The treatment outcomes of tuberculosis among health care workers in a general hospital in the Mpumalanga province, South Africa

Background: South Africa is one of the countries in the world with a high burden of tuberculosis (TB). High rates of unfavourable treatment outcomes have remained a feature of TB control in the country. The objective of the current study was to examine the treatment outcomes of TB among health care workers (HCWs) at a rural general hospital in the Mpumalanga province of the country, as well as the clinical care that was provided to the HCWs. The purpose of the study was to identify possible areas for improvement in the TB care services provided to HCWs in the hospital, especially with regard to their clinical management. Method: The research described in this article consists of a retrospective descriptive study. Relevant data on HCWs diagnosed with TB in the hospital during 2007, the TB care services offered to the HCWs, and the treatment outcomes of the HCWs were captured from the occupational health and TB control programme registers at the hospital onto a data capture sheet for the study and were subsequently analysed manually. Results: Nine HCWs, eight females and one male, were diagnosed and treated for TB in the hospital during 2007, an incidence rate of 941/100 000. Their ages ranged from 39 to 54 years, with a mean age of 48 years. By occupation, the nine HCWs consisted of six nurses (67%), one porter (11%), one general assistant (11%), and one clerk (11%). Of those treated for TB, seven (78%) had smearpositive pulmonary TB (PTB) and two (22%) had extra-pulmonary TB (EPTB). TB culture and drug susceptibility testing (DST) was undertaken for only one HCW. The HIV status was known for only two (22%) of the nine HCWs under review. Neither of the two HCWs with EPTB had the diagnosis confi rmed by bacteriological or histopathological method. The seven HCWs with smearpositive PTB achieved a cure, and the two HCWs with EPTB successfully completed treatment, resulting in a treatment success rate of 100% for the nine HCWs. Conclusion: The HCWs at Themba Hospital in the Mpumalanga province of South Africa who were diagnosed and treated for TB during 2007 all achieved favourable treatment outcomes. However, in view of the high rate of HIV/TB co-infection and the increasing problem of drug-resistant TB in the country, the clinical care provided to HCWs with TB by the hospital should be improved with regard to routine HIV counselling and testing and the routine early provision of DST. A protocol for the comprehensive management of HCWs with TB is currently undergoing development. Vol. 1 No. 1 Page 1 of 4 INTRODUCTION The risk of transmission of tuberculosis (TB), including drug-resistant TB, to health care workers (HCWs) in health care facilities where patients with the disease are diagnosed and treated is a recognised occupational hazard. Infection prevention and control procedures reduce, but do not completely eliminate, the risk of TB transmission in health care facilities.1, 2, 3 Studies in many countries with a high burden of TB have documented increased risk of TB infection and disease in HCWs, compared with the general population.1 The ongoing pandemic of human immunodefi ciency virus (HIV) infection has further worsened the risk situation for HCWs.2 South Africa is burdened with a high rate of TB.4, 5 High rates of unfavourable treatment outcomes, such as defaulting from treatment, treatment failure and death, have remained a feature of the TB control programme in the country. In particular, defaulting from treatment was reported as the main barrier to reaching the internationally recommended treatment success target of 85% in the country.4, 5 In South Africa, unfavourable treatment outcomes have been shown to be signifi cantly associated with increased risk for all forms of drug-resistant TB.6 A high prevalence of patients with unfavourable treatment outcomes could increase the risk of transmission of drug-resistant TB to HCWs in health care facilities. Between January 2004 and April 2007, 11 000 laboratory-confi rmed multidrug-resistant TB (MDR-TB) cases were reported in the country.4 At least 6 000 newly active cases of MDR-TB have been reported in the country each year.3 Community and nosocomial transmission of MDR-TB is reported to have been confi rmed in the country by epidemiological and molecular genetics studies.6 Drug-resistant TB, especially MDR-TB, is a recognised cause of failure of treatment with fi rst-line anti-TB drugs.3, 7, 8 Extensively drug-resistant TB (XDR-TB) carries very high mortality potential, especially among people with HIV/AIDS.9 The increased transmission of such forms of drug-resistant TB from patients to attending HCWs could result in an increased risk of unfavourable treatment outcomes, with cases of treatment failure and death among the HCWs concerned. The unfavourable TB treatment outcome of defaulting from treatment is a major public health concern. The management of TB, therefore, lays much emphasis on measures to ensure adherence to treatment.7 Due to HCWs being at increased risk of contracting drug-resistant TB which, in turn, increases their risk of unfavourable treatment outcomes, additional special diagnostic and therapeutic measures for aggressive Original Research Ukpe, Blitz, Hugo, Nkosi, Mpangane & McLaren PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e