Community Home-based Care Programme Research Articles

Clinical waste management in the context of the Kanye community home-based care programme, Botswana

This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye, southern Botswana. This qualitative study involved 10 focus group discussions with a total of 82 HIV/AIDS primary caregivers in Kanye, one-to-one interviews with the five nurses supervising the programme, and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme, namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers, including burning and burying the healthcare wastes, and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste.

Efficacy of a limb-care regime in preventing acute adenolymphangitis in patients with lymphoedema caused by bancroftian filariasis, in Colombo, Sri Lanka

The efficacy of a programme of community home-based care (CHBC) for lymphoedematous limbs was evaluated among 163 lymphoedema patients attending two filariasis clinics in Colombo. Each patient was interviewed and examined and his or her lymphoedema was graded during a baseline assessment, before the CHBC programme, and again, during a post-intervention assessment, after the patient had been in the programme for 1 year. The number of patients having entry lesions was 24% lower at the post-intervention assessment than at the baseline (P<0.001), with a reduction in the frequency of each type of entry lesion investigated. In the year the patients were in the CHBC programme, 30% fewer of them experienced at least one attack of adenolymphangitis (ADL; P<0.001), the mean number of ADL attacks/patient was lower (P<0.001), and the mean duration of each ADL attack suffered was slightly shorter (5.70 v. 5.84 days; P>0.05) than in the year before the baseline assessment. The reduction in the incidence of ADL attacks was greatest in the patients with the higher grades of lymphoedema. Approximately 66% of the patients perceived an improvement in their swollen limb post-intervention. Eleven patients had grade-II lymphoedema at baseline but only grade-I lymphoedema after being on the CHBC programme for a year (P=0.012). The programme appeared to increase the frequencies with which patients followed each of the limb-care measures considered and most of the measures for the home management of ADL attacks that were investigated. It is recommended that the CHBC programme be implemented as a national programme in Sri Lanka.

Challenges Facing Community Home Based Care Programmes in Botswana

This study examines the role of Community Home-Based Care in Botswana for people with HIV/AIDS and those with other terminal illnesses. Kerkhoven and Jackson (1995) attribute the popularity of Community Home-Based Care (CHBC) programmes in the developing countries to high rates of HIV/AIDS. Botswana has adult HIV/AIDS prevalence rate of 37 per cent and over 350,000 people living with HIV/AIDS. Rapid rise in incidences of HIV/AIDS has hence resulted in increasing need for CHBC and thus many CHBC services have been established through disorganized and fragmented manners. This paper is an extended literature review. It identifies and discusses challenges facing CHBC programmes in Botswana. The findings indicate that poverty, high cost of community care, inadequate medical facilities, poor infrastructures and socio-cultural issues have threatened the sustainability of CHBC programmes in Botswana. Recommendations and policy options are discussed.

Community impact of HIV status disclosure through an integrated community home-based care programme

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities; of these, 211 and 586, respectively, were in the ICHC programme (thus representing the ICHC-served group) and 152 and 442, respectively, were not in the programme (representing the non-served or control group). The micro-community group served by the ICHC programme reported significantly more positive attitudes towards HIV, better knowledge of HIV, fewer instances of sexually-transmitted infections, a tendency for fewer sexual partners, and less perceived risk of acquiring HIV than the non-served micro-community group. Also, the micro-community served by the programme did not show significantly better uptake of voluntary counselling and testing than did the non-served micro-community. There was no difference in condom-use between the two groups.

Lymphoedema and its management in cases of lymphatic filariasis: the current situation in three suburbs of Matara, Sri Lanka, before the introduction of a morbidity-control programme

Using in-depth interviews, information on the current state of lymphoedema management was collected from 101 cases of lymphatic filariasis with lymphoedema in three suburbs of Matara. The interviews were conducted prior to the introduction of a programme of community home-based care (CHBC) that incorporates modern lymphoedema-management strategies. Thirty-two of the interviewees had severe lymphoedema (of grade III or above). The male interviewees had significantly more entry lesions than the female. Most of the subjects had suffered from episodes of limb pain with fever, although the incidence of these episodes appeared unrelated to the severity of the lymphoedema. The frequency of the episodes of limb-pain/fever in the 12 months prior to the interviews appeared unrelated either to the level of daily hygiene, which was generally poor, or to the frequency of bathing. Many (65%) of the subjects paid no attention to limb care when bathing, and 44% did not use footwear. Over 80% made no effort to keep their afflicted limbs elevated, and 95% did not exercise. Most of the female interviewees felt shameful of their condition and were, in consequence, less likely to attend government clinics, for treatment, than the male interviewees. The drug treatment that the interviewees had received was often inadequate, and most had stopped seeking treatment because they had not perceived any significant treatment-attributable improvement in their condition. Modern lymphoedema-management strategies (based on regular washing, careful drying, and treatment, with antifungal, antibiotic or emollient creams, of the affected limbs, limb elevation, exercise, and use of footwear) had not reached the study communities and the local physicians were not aware of them. When dermatology life-quality indexes (DLQI) were calculated for the interviewees, the 26 most impaired subjects gave scores of 5-15 (mean=8.6). The DLQI for these subjects will be regularly re-evaluated, as a measure of the effectiveness of the CHBC programme that has now begun.

Effects of the AIDS epidemic and the Community Home-Based Care programme on the health of older Batswana

Several recent studies have focussed on the needs and problems of different demographic groups pertaining to the HIV/AIDS epidemic in Botswana. However, none has paid particular attention to the impact of the epidemic on older persons, with specific reference to the Community Home-Based Care (CHBC) programme. This paper examines the experience of older Batswana of the AIDS epidemic, briefly describes the nature of the CHBC programme, and critically examines the social-psychological, economic and health implications of the programme for older persons, with specific reference to their role as primary caregivers to persons with AIDS and AIDS orphans. The dynamics of problems of the CHBC programme are analysed and solutions to the problems are suggested.