Socio-cultural dimensions of leprosy in north-western Botswana.

A study to determine some socio-cultural factors influencing knowledge and attitudes of the community toward leprosy was carried out in north-western Botswana, where cases of leprosy have been known to exist over the years. The study was largely qualitative, using ethnographic approaches. The research was tailored in a way to capture the ethnic diversity of the region, in particular two ethnic groups, namely Bayei and Bambukushu. The name or symptom complex associated with leprosy was 'ngara' or 'lepero' and this was associated with bad blood. Knowledge on disease causation was lacking, which in turn influenced health seeking behaviour of patients. Patients were well integrated and accepted into the social structure of communities. Women caring for these patients did experience some additional burden and identified time as their major constraint in caretaking. It was apparent that the degree of rejection correlated with seriousness of the disease and extent of disabilities and dysfunction. The present pattern of health seeking behaviour needs to be altered, so that an early diagnosis can be made at the health facility. This will aid appropriate management and prevent occurrence of deformities and disabilities, which in turn will reduce rejection and isolation of patients. Education of community, patients, traditional and religious healers on various aspects of the disease, especially causation, is essential to achieve a change in the health seeking behaviour.

Knowledge and attitude of health workers towards leprosy in north-western Botswana.

The knowledge and attitude of health workers in north-western Botswana towards leprosy was determined by interviewing ninety nine health workers from various health institutions. Knowledge on causation of leprosy was generally lacking. Although majority of respondents knew that the disease is curable, less than half knew the correct duration of treatment. The attitude of service providers was influenced by poor knowledge, and more than a third claimed that patients should be isolated. The pattern of health seeking behaviour, initially traditional or religious healers and then modern health facilities, was a significant finding. In order to ensure early case detection and prevent deformities, it is vital that education of community, patients and health workers is provided to an extent that health seeking behaviour is altered. Traditional and religious leaders must also be included in such training sessions.

Case finding survey for leprosy in Botswana.

A baseline survey to establish the point prevalence of leprosy was carried out in July and August, 1991 in northern Botswana, where cases of leprosy have existed over the years. A total of 799 contacts of 127 index cases and 8235 school children from 18 schools were clinically screened for leprosy. In all, 44 active cases of leprosy were registered and started on multidrug therapy recommended by World Health Organization. Of these cases, 32% were newly identified during the survey. Due to the moderate outcome, surveillance and control of leprosy has been integrated with existing TB control programme. This is the first time ever a systematic attempt was made to establish a programme for control of leprosy in Botswana.

PIP: During July-August 1991, health workers conducted leprosy screening in Ngami, Okavango, Chobe, Boteti, and Mahalapye in northern Botswana to determine the point prevalence of leprosy. They screened 799 contacts of 127 index cases and 6235 school children from 9 secondary and 9 primary schools. During the contact survey, they detected 42 active cases of leprosy, whom they started on multidrug therapy. Only 2 students had active leprosy (paucibacillary cases). They lived in Okavango subdistrict. The health workers also started them on multidrug therapy. The surveys identified 14 (32%) new leprosy cases. Multibacillary leprosy was more common than paucibacillary leprosy (68% vs. 32%). Most cases (84%) were older than 25 years old. Most leprosy cases lived in Ngami and Okavango subdistricts (43% and 41%, respectively). The point prevalence of registered leprosy cases on multidrug therapy in the 5 subdistricts in northern Botswana was 0.18/1000. Since the surveys showed that leprosy prevalence is low, surveillance and control of leprosy activities have been integrated into the existing tuberculosis control program. This integration was the first time that a leprosy control program has been systematically attempted in Botswana.

Case holding in patients with tuberculosis in Botswana.

OBJECTIVE: To evaluate the effectiveness of daily supervised short course chemotherapy in a national tuberculosis programme. DESIGN: Observation of programme during 1984-90. In October 1986 short course chemotherapy was introduced with patients receiving treatment daily from staff in their nearest health facility. SETTING: Botswana national tuberculosis programme. SUBJECTS: All patients with tuberculosis. MAIN OUTCOME MEASURES: Proportions of patients complying with and defaulting from treatment (missing > or = 43 days' treatment). RESULTS: 2938 cases of tuberculosis were recorded in 1990, 1528 of which were of sputum positive pulmonary disease. 2711 (92.3%) patients complied with treatment and 227 (7.7%) defaulted. Before introduction of short course chemotherapy compliance was about 60% compared with over 90% in 1987-90. CONCLUSIONS: A programme using daily supervised short course chemotherapy integrated into the primary health care system is an effective method of treating tuberculosis. The costs of the programme need to be evaluated.

Health programme planning for consolidation and quality.

Botswana's Ministry of Health is implementing a new approach to resource planning and management whereby the work of planners and technical experts is integrated with that of managers of programmes and facilities. The aim is to help the managers to make better use of resources in service delivery.