Women's utilisation of prevention of mother-to-child transmission of human immunodeficiency virus services in Addis Ababa, Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV) mother-to-child transmission (MTCT) can be prevented when HIV-positive pregnant women use effective prevention of mother-to-child transmission (PMTCT) of HIV services. Approximately 50% of HIV-positive pregnant women used free PMTCT services in Ethiopia. AIM: This study attempted to identify factors influencing women's utilisation of PMTCT services. Addressing such factors could enable more Ethiopian women to use PMTCT services. The study investigated whether women's utilisation of services was affected by socio-demographic issues, their partners' known HIV status, disclosure of their HIV-positive status, stigma and discrimination, and satisfaction with services. SETTING: Prenatal clinics in Addis Ababa, Ethiopia. METHODS: A quantitative, cross-sectional study design was used and 384 questionnaires were completed by women who used PMTCT services in Addis Ababa. RESULTS: No socio-demographic characteristic prevented women's utilisation of PMTCT services, nor did stigma, discrimination or disclosure of their HIV-positive status. Most respondents' partners with unknown HIV status did not know that the respondents used PMTCT services. Most women were satisfied with the PMTCT services. CONCLUSIONS: Prevention of mother-to-child transmission services should remain accessible to all HIV-positive women in Ethiopia. Concurrent HIV partner testing should be encouraged with appropriate counselling. HIV-positive pregnant women should be encouraged to disclose their status to their partners so that they need not use PMTCT services secretly. Patients' high levels of satisfaction with PMTCT services are a good indicator for rolling out PMTCT initiatives at other facilities. Future research should focus on HIV-positive pregnant women who do not use PMTCT services.

Health-related quality of life of patients on antiretroviral treatment in Botswana: A cross-sectional study.

OBJECTIVE: Antiretroviral therapy (ART) affords longevity to patients infected with the human immune deficiency virus (HIV). Since little is known about the health-related quality of life (HRQoL) of persons who have been on ART for at least five years, the present study investigated the HRQoL of these patients in Botswana. METHOD: Medical records, structured interviews, and the World Health Organization Quality of Life-BREF (WHOQoL-HIV-BREF) instrument were employed to obtain information from 456 respondents. RESULTS: Univariate and multivariate regression analyses showed that respondents' highest scores were in the "physical" domain (mean = 15.8, SD = 3.5), while the lowest scores were in the "environment" domain (mean = 12.9, SD = 2.5). Thus, the physical domain had the greatest impact on patients' overall HRQoL. Self-education about HIV-related issues was significantly correlated with all domains of HRQoL scores: physical (ρ = -2.32, CI 95% = -3.02, -1.61); psychological (ρ = -2.26, CI 95% = -2.87, -1.65); independence (ρ = -1.81, CI 95% = -2.54, -1.06); social relationships (ρ = -1.40, CI 95% = -2.13, -0.67); environment (ρ = -1.58, CI 95% = -2.13, -1.04); and spirituality (ρ = -1.70, CI 95% = -82.27, -1.13). SIGNIFICANCE OF RESULTS: HRQoL assessments can identify and address patients' needs, and it is important that guidelines be developed that will yield improved care to ART patients in Botswana.

An assessment of the outcomes of prevention of mother-to-child transmission of HIV services in Addis Ababa, Ethiopia.

BACKGROUND: This article assessed maternal and neonatal outcomes amongst users of prevention of mother-to-child transmission (PMTCT) of HIV services in Addis Ababa, Ethiopia. OBJECTIVES: The study aimed to assess the health outcomes (antiretroviral prophylaxis versus antiretroviral treatment, CD4 counts, World Health Organization (WHO) stages of illness, other illnesses) of women who had used these services, as well as the HIV status of their babies and the infant feeding method adopted. METHODS: A quantitative, cross sectional, retrospective cohort design was used. Document reviews were conducted with a sample of 384 mother-infant pairs (out of a population of 796) who had used PMTCT services. RESULTS: All respondents were using prophylactic antiretrovirals or antiretroviral therapy, but some were on the wrong treatment based on their CD4 counts. The CD4 counts increased four times more for women on antiretroviral treatment than for those on prophylactic antiretrovirals. The WHO's stages of HIV illness did not improve but deteriorated in some cases, and 52 other illnesses were recorded. Out of the 384 infants, 6.0% (n = 23) were HIV-positive. Most respondents opted for exclusive breast feeding but some used mixed feeding during the first six months of their infants' lives, despite having received health education related to infant feeding options. CONCLUSION: The respondents' improved CD4 counts were inadequate to improve their World Health Organization stages of HIV illness. Some babies received mixed feeding during the first six months of their lives and 6% of the babies were HIV-positive despite their mothers' utilisation of PMTCT services.

Health-related quality of life of antiretroviral treatment defaulters in Botswana.

BACKGROUND: Antiretroviral therapy (ART) improves patients' health-related quality of life (HRQoL). Defaulting from ART has detrimental consequences, including the development of viral resistance, treatment failure and increased risks of disease progression. Little is known about the quality of life of ART defaulters and reasons for discontinuing their ART. OBJECTIVES: This study sought to measure the HRQoL of ART patients in Botswana who were on ART for up to 5 years but had discontinued treatment for at least 3 months, and to identify factors associated with ART defaulting. METHOD: We conducted a cross-sectional study with 104 eligible respondents in four ART clinics in south eastern Botswana. We assessed respondents' HRQoL using the World Health Organization Quality of Life Questionnaire for HIV short form. Clinical information was obtained from respondents' medical records. Data were analysed using SAS version 9.2. RESULTS: Reasons for discontinuing ART were inaccessible clinics (22.4%), feeling better (21.4%), running out of pills (11.2%), depression (8.2%), lack of care and/or support (8.2%), failure to understand instructions (7.7%), medications' side effects (6.1%) and alcohol abuse (3.1%). In multivariate analyses, respondents aged 36-45 years had a 0.03 lower independence HRQoL score compared to those aged 35 and younger (ß = -0.03; 95% confidence interval: -1.72, -1.66). Despite defaulting from their ART, respondents' calculated HRQoL scores were moderate. CONCLUSION: This study highlights the need to enhance ART adherence in order to improve the HRQoL of people living with HIV and/or AIDS.

Adherence to antiretroviral treatment by adults in a rural area of Botswana.

BACKGROUND: As antiretroviral therapy (ART) is becoming increasingly available to people in developing countries, ART adherence challenges assume ever greater significance. Often underlying treatment failure is the fact that suboptimal adherence to ART is the strongest predictor of failure to achieve viral suppression below the level of detection. OBJECTIVES: The study's main objective was to identify factors affecting ART adherence levels, as well as the impact on immunologic and virologic responses in adult patients in one rural district in Botswana. METHODS: A cross-sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients between November 2011 and February 2012. Data were analysed, then presented in charts, graphs and frequency tables. RESULTS: The prevalence of non-adherence to ART was 14.0%. Motivators of good adherence included disclosure of HIV-positive status to more than one person, frequent adherence counselling, self-efficacy for adherence to ART, positive interactions between patients and healthcare providers; and using adherence partners. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side-effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95% CI 4.9-34). CONCLUSION: Adherence to ART is closely tied to virologic, immunologic, and clinical outcomes. Increases in adherence levels resulted in significant improvements in these outcomes. Near perfect adherence, however, is required to maximise the likelihood of long-term clinical success, which could pose challenges to many ART patients, especially in resource-limited rural settings.

An audit of diagnosis and treatment of tuberculosis in Ethiopia.

BACKGROUND: Despite the existence of national tuberculosis guidelines (NTG) in Ethiopia, the incidence and prevalence of tuberculosis did not decline markedly. Audits could attempt to determine whether or not healthcare professionals actually implemented these guidelines, as non-implementation could contribute to suboptimal tuberculosis treatment outcomes. AIM: To evaluate healthcare providers' implementation of Ethiopia's NTG during the diagnosis and treatment of tuberculosis in order to enhance tuberculosis treatment outcomes. METHODS: A descriptive, cross-sectional study design was used. RESULTS: Healthcare providers implemented the NTG during tuberculosis diagnosis for female (60.9%; n = 67) and male (56.1%; n = 69) patients. The correct numbers of anti-tuberculosis pills, complying with the NTG recommendations, were prescribed for 91.8% (n = 101) of the women and for 90.2% (n = 111) of the men. However, both over- and under-prescriptions of anti-tuberculosis drugs occurred. There was an over-diagnosis of smear-negative pulmonary tuberculosis. Only 2.6% (n = 2) of the 76 smear-negative pulmonary tuberculosis patients had been diagnosed correctly. CONCLUSION: Implementation of the NTG should be enhanced, especially with regard to the diagnosis of smear-negative pulmonary tuberculosis patients and the correct prescription of anti-tuberculosis drugs. This would help to increase the number of correctly-diagnosed and -treated tuberculosis patients, improve tuberculosis treatment outcomes, decrease the spread of tuberculosis and prevent the development of multi-drug-resistant tuberculosis strains.

Cardiopulmonary resuscitation knowledge and skills of registered nurses in Botswana.

BACKGROUND: In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations. OBJECTIVE: The objective of this descriptive study was to assess registered nurses' CPR knowledge and skills. METHOD: A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple-choice questionnaire and checklist were used to collect data. RESULTS: All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted. CONCLUSION: The significantly low levels of registered nurses' CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses

Factors contributing to sleep deprivation in a multidisciplinary intensive care unit in South Africa.

Patients in intensive care units require rest and sleep to recuperate, but might suffer from sleep deprivation due to ongoing unit activities. The study aimed to identify and describe the factors contributing to sleep deprivation in one multi-disciplinary intensive care unit (MDICU) in a private hospital in South Africa. Quantitative, descriptive research was conducted to identify factors contributing to sleep deprivation in the research setting, and to make recommendations to enhance these patients' abilities to sleep. Structured interviews were conducted with 34 adult non-ventilated patients who had spent at least one night in the MDICU and who gave informed consent. Out of the 34 interviewed patients 70.6% (n=24) indicated that they suffered from sleep deprivation in the MDICU. The five major factors contributing to sleep deprivation in a MDICU were, (1) not knowing nurses' names, noise caused by alarms, (2) stress, (3) inability to understand medical terms, and (3) blood pressure cuffs that restricted patients' movements and smelled badly. Patients' abilities to sleep were enhanced by reassuring nurses whose names they knew and with whom they could communicate. By attending to the identified five major factors, patients' abilities to sleep in a MDICU could be enhanced enabling patients to recuperate faster. The implementation of such measures need not incur financial costs for the MDICU concerned.

HIV and AIDS Knowledge and Sexual Behaviours amongst Secondary School Learners in Harare; Zimbabwe

Efforts to stem the tide of the Human immunodeficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS) pandemic in Africa emphasise the necessity that learners should be able to make informed decisions. Although learners in Zimbabwe's schools are taught about HIV and AIDS; the extent of their knowledge needed to be determined. The major objective was to assess the knowledge of secondary school learners in Harare; Zimbabwe; about HIV and AIDS. Structured interviews were conducted with 75 Grade 8 (Form 1) secondary school learners from four schools in Harare. Most learners had obtained their HIV and AIDS knowledge from schools; but some did so from their parents; community activities; the radio or television. No learner had commenced with sexual activities and all had heard about HIV; but not all knew what HIV was; and even fewer could define AIDS. Less than one-third of the learners could mention the three most important HIV preventive measures. Most learners were willing to undergo voluntary counselling and testing (VCT); but few had done so. As no learner had commenced sexual activities; opportunities existed to empower Grade 8 (Form 1) learners with adequate HIV and AIDS knowledge. Generally the learners' HIV and AIDS knowledge levels were high but some misconceptions existed. Schools should engage with radio and television programmes to address misconceptions about HIV and AIDS. Learners should be enabled to access VCT services. More effective HIV prevention education in Zimbabwe's schools; could enable more youth to remain HIV negative

Audits of Emergency Trolleys' Contents in Selected Hospitals in Botswana

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment; as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana's hospitals' wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley; some units failed to check their emergency trolleys' contents daily. All 20 hospital wards or units that participated in this study; needed to improve the contents and maintenance of their emergency trolleys; otherwise in-hospital CPR efforts in Botswana might be doomed to failure; losing lives that could have been saved if emergency trolleys' equipment and supplies had been up to standard

Audits of adolescent prenatal care rendered in Bulawayo, Zimbabwe.

OBJECTIVE: To evaluate the adequacy of recorded prenatal care provided to adolescents in Bulawayo, Zimbabwe. DESIGN: A quantitative descriptive design, using checklists to audit 80 prenatal records, based on the assumption that care recorded reflects care rendered. SETTING: Four clinics and two hospitals providing public prenatal and birth services in Bulawayo, Zimbabwe. PARTICIPANTS: 80 Adolescents' prenatal records were audited. MEASUREMENT AND FINDINGS: Recorded prenatal care was checked according to the expected prenatal activities: history taking, health education and counselling, physical examinations, routine laboratory tests, client evaluations and planning for birth. KEY CONCLUSIONS: documentation in the prenatal records was incomplete, especially on aspects of health promotion and social history. IMPLICATIONS FOR PRACTICE: Inadequacies in prenatal records could denote poor prenatal care rendered to adolescents, limiting the potential benefits pregnant adolescents and their infants could derive from these services in Bulawayo. In-service education should be offered to the midwives to enhance their knowledge and skills on health assessment, history taking, physical examinations and accurate documentation of all aspects of prenatal care.

Compliance amongst asthma patients registered for an asthma disease risk-management programme in South Africa.

The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM) programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative, exploratory, and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data.Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients' compliance with the DRM programme can be enhanced by the sustained, positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease.Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition, which would prevent or at least reduce asthma attacks and/or hospital admissions.

Factors influencing the retention of registered nurses in the Gauteng Province of South Africa.

BACKGROUND: South Africa is a source country for many destination countries that recruit registered nurses who emigrate for personal and/or professional reasons. A large number of South African nurses belong to the baby boomer generation (born between 1943 and 1964) who will retire within the foreseeable future. Statistics from the South African Nursing Council show a decline of 42.0% in the number of nurses who completed their training in South Africa from 1996 to 2005. These aspects combine to predict a potential dire shortage of nurses in South Africa within the foreseeable future. OBJECTIVES: Retention of registered nurses should be the focus of health-care planners to avoid crises in South Africa's health-care services. This study attempted to identify factors that would influence registered nurses' decisions to stay with their current employers in the Gauteng Province of South Africa. METHODS: An exploratory descriptive quantitative design was adopted and questionnaires were sent to a sample of nurses, registered with the South African Nursing Council (SANC), with addresses in the Gauteng Province. A total of 108 nurses completed and returned questionnaires, of whom 77 (73.1%) had considered leaving their current employers. RESULTS: The most important factors that would influence more than 90.0% of these nurses' decisions to stay with their current employers related to finances, safety and security, equipment and/or supplies, management, staff and patients. CONCLUSIONS: In terms of Maslow's Hierarchy of Needs Theory, deficiency needs (physiological, safety and social needs) should be met by improved salaries revised on an annual basis, paying long-service and outstanding-service bonuses, and improving the safety and security, as well the available equipment and supplies, at institutions. Sufficient numbers of nurses should be employed and vacancies should be filled rapidly. However, not all changes required to enhance nurses' retention rates involve increased costs. Managers should lead by example and respect nurses, and encourage doctors as well as patients to do so, to meet nurses' self-esteem needs. Recognising and rewarding outstanding service would meet nurses' self-actualisation needs, as well as opportunities to further their education.

Nigerian Health Workers' Views Concerning Factors Influencing Paediatric Adherence to Anti-Retroviral Therapy

New studies have focused on paediatric anti-retroviral therapy (ART) adherence in Nigeria; probably because of the ethical challenges involved in studying children. The study aimed to identify factors that influence paediatric ART adherence as perceived by health care workers providing ART services in two cities in Nigeria. Knowledge about such factors would be used to formulate recommendations for enhancing paediatric ART adherence in Nigeria; for facilitating the tasks of the health care workers and for enhancing the ART programme's effectiveness. An exploratory descriptive qualitative research design was used to identify and to describe health care workers' views in Kano and Lagos; Nigeria. Three focus group discussions were conducted at two clinics that provide free paediatric ARVs (antiretroviral drugs). The transcribed data were analysed by using the framework approach of data analysis. Health care providers perceived poverty; illiteracy; stigma; discrimination; inappropriate care approaches; and parental dynamics as factors that influence paediatric ART adherence. Paediatric ART adherence levels in Nigeria could be enhanced by emphasising paediatric ART adherence counselling and by adopting a comprehensive family centred care approach; by improving free paediatric ART services and by empowering parents and reducing stigma and discrimination

Compliance amongst Asthma Patients Registered for an Asthma Disease Risk-Management Programme in South Africa

The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM) programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative; exploratory; and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data. Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients' compliance with the DRM programme can be enhanced by the sustained; positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease. Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition; which would prevent or at least reduce asthma attacks and/or hospital admissions

Factors Influencing the Retention of Registered Nurses in the Gauteng Province of South Africa

Background: South Africa is a source country for many destination countries that recruit registered nurses who emigrate for personal and/or professional reasons. A large number of South African nurses belong to the baby boomer generation (born between 1943 and 1964) who will retire within the foreseeable future. Statistics from the South African Nursing Council show a decline of 42.0in the number of nurses who completed their training in South Africa from 1996 to 2005. These aspects combine to predict a potential dire shortage of nurses in South Africa within the foreseeable future. Objectives: Retention of registered nurses should be the focus of health-care planners to avoid crises in South Africa's health-care services. This study attempted to identify factorsthat would influence registered nurses' decisions to stay with their current employers in the Gauteng Province of South Africa. Methods: An exploratory descriptive quantitative design was adopted and questionnaires were sent to a sample of nurses; registered with the South African Nursing Council (SANC); with addresses in the Gauteng Province. A total of 108 nurses completed and returnedquestionnaires; of whom 77 (73.1) had considered leaving their current employers. Results: The most important factors that would influence more than 90.0of these nurses' decisions to stay with their current employers related to finances; safety and security; equipment and/or supplies; management; staff and patients. Conclusions: In terms of Maslow's Hierarchy of Needs Theory; deficiency needs (physiological; safety and social needs) should be met by improved salaries revised on an annual basis; paying long-service and outstanding-service bonuses; and improving the safety and security; as well the available equipment and supplies; at institutions. Sufficient numbers of nurses should be employed and vacancies should be filled rapidly. However; not all changes required to enhance nurses' retention rates involve increased costs. Managers should lead by example and respect nurses; and encourage doctors as well as patients to do so; to meet nurses' self-esteem needs. Recognising and rewarding outstanding service would meet nurses' self-actualisation needs; as well as opportunities to further their education

Midwives' perceptions about adolescents' utilisation of public prenatal services in Bulawayo, Zimbabwe.

OBJECTIVES: to identify midwives' perceptions about adolescents' failure to utilise prenatal services or to initiate such utilisation late during their pregnancies. DESIGN: a quantitative descriptive and exploratory design, using questionnaires to collect data, to describe midwives' perceptions about factors influencing pregnant adolescents' non-utilisation or late utilisation of prenatal services. SETTING: 20 public health centres (comprising two hospitals and 18 primary health-care clinics) rendering prenatal services, distributed throughout the city of Bulawayo, Zimbabwe. PARTICIPANTS: 52 midwives, rendering prenatal services in Bulawayo, completed questionnaires. MEASUREMENTS AND FINDINGS: demographic, socio-economic, knowledge-related and service-related factors (unfriendly midwives and substandard prenatal services) influenced pregnant adolescents' late or non-utilisation of prenatal services. KEY CONCLUSIONS: transport costs and charges for prenatal services were major factors influencing adolescents' late or non-utilisation of prenatal services. Adolescents needed more knowledge about the advantages of prenatal services. Effective prenatal services should be provided by friendly and welcoming midwives. IMPLICATIONS FOR PRACTICE: pregnant adolescents need more knowledge about the advantages of prenatal services, and these should be more accessible. Charges for public prenatal services must be reduced or abandoned; subsidised or free public transport for pregnant adolescents could enhance their utilisation of prenatal services.

Patients' adherence to anti-retroviral therapy in Botswana.

PURPOSE: To identify factors influencing patients' anti-retroviral therapy (ART) adherence at four clinics in Botswana. DESIGN: Quantitative descriptive. Structured interviews were conducted with a random sample of 400 patients out of the population of all patients attending the four randomly selected ART clinics in Botswana during April and May 2007. METHODS: Data were analysed using SPSS version 13. Chi-square and p-value calculations were done to test significance of the relationships between categories or variables. FINDINGS: Patient-centred barriers to ART adherence included inadequate knowledge about ART, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), CD4 cell and viral-load results, stigma, travelling costs, waiting times at clinics, side effects of ART, use of traditional (indigenous or folk) medicines, and abuse of alcohol. Service-centred barriers included nurses' attitudes and knowledge, health workers' inability to conduct home visits and to contact defaulters, limited clinic hours, delays in getting CD4 and viral-load results. CONCLUSIONS: ART adherence requires more than free ART. Adherence levels will improve if both patient-centred and service-centred barriers are addressed. CLINICAL RELEVANCE: Nurses play key roles in educating patients about ART adherence and side effects, but they should also educate patients about CD4 and viral-load test results and about the dangers of using traditional medicines and alcohol with ART. Shorter waiting times at clinics could make ART patients' lives more manageable.

Experiences of a community-based tuberculosis treatment programme in Namibia: a comparative cohort study.

BACKGROUND: Tuberculosis (TB) remains a widespread healthcare problem in Africa, although it can be cured within 6-8 months' effective treatment. However, many patients fail to adhere to TB treatment, resulting in failure to get cured and the possible development of multi-drug resistant TB (MDR TB). A community-based TB treatment programme, was started in the Omaheke region of Namibia during 2002. The efficacy of this community-based TB programme, compared to the standard hospital- and clinic-based TB treatment, was unknown. OBJECTIVES: The major objectives were to compare TB treatment outcomes for patients who used the community-based TB with those who chose the clinic/self-administered TB treatment option; and to identify advantages and disadvantages of community-based TB care as experienced by patients who had completed their community-based TB treatment. DESIGN: A quasi-experimental study design was used to compare TB patients' treatment outcomes using checklists and exit interviews. SETTING: The study was conducted in the Omaheke region of Namibia. PARTICIPANTS: TB patients (n=332) who were hospitalised during the study period participated in the study. METHODS: An analytic cohort prospective design was used to do follow-up visits, and complete checklists, of 332 TB patients. Structured exit interviews were conducted with 101 TB patients who had completed their community-based TB treatment. RESULTS: Enhanced knowledge of TB patients improved their participation in community-based TB care. A family member was the most convenient, acceptable and accessible directly observed treatment (DOT) supervisor for 72.8% of the participants. A statistically significant difference in cure rates between community-based and the clinic/self-administered groups was found (chi(2) 11.78; p