An assessment of current support strategies for patients with TB in KwaZulu-Natal

Elizabeth Lutge, Zimisele Ndlela and Irwin Friedman

In relation to research being undertaken by HST, Dr Irwin Friedman, director of HST's research cluster, stated, Poverty and TB have been bedfellows since the epidemic wiped-out populations in Europe, Asia and Americas in the 19th century and the first-half of the 20th century. Long before drugs, which are the current mainstay of treatment were discovered, the disease had already begun to disappear due to improvements in living conditions, especially nutrition.

The current support strategies study, led by Dr Elizabeth Lutge, examined the role that food-support, clinic gardens and a disability grant in KZN for patients with TB, have played in ameliorating the living conditions of the poor - thereby contributing to combating the ravages of the disease.

The research team set out to formally assess patients' responses to these support programmes. A total of 487 patients participated in the study, with 80% of patients living in rural areas, 14% in townships, and 6% in an informal settlement.

Data collected showed a distinct correlation between poverty and TB. Over half of all patients described their household finances as poor or extremely poor. This is a direct result of low or no income, with 53% of the patients indicating they are too sick to work. The study also found that the cost of transport to the clinic was a significant barrier to gaining access to and completing treatment. Travel costs to the clinic for TB appointments were approximately R16.64, with almost three-quarters of the patients citing a lack of money as the main difficulty they faced in accessing a clinic.

Food insecurity was another major problem facing households particularly in situations where people were not in a position to grow their own fruit and vegetables. Only 11% of patients reported receiving food from the clinic gardens, with 34% of them indicating that the amount of food received was not sufficient for their needs. The poor conditions and financial status of the patients were validated by the number of adults and children that reported being forced to skip meals due to a lack of money.

Although only 21%of patients received a disability grant for TB or HIV, 73% of these relied on the disability grant support, describing it as very important - we need it to survive. The study showed that patients spent more than 20% of the grant on food, 10% on clothing and more than 5% on transport. No patients reported expenditure on non-essential items.

Only 51% of patients received food parcels as part of their TB treatment. Although half of them indicated that the parcels were too small, they were, nonetheless, grateful for the support. Patients described the food parcels as very helpful - we are very short of food at home.

An assessment of current support strategies for patients with TB in KwaZulu-Natal highlights the greater need, across South Africa, to assess the economic impact of TB, as well as to develop support structures for TB patients. According to Dr Friedman, this study provides valuable additional evidence of the need to provide non-medical support strategies for TB patients in poor communities.