs were found. Weight loss, fever, cough and haemoptysis were considered the typical symptoms. Cough alone did not raise suspicion of TB. The TB patient inspired a fear attributable to the infection risk: lost of employment after diagnosis and even divorce was common. Cough was considered a mechanism of transmission, but covering the mouth when coughing was not a common practice. Patient isolation during the treatment (avoidance of sex relations, kisses, sharing of meals and dishes, etc.) was the commonest approach to deal with the infection risk. Conventional treatment of formal medicine was considered the best one. The TB patient isolation, ignorance about mechanisms of TB infection and about cough as earlier symptom is common in lay people in Cali. Abolishment of stigma associated to TB could help to improve patient's quality of life. Raising awareness about TB as an airborne disease and cough as an earlier symptom could help to improve diagnostic coverage and impact of the TB Control Program.
086-PA12 A trial on reduction of TB case finding delay in the pilot area in Solomon Islands lmamura, E. (JICA Expert to Solomon Islands), Konare, K. (TB Unit, Ministry of Health, SI), Ishikawa, N. (Res. Inst. TB Japan, Tokyo, Japan)
To reduce TB case finding delay (case and facility
delays), we made the analysis from March 1992 to December 1994 by establishing an intensified pilot area at the northern half of Malaita Island where are nine clinics and one referral hospital. The case delay was significantly reduced from 57 days of 100 cases in 1993 to 40.8 days of 75 cases in 1994. The facility delay was further reduced from 99 days to 8.6 days in the same period. The dramatic reduction of the facility delay was achieved by (1) Systematization of case finding processes by introducing Chronic Cough Registry in the clinics. (2) Facilitation of the communication between the clinics and the hospital with a Request Mycobacterial Examination Form. (3) Provision of regular guidance and supervision to the medical staff to rouse their incentive. Meanwhile, the case delay was attenuated by holding popular TB education meetings in communities.
087-PA12 The role of a Japanese public health nurse in TB control activities of JICA/PHC project in Solomon Islands lmamura, E., Hara, M. (JICA Experts, Honiara, Solomon Islands), Ishikawa, N. (Res. Inst. TB Japan, Tokyo, Japan)
For a successful and sustainable health program, it is a prerequisite to have a complete integration of good administrative management and participating community through PHC activities. Here, a public health nurse should take an active role to communicate both sides. With this aim, Japan International Cooperation Agency has dispatched us as technical advisors for the TB control project in SI. So far, we have carried out administrative analysis, delay analysis, and development of health education material and teaching manuals for nurses with our counterparts. In addition, following our long successful experience in Japan, we have not only introduced the technical know-how of chemotherapy, community involvement and improvement of administrative management (systematization, recording and reporting system and communication between national and peripheral levels), but also motivated PHC nurses enthusiasm for patient care.
154-PA12 Following patients on antituberculous drugs: nurse's call versus physician visit Schraufnagel, D.E. Dept Medicine, Univ Illinois, Chicago, USA
Beginning in June 1993, all employees at the University of Illinois Medical Center were skin-tested for tuberculosis. Those with criteria for preventive therapy were referred to a physician in a medicine clinic and then randomized to 1) be followed in the usual manner by the physician with monthly visits or 2) to choose between monthly phone calls by a nurse or the usual physician visits. Compliance optimizers were used. Outcomes included defaulting, clinic appointments kept, pills taken,
Tubercle and Lung Disease: Supplement 2
widespread stigma associated to TB. Removing these wrong beliefs about TB and negative attitudes toward patients could be a useful intervention to improving the TB Control Program performance.
061-PA12 Knowledge, attitudes and practices of lay people about tuberculosis in Cali, Colombia Jaramillo E.B. Colombian League Against Tuberculosis, Cali, Colombia
Tuberculosis (TB) is the largest cause of death from a single infectious agent in the world. Several factors explain the persistence of TB burden: lack of integration into the primary health care strategy, minimal use of short course chemotherapy, insufficient diagnostic coverage and treatment uncompliance, for instance. Some researchers have emphasized the importance of local beliefs and social stigma associated as an obstacle to the accomplishment of the community role required in order to control TB. A qualitative research about lay beliefs on TB, aimed to design an educational intervention was carried out in Cali. Techniques used consisted of direct observation, key informants interviews, in-depth and informal interviews with patients and health care workers, and focus groups. All observations were uncovered. Inquiry ended when new supplementary information was not observed or obtained. Most of the subjects obtained information from their parents and from people who suffered or had a relative suffering TB. The younger the subjects the more naive they were about TB, and the elder they were the more mythical beliefs were found. Weight loss, fever, cough and haemoptysis were considered the typical symptoms. Cough alone did not raise suspicion of TB. The TB patient inspired a fear attributable to the infection risk: lost of employment after diagnosis and even divorce was common. Cough was considered a mechanism of transmission, but covering the mouth when coughing was not a common practice. Patient isolation during the treatment (avoidance of sex relations, kisses, sharing of meals and dishes, etc.) was the commonest approach to deal with the infection risk. Conventional treatment of formal medicine was considered the best one. The TB patient isolation, ignorance about mechanisms of TB infection and about cough as earlier symptom is common in lay people in Cali. Abolishment of stigma associated to TB could help to improve patient's quality of life. Raising awareness about TB as an airborne disease and cough as an earlier symptom could help to improve diagnostic coverage and impact of the TB Control Program.
086-PA12 A trial on reduction of TB case finding delay in the pilot area in Solomon Islands lmamura, E. (JICA Expert to Solomon Islands), Konare, K. (TB Unit, Ministry of Health, SI), Ishikawa, N. (Res. Inst. TB Japan, Tokyo, Japan)
To reduce TB case finding delay (case and facility
delays), we made the analysis from March 1992 to December 1994 by establishing an intensified pilot area at the northern half of Malaita Island where are nine clinics and one referral hospital. The case delay was significantly reduced from 57 days of 100 cases in 1993 to 40.8 days of 75 cases in 1994. The facility delay was further reduced from 99 days to 8.6 days in the same period. The dramatic reduction of the facility delay was achieved by (1) Systematization of case finding processes by introducing Chronic Cough Registry in the clinics. (2) Facilitation of the communication between the clinics and the hospital with a Request Mycobacterial Examination Form. (3) Provision of regular guidance and supervision to the medical staff to rouse their incentive. Meanwhile, the case delay was attenuated by holding popular TB education meetings in communities.
087-PA12 The role of a Japanese public health nurse in TB control activities of JICA/PHC project in Solomon Islands lmamura, E., Hara, M. (JICA Experts, Honiara, Solomon Islands), Ishikawa, N. (Res. Inst. TB Japan, Tokyo, Japan)
For a successful and sustainable health program, it is a prerequisite to have a complete integration of good administrative management and participating community through PHC activities. Here, a public health nurse should take an active role to communicate both sides. With this aim, Japan International Cooperation Agency has dispatched us as technical advisors for the TB control project in SI. So far, we have carried out administrative analysis, delay analysis, and development of health education material and teaching manuals for nurses with our counterparts. In addition, following our long successful experience in Japan, we have not only introduced the technical know-how of chemotherapy, community involvement and improvement of administrative management (systematization, recording and reporting system and communication between national and peripheral levels), but also motivated PHC nurses enthusiasm for patient care.
154-PA12 Following patients on antituberculous drugs: nurse's call versus physician visit Schraufnagel, D.E. Dept Medicine, Univ Illinois, Chicago, USA
Beginning in June 1993, all employees at the University of Illinois Medical Center were skin-tested for tuberculosis. Those with criteria for preventive therapy were referred to a physician in a medicine clinic and then randomized to 1) be followed in the usual manner by the physician with monthly visits or 2) to choose between monthly phone calls by a nurse or the usual physician visits. Compliance optimizers were used. Outcomes included defaulting, clinic appointments kept, pills taken,