Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study.

BACKGROUND: Tuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions. METHODS: The study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis. RESULTS: The overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835-2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21-30 years old (aOR = 1.643, 95% CI = 1.005-2.686, p = 0.048), 31-40 years old (aOR = 1.725, 95% CI = 11.026-2.9, p = 0.040), 41-50 years old (aOR = 2.003, 95% CI = 1.155-3.476, p = 0.013) and 51-60 years old (aOR = 2.106, 95% CI = 1.228-3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy. CONCLUSION: The study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.

Corn? When did I eat corn? Gastrointestinal transit time in health science students.

The objective of this study was to determine gastrointestinal transit time in first-year health science students with a laboratory practical exercise conducted in two cohorts (classes of 2018 and 2019) of first-year health sciences students at the Health Science Campus in Windhoek, Namibia. All first-year health science students undertaking the Physiology course were invited to take part in the laboratory exercise. The primary outcome was the measurement of gastrointestinal transit time from the amount of time taken for ingested whole-kernel sweetcorn to be eliminated, which was calculated as the time period between ingestion of corn and the time of corn first seen in the stool and the time corn was last seen in the stool. The secondary outcome was an association between emotional irritability and/or anxiety and gastrointestinal transit time. The study analyzed responses of 175 students, who reported a median transit time of 29 (1-99) h. There was no difference in gastrointestinal transit time between male and female students. Likewise, there was no difference in the duration of the corn in the bowel between male and female students. Students who reported being worried and irritable during the exercise had more bowel movements before they saw corn in their stool and had slower transit times, respectively. A wider range of transit time was reported in a group of young, healthy students compared with previous studies in the literature. There were no differences between male and female student bowel activity. Anxiety did impact the bowel activity of the participants.