NURSES ROLES AND EXPERIENCE WITH ENHANCING ADHERENCE TO TUBERCULOSIS TREATMENT AMONG PATIENTS IN UBTH

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background of study

For many years tuberculosis (TB) has been one of the killer diseases in Nigeria. It is still a major health problem, despite the fact that it is both preventable and curable. The World Health Organization(WHO),cited in Smeltzeretal. (2010:567),estimated that about 1% of Nigerians (roughly 200,000) contracted TB in 2008. According to Vlok (2006:515), TB is associated with poverty and poor living conditions, which make a person particularly susceptible to TB if he or she comes into contact with an infected person.

The WHO found that TB is the second highest cause of death globally (WHO 2005:1), after the human immunodeficiency virus (HIV)  and  acquired  immunodeficiency  syndrome  (AIDS),  as it kills nearly two million people every year. A few years ago it was thought that TB could   be successfully treated and even perhaps prevented by advances in medical treatment such      as chemotherapy. Unfortunately this has not been the case, and TB can still be fatal (Tothet al. 2004:28).AfricaisoneofthecountrieswiththehighestincidenceofTB.Itisestimatedthat

2.4 million new TB cases are diagnosed and 540 000 deaths are caused by TB  every year  (WHO 2005:1).

Controlling TB effectively is not the responsibility of healthcare workers alone; it is also the responsibility of each individual to prevent the spread of TB. This view is supported by the results of a study conducted by Richter and Peu (2004:38) who found that caregivers can help increase awareness of the community of their right to access effective TB care. Caregivers should make people aware of DOTS therapy, and assess environmental conditions to determine whether the community’s needs are being met (Richter & Peu2004:38).

Molefe (1999:178), supported by Dick et al. (2007:383), stated that the current approach to TB control is based at the primary healthcare level, but this poses a problem for nurses as it increases their workload and responsibilities. This leads to the question of what the role of nurses is in the prevention of TB, especially in the face of its rapid escalation. If the incidence of TB increases further, this will have an influence on the role played by nurses in the community. Nurses have to realise that they are the pillars of TB prevention and management. Nurses have the opportunity to assess, diagnose, treat and refer patients with TB  for further care.

Despite the fact that DOTS had 93% coverage in 2004, Nigeria continues to notify the WHO of more TB cases (WHO 2005:1). A variety of activities can be put in place to prevent the increase of TB, and the role of nurses in these activities should be considered. It has been speculated that TB will have a serious impact on Nigeria’s economy because of the death rate amongst people in their productive years:61% of people between the ages of 20 and 39 years and 26% of people between the ages of 40 and 49 may die because of TB (Van Rensburg 2004:255). Van Rensburg (2004:255) suggested that Nigeria should adopt strategies similar to those used by Vietnam and Peru, which have demonstrated the effect of well-functioning control programmes on both morbidity and mortality.

Van Rensburg (2004:255) points to the west as the region with the worst TB statistics, with an infection rate of 559 per 100000 people annually, almost double the rate of all new infections in the country. It is almost seven times higher than that of Limpopo (85.9 per 100 000), the province with the lowest reported incidence of TB. KwaZulu-Natalshowed a TB incidence rate of 64.6%, followed by Mpumalanga with 59.1% and the Free State with 51.7%(VanRensburg 2004:255).

NURSES ROLES AND EXPERIENCE WITH ENHANCING ADHERENCE TO TUBERCULOSIS TREATMENT AMONG PATIENTS IN UBTH