Tuberculosis among health care workers in hospitals in the Ethekwini Municipality of KwaZulu-Natal.
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Date
2006
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Abstract
Tuberculosis is a disease of global importance and remains the leading cause
of death in the developing world. In South Africa a weak notification system
and poor occupational health services for health care workers has resulted in
little information being available about the incidence of tuberculosis and the
groups at highest risk of contracting tuberculosis amongst health care workers,
the clinical presentation and management of workers infected with tuberculosis.
The purpose of this study was to describe the incidence of tuberculosis, and
the clinical and public health aspects of the management of tuberculosis among
health care workers in eight public sector hospitals in the Ethekwini Municipality
of KwaZulu-Natal. Data was collected through a retrospective review of hospital
records for the study period January 1999 to June 2004. Study findings: Five
hundred and eighty three (N=583) health care workers were diagnosed with
tuberculosis for the period under review. The mean age of the HCWs was 38
years (95% Cl: 37-39). The mean cumulative incidence for the study period
was 1040/100 000 HCW population (95% Cl: 838-1242). The mean
cumulative incidence of TB was highest in males (1544/100 000 HCW
population; 95% Cl 1228 -1859), the age group 25 to 34 years (1043/100 000
HCW population; 95% CI: 650 -1436) and in paramedical staff (1675/100 000
HCW population; 95%CI: 880-2470). The majority of health care workers
presented with pulmonary tuberculosis (77%, n=322) and 3% (n=13) had multidrug
resistant tuberculosis. Successful treatment outcomes were achieved in
63% (n=334) of health care workers. Only one hospital has a work place policy
with regard tuberculosis in health care workers. Compensation for this
occupational disease was sought as follows. Submissions of a first medical
report were made in 107 (18%) of the 583 health care workers. In the 107
cases initially reported submission of progress reports (n=75; 70%) and final
reports (n=60; 56%) decreased considerably. In conclusion, the incidence of
tuberculosis in health care workers has increased annually since 1999 and the
treatment outcomes among health care workers do not reach the targets set by
the National Tuberculosis Control Programme. Recommendations based on
the study findings include establishing a uniform provincial policy for the
prevention and reduction of tuberculosis infections among health care workers
for implementation in hospitals; the implementation of a medical surveillance
system for health care workers with respect to tuberculosis and a provincial
training programme for staff on the clinical and administrative management of
TB in health care workers.
Description
Thesis (M.Med.)-University of KwaZulu-Natal, 2006.
Keywords
Tuberculosis--Epidemiology., Hospitals--Employees--Diseases--Epidemiology., Theses--Public health medicine.