1. 11
COMMUNITY CONTRIBUTIONSCOMMUNITY CONTRIBUTIONS
IN TB CONTROL.IN TB CONTROL.
BY CHUNGU M. CHAMA.BY CHUNGU M. CHAMA.
MIH- THESIS –RESEARCH INMIH- THESIS –RESEARCH IN
CHINGOLA DISTRICT - ZAMBIA.CHINGOLA DISTRICT - ZAMBIA.

2. 22
BACKGROUND PROBLEMBACKGROUND PROBLEM
STATEMENTSTATEMENT
BURDEN OF TUBERCULOSIS IS HIGH WITH THEBURDEN OF TUBERCULOSIS IS HIGH WITH THE
PROPORTION OF NEW, REGISTERED TB CASESPROPORTION OF NEW, REGISTERED TB CASES
PER 100,000 POPULATION ARE;PER 100,000 POPULATION ARE;
 ZAMBIA 580/100,000 (’CDC,JICA-2004)ZAMBIA 580/100,000 (’CDC,JICA-2004)
 COPPERBELT PROVINCE; 312/100,000 (HMISCOPPERBELT PROVINCE; 312/100,000 (HMIS
2005).2005).
 CHINGOLA DISTRICT REGISTEREDCHINGOLA DISTRICT REGISTERED
166/100,000 NEW CASES (HMIS 2005)166/100,000 NEW CASES (HMIS 2005)
13% OF ADULT HOSPITAL DEATHS IN ZAMBIA13% OF ADULT HOSPITAL DEATHS IN ZAMBIA
ARE DUE TO TB.ARE DUE TO TB.

3. 33
RISK FACTORSRISK FACTORS
 POVERTY.POVERTY.
 HIV/AIDS EPIDEMIC.HIV/AIDS EPIDEMIC.
 MALNUTRITIONMALNUTRITION
 IMMUNOSUPPRESANT TREATMENT.IMMUNOSUPPRESANT TREATMENT.
 DIABETES MELLITUS.DIABETES MELLITUS.
 MALIGNANCIES.MALIGNANCIES.
 CYTOTOXIC TREATMENTCYTOTOXIC TREATMENT

4. 44
TB AND HIV IN ZAMBIATB AND HIV IN ZAMBIA
 70% TB CASES ARE HIV POSITIVE IN70% TB CASES ARE HIV POSITIVE IN
ZAMBIA (HIV/AIDS MANAGEMENTZAMBIA (HIV/AIDS MANAGEMENT
GUIDELINES 2004)GUIDELINES 2004)
 50% HIV CASES MANEFEST SYMPTOMS50% HIV CASES MANEFEST SYMPTOMS
OF TB (NATIONAL AIDS COUNCILOF TB (NATIONAL AIDS COUNCIL
GUIDELINES 2004)GUIDELINES 2004)
THEREFORE A DRIVE TO INTEGRATE TBTHEREFORE A DRIVE TO INTEGRATE TB
AND HIV PROGRAMMESAND HIV PROGRAMMES

5. 55
TB SUPPORTERS IN ZAMBIATB SUPPORTERS IN ZAMBIA
 COMMUNITY HEALTH WORKERSCOMMUNITY HEALTH WORKERS
INTRODUCED IN 1996 DUE TO HUMANINTRODUCED IN 1996 DUE TO HUMAN
RESOURCE CRISISRESOURCE CRISIS
 SPECIFIC TB SUPPORTERS INTRODUCEDSPECIFIC TB SUPPORTERS INTRODUCED
INTO CHINGOLA DISTRICT IN 2002INTO CHINGOLA DISTRICT IN 2002
 TASKS OF TB SUPPORTERS INCLUDE: CASETASKS OF TB SUPPORTERS INCLUDE: CASE
DETECTION, DEFAULTER TRACING, HEALTHDETECTION, DEFAULTER TRACING, HEALTH
EDUCATION, RECORDING OF CASES,EDUCATION, RECORDING OF CASES,
COLLECTING SPUTUM AND SUPERVISINGCOLLECTING SPUTUM AND SUPERVISING
ORAL MEDICATIONORAL MEDICATION

6. 66
FAMILY TREATMENTFAMILY TREATMENT
SUPPORTERSSUPPORTERS
 A RECENT MOVE FROM COMMUNITYA RECENT MOVE FROM COMMUNITY
VOLUNTEERS FOR SUPPORT TO TBVOLUNTEERS FOR SUPPORT TO TB
PATIENTS TO FAMILY HEALTHPATIENTS TO FAMILY HEALTH
PROVIDERS (GUARDIANS).PROVIDERS (GUARDIANS).
 MALAWI, KENYA, TANZANIA, SOUTHMALAWI, KENYA, TANZANIA, SOUTH
AFRICA AND INDIA (WANDALO E. et alAFRICA AND INDIA (WANDALO E. et al
2005.)2005.)
 LIMITED INFORMATION ON COMMUNITYLIMITED INFORMATION ON COMMUNITY
CONTRIBUTIONS IN ZAMBIA AVAILABLECONTRIBUTIONS IN ZAMBIA AVAILABLE

7. 77
RATIONALE FOR THE STUDY.RATIONALE FOR THE STUDY.
1.1. LIMITED INFORMATION AVAILABLE ONLIMITED INFORMATION AVAILABLE ON
COMMUNITY CONTRIBUTIONS IN ZAMBIACOMMUNITY CONTRIBUTIONS IN ZAMBIA
2.2. CONTRIBITUIONS TO TB SUPPORT CAN BECONTRIBITUIONS TO TB SUPPORT CAN BE
TAPPED FOR SUPPORTING HIV CLIENTS.TAPPED FOR SUPPORTING HIV CLIENTS.
3.3. EFFICACY OF TB SUPPORTERS/CHW HASEFFICACY OF TB SUPPORTERS/CHW HAS
NOT BEEN EVALUATED.NOT BEEN EVALUATED.

8. 88
OBJECTIVEOBJECTIVE
TO DETERMINE COMMUNITYTO DETERMINE COMMUNITY
CONTRIBUTIONS IN THE MANAGEMENT,CONTRIBUTIONS IN THE MANAGEMENT,
CARE AND CONTROL OFCARE AND CONTROL OF
TUBERCULOSIS IN CHINGOLA DISTRICTTUBERCULOSIS IN CHINGOLA DISTRICT
IN TERMS OF (MONEY, FOOD, TIME,IN TERMS OF (MONEY, FOOD, TIME,
TRANSPORT AND MATERIALS).TRANSPORT AND MATERIALS).

9. 99
SPECIFIC OBJECTIVESSPECIFIC OBJECTIVES
 TO IDENTIFY THE EXACT COMMUNITYTO IDENTIFY THE EXACT COMMUNITY
CONTRIBUTIONS TOWARDS DOTS.CONTRIBUTIONS TOWARDS DOTS.
 TO DESCRIBE THE POSITIVE ANDTO DESCRIBE THE POSITIVE AND
NEGATIVE COMMUNITYNEGATIVE COMMUNITY
CONTRIBUTIONS IN TB MANAGEMENT.CONTRIBUTIONS IN TB MANAGEMENT.

10. 1010
METHODOLOGYMETHODOLOGY
DATA COLLECTIONDATA COLLECTION
 A DESCRIPTIVE STUDY(CROSS-SECTIONAL) WASA DESCRIPTIVE STUDY(CROSS-SECTIONAL) WAS
CARRIED OUT IN CHINGOLA DISTRICT.CARRIED OUT IN CHINGOLA DISTRICT.
 CONVENIENCE SAMPLING TECHNIQUE WAS USED INCONVENIENCE SAMPLING TECHNIQUE WAS USED IN
FOUR TB DIAGNOSTIC CENTRES.FOUR TB DIAGNOSTIC CENTRES.
 A SAMPLE OF128 PARTICIPANTS INVOLVED.A SAMPLE OF128 PARTICIPANTS INVOLVED.
 QUALITATIVE- SEMI-STRUCTURED INTERVIEWSQUALITATIVE- SEMI-STRUCTURED INTERVIEWS
(N=128 ), FOCUS GROUP DISCUSSION(N=128 ), FOCUS GROUP DISCUSSION
 STRUCTURED QUESTIONNAIRE INTERVIEWSSTRUCTURED QUESTIONNAIRE INTERVIEWS
ANALYSISANALYSIS
 VARIABLES MEASURED: MONEY, FOOD, TIME,VARIABLES MEASURED: MONEY, FOOD, TIME,
TRANSPORT,MATERIALSTRANSPORT,MATERIALS
 EPI INFO USED FOR QUANTITIAVE ANALYSISEPI INFO USED FOR QUANTITIAVE ANALYSIS

11. 1111
RESULTSRESULTS
Overall percentages of all support given
to TB patients
36%
34%
17%
6%
1%
6% Money
Food
Time
Transport
Materials
None

12. 1212
TB PATIENTS BY AGE
0
5
10
15
20
25
30
35
<25 25-34 35-74
AGE IN YEARS

13. 1313
TB PATIENTS BY EDUCATIONTB PATIENTS BY EDUCATION
AND EMPLOYMENTAND EMPLOYMENT
0
5
10
15
20
25
30
<G
R
A
D
E
7
G
R
A
D
E
7
>G
R
A
D
E
7
U
N
E
M
P
LO
Y
E
D
BU
S
IN
E
S
S
O
TH
E
R

14. 1414
RESULTSRESULTS
 THE MAJORITY (94%) TB PATIENTS RECEIVEDTHE MAJORITY (94%) TB PATIENTS RECEIVED
SUPPORTSUPPORT
 MOST OF THE SUPPORT WAS PROVIDED BY THEMOST OF THE SUPPORT WAS PROVIDED BY THE
FAMILY MEMBERSFAMILY MEMBERS
 THERE WAS NO SIGNIFICANT DIFFERENCES INTHERE WAS NO SIGNIFICANT DIFFERENCES IN
CONTRIBUTION OF MONEY BY AGE, EDUCATIONCONTRIBUTION OF MONEY BY AGE, EDUCATION
LEVEL, SEX OR EMPLOYMENTLEVEL, SEX OR EMPLOYMENT
 HOWEVER, CONTRIBUTION OF FOOD BY SEX ANDHOWEVER, CONTRIBUTION OF FOOD BY SEX AND
EDUCATION SHOWED SIGNFICANT DIFFERENCESEDUCATION SHOWED SIGNFICANT DIFFERENCES
 AMOUNT OF TIME SPENT FOR DIFFERENT AGEAMOUNT OF TIME SPENT FOR DIFFERENT AGE
GROUPS WAS ALSO SIGNIFICANTGROUPS WAS ALSO SIGNIFICANT

15. 1515
SUPPORT RECEIVED BY TBSUPPORT RECEIVED BY TB
PATIENTS FROM OTHERPATIENTS FROM OTHER
PERSONS.PERSONS.
54%
14%
6%
6%
10%
3%
7% Family
Friends/peers
Neighbours
Church
CHW
Others
None

16. 1616
CONTRIBUTIONSCONTRIBUTIONS
11%
89%
CHW
OTHERS
93%
7%
SUPPORT
NO SUPPORT

17. 1717
LIMITATIONSLIMITATIONS
 TIME AND FINANCIAL CONSTRAINTS.TIME AND FINANCIAL CONSTRAINTS.
 PARTICIPANTS WERE NOT FOUND IN THEIRPARTICIPANTS WERE NOT FOUND IN THEIR
HOMES AS THEY WERE REPORTING ATHOMES AS THEY WERE REPORTING AT
HEALTH CENTRES FOR THEIR MEDICATIONS.HEALTH CENTRES FOR THEIR MEDICATIONS.
 IN THE RURAL AREAS PARTICIPANTS WEREIN THE RURAL AREAS PARTICIPANTS WERE
LIVING VERY FAR FROM THE CLINIC.LIVING VERY FAR FROM THE CLINIC.
 EXTENDED FAMILY V. NUCLEAR.EXTENDED FAMILY V. NUCLEAR.
 HIV STATUS WAS NOT REQUESTEDHIV STATUS WAS NOT REQUESTED

18. 1818
CONCLUSIONCONCLUSION
 MOST TB PATIENTS NEED SUPPORTMOST TB PATIENTS NEED SUPPORT
 THE MAIN CONTRIBUTIONS OF THETHE MAIN CONTRIBUTIONS OF THE
COMMUNITY TO TB PATIENTS WERE MONEYCOMMUNITY TO TB PATIENTS WERE MONEY
(36%), FOOD (34 %)AND TIME (17%).(36%), FOOD (34 %)AND TIME (17%).
 MINIMUM SUPPORT BY CHW (11%)MINIMUM SUPPORT BY CHW (11%)
 FAMILIES CONTRIBUTING SIGNIFICANTLYFAMILIES CONTRIBUTING SIGNIFICANTLY

19. 1919
CONCLUSIONCONCLUSION
 THE MAJORITY OF TB PATIENTS( 94%)THE MAJORITY OF TB PATIENTS( 94%)
RECEIVED COMMUNITY SUPPORT IN ONE OFRECEIVED COMMUNITY SUPPORT IN ONE OF
THE FIVE AREAS.THE FIVE AREAS.
 SUPPORT WAS GIVEN MOSTLY BY FAMILYSUPPORT WAS GIVEN MOSTLY BY FAMILY
RATHER THAN BY CHW.RATHER THAN BY CHW.

20. 2020
RECOMMENDATIONSRECOMMENDATIONS
 GOVERNMENT TO INCREASE INCOME IT WILL TRICKLE TOGOVERNMENT TO INCREASE INCOME IT WILL TRICKLE TO
OTHER FAMILY MEMBERS AS WELL AS FOOD SECURITY TOOTHER FAMILY MEMBERS AS WELL AS FOOD SECURITY TO
REDUCE THE TB BURDEN AND IMPROVE SELF RELIANCE OF TBREDUCE THE TB BURDEN AND IMPROVE SELF RELIANCE OF TB
PATIENTS.PATIENTS.
 MOH TO CONSIDER REPLACING TB SUPPORTERS WITH FAMILYMOH TO CONSIDER REPLACING TB SUPPORTERS WITH FAMILY
SUPPORTERS USING EVIDENCE FROM NEIGHBOURINGSUPPORTERS USING EVIDENCE FROM NEIGHBOURING
COUNTRIES.COUNTRIES.
 IF TB SUPORTER ARE TO BE CONTINUED NEED TOIF TB SUPORTER ARE TO BE CONTINUED NEED TO
ENCOURAGE TB SUPPORTIVE HEALTH WORKERS TOENCOURAGE TB SUPPORTIVE HEALTH WORKERS TO
PARTICIPATE FULLY THROUGH SUPERVISION, MONITORINGPARTICIPATE FULLY THROUGH SUPERVISION, MONITORING
AND INCETIVES TO .AND INCETIVES TO .
 NTP TO CAPACITY BUILD DISTRICTS IN PLANNING FORNTP TO CAPACITY BUILD DISTRICTS IN PLANNING FOR
BUDGETS FOR MORE TB TREATMENT SUPPORTERS TO BEBUDGETS FOR MORE TB TREATMENT SUPPORTERS TO BE
ENROLLED.ENROLLED.

21. 2121
RECOMMENDATIONS. CONT.RECOMMENDATIONS. CONT.
 FAMILY SUPPORTERS TO BE TRAINED, GIVENFAMILY SUPPORTERS TO BE TRAINED, GIVEN
INFORMATION AND INCENTIVES.INFORMATION AND INCENTIVES.
 INTEGRATION OF TB WITH HIV/AIDSINTEGRATION OF TB WITH HIV/AIDS
PROGRAMME.PROGRAMME.

22. 2222
FURTHER RESEARCH NEEDED:FURTHER RESEARCH NEEDED:
 RESEARCH IN OTHER DISTRICTS INRESEARCH IN OTHER DISTRICTS IN
ORDER TO KNOW THE SPECIFCORDER TO KNOW THE SPECIFC
COMMUNITY CONTRIBUTIONS.COMMUNITY CONTRIBUTIONS.
 FAMILY SUPPORT FOR TB PATIENTS.FAMILY SUPPORT FOR TB PATIENTS.

23. 2323
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
 SPECIAL THANKS GO TO THESPECIAL THANKS GO TO THE
FOLLOWING:FOLLOWING:
 Dr S. Miti, the Permanent Secretary. MoH.Dr S. Miti, the Permanent Secretary. MoH.
 Dr Victor Mukonka, Director Public HealthDr Victor Mukonka, Director Public Health
and Research. MoH.and Research. MoH.
 Dr Chandwa Ngambi and Staff. PHO.Dr Chandwa Ngambi and Staff. PHO.
Copperbelt ProvinceCopperbelt Province
 Dr Emmanuel Kafwembi –Director-TDRCDr Emmanuel Kafwembi –Director-TDRC

24. 2424
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
 Mr D. Mwakazanga- Statistician- TDRCMr D. Mwakazanga- Statistician- TDRC
 Mary Hadley- Senor Health AdvisorMary Hadley- Senor Health Advisor
 Dr Chikafuna Banda- DDH –ChingolaDr Chikafuna Banda- DDH –Chingola
districtdistrict
 Mrs Musonda Kangombe. TB Focal Person-Mrs Musonda Kangombe. TB Focal Person-
Chingola districtChingola district
 Mr Chima- Human Resource OfficerMr Chima- Human Resource Officer
 Professor Ib Bygbjerg: University ofProfessor Ib Bygbjerg: University of
Copenhagen. Denmark.Copenhagen. Denmark.