Case study of south africa
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For the past decade, a concerted effort to reform TB control in South Africa has resulted in changes in case-finding and treatment policies, standardization of recording and reporting systems, and monitoring of the performance of control programmes using pre-defined indicators; these changes were all made in line with the internationally recommended DOTS strategy. The essential elements of the revised strategy,1 implemented in 1996 after TB was declared a national emergency, include bacteriological confirmation of disease, standardized first-line treatment regimens that are exclusively based on fixed-dose combination formulations and an electronic recording and reporting system. Expansion of the DOTS strategy followed rapidly: in 2003 there was complete coverage in all nine provinces, covering 183 health districts. Comprehensive programmatic management of patients with MDR-TB became national policy in 2000 and was implemented through a network of dedicated provincial MDR-TB referral centres.
Despite these efforts, however, TB incidence and case–fatality rates have increased threefold in South Africa over the ensuing decade.2 More than 400 000 cases of TB require treatment annually, but cure rates barely reach 50%,2 reflecting the classic mistake made in TB control of identifying cases but not treating them adequately. TB mortality is at an all-time high. There are some 10 000 incident cases of MDR-TB per year,3 representing the largest MDR-TB burden in Africa and further pointing towards a failure of TB control. Although a favourable outcome (cure and treatment completed) is achieved in more than 80% of MDR-TB patients who complete the full course of standardized treatment, deaths (up to 20% of patients who started treatment), defaulting from treatment (up to 25% of patients) and failure of treatment (around 10%) reduce the overall effectiveness of the programme to less than 50% (South African Medical Research Council, unpublished data, 2002–2004). Worryingly, patients with XDR-TB have been identified in each of the nine provinces over the past 18 months.
Determinants of the worsening TB epidemic in South Africa are diverse and multifactorial. Historically, there has been a legacy of neglect, poor management of patients and fragmented health services.4Contemporary barriers to effective TB control in South Africa are similar to those elsewhere in Africa, and include an exploding HIV epidemic, deteriorating socioeconomic conditions among already vulnerable populations and constraints on human resources in the health-service sector. Although TB control has been fully integrated into primary health-care services and decentralized to district level, delivery is hampered by competing health priorities, slow district reform and deficient management capacity, especially at the level of implementation. Unemployment rates of up to 40%, as well as the resultant migration and massive growth in informal urban settlements, lead to failures in supervision of treatment and follow-up. Reasons for defaulting from TB and MDR-TB treatment include patients’ perceptions of negative attitudes among health-care workers, substance abuse and employment concerns.5,6
However, it is the lost opportunity for early, effective HIV intervention in South
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Despite these efforts, however, TB incidence and case–fatality rates have increased threefold in South Africa over the ensuing decade.2 More than 400 000 cases of TB require treatment annually, but cure rates barely reach 50%,2 reflecting the classic mistake made in TB control of identifying cases but not treating them adequately. TB mortality is at an all-time high. There are some 10 000 incident cases of MDR-TB per year,3 representing the largest MDR-TB burden in Africa and further pointing towards a failure of TB control. Although a favourable outcome (cure and treatment completed) is achieved in more than 80% of MDR-TB patients who complete the full course of standardized treatment, deaths (up to 20% of patients who started treatment), defaulting from treatment (up to 25% of patients) and failure of treatment (around 10%) reduce the overall effectiveness of the programme to less than 50% (South African Medical Research Council, unpublished data, 2002–2004). Worryingly, patients with XDR-TB have been identified in each of the nine provinces over the past 18 months.
Determinants of the worsening TB epidemic in South Africa are diverse and multifactorial. Historically, there has been a legacy of neglect, poor management of patients and fragmented health services.4Contemporary barriers to effective TB control in South Africa are similar to those elsewhere in Africa, and include an exploding HIV epidemic, deteriorating socioeconomic conditions among already vulnerable populations and constraints on human resources in the health-service sector. Although TB control has been fully integrated into primary health-care services and decentralized to district level, delivery is hampered by competing health priorities, slow district reform and deficient management capacity, especially at the level of implementation. Unemployment rates of up to 40%, as well as the resultant migration and massive growth in informal urban settlements, lead to failures in supervision of treatment and follow-up. Reasons for defaulting from TB and MDR-TB treatment include patients’ perceptions of negative attitudes among health-care workers, substance abuse and employment concerns.5,6
However, it is the lost opportunity for early, effective HIV intervention in South
pls mark me brainliest
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