Prevalence of multi-drug resistant tuberculosis and the associated risk factors at a tuberculosis outpatient facility in Durban, South Africa.
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Date
2011
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Abstract
Introduction
Tuberculosis (TB) is a major cause of death worldwide. Control of Tuberculosis is a
serious challenge to global health. A new and potentially devastating threat to TB
control is the emergence of multi-drug resistant TB (MDR-TB). South Africa was
ranked fourth among the countries with the highest number of confirmed MDR-TB
cases.
Aim
The aim was to investigate the annual MDR-TB prevalence and associated risk
factors for MDR-TB from 2001 to 2007 at the Prince Cyril Zulu Communicable
Disease Centre. To investigate previous TB treatment duration, previous TB
treatment outcome, and duration of previous TB treatment interruption in a subgroup
of patients who were previously treated for TB. To determine the average length of
time from diagnosis of TB to diagnosis of MDR-TB and commencement of MDR-TB
treatment.
Methods
An observational analytic nested case-control study design was used. All patients
who were diagnosed with pulmonary TB and who had a sputum culture performed
between 2001 and 2007 were included in the study. The cases were all MDR-TB
cases diagnosed on sputum culture between 2001 and 2007. The controls were
drug susceptible TB cases which had a sputum culture done at diagnosis, and were
diagnosed in the same month as the MDR-TB case
Results
There were 10 205 sputum cultures performed from 2001 to 2007. MDR-TB was
found in 445 patients. An increase in the prevalence of MDR-TB occurred in 2007,
due to a significant increase in prevalence among new TB cases. The MDR-TB
prevalence was 11.7% among new TB cases and 4.7% among previously treated
TB cases in 2007. There was no significant association between demographic
characteristics and MDR-TB. Previous TB treatment failure and a duration of
previous TB treatment of greater than 32 weeks was found to be significantly
associated with MDR-TB. The median time from TB diagnosis to MDR-TB diagnosis
was 98 day and from MDR-TB diagnosis to MDR-TB treatment 10 days.
Discussion
Delays in the diagnosis of MDR-TB, long waiting times before MDR-TB treatment
commencement and lack of isolation have contributed to the spread of primary
MDR-TB and was most likely responsible for the increase in prevalence of MDR-TB
among new TB cases.
Recommendations
It was suggested that a sputum specimen should be obtained for culture and
sensitivity from all new TB patients in areas which have an MDR-TB prevalence of
greater than 3% among new TB patients.
Ensure patient education on basic infection control measures.
Improve MDR-TB diagnosis and reduce waiting times for MDR-TB treatment.
Description
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.
Keywords
Multidrug-resistant tuberculosis., Hospitals--Outpatient services--KwaZulu-Natal--Durban., Tuberculosis--KwaZulu-Natal--Durban., Tuberculosis--Hospitals--KwaZulu-Natal--Durban., Theses--Public health.