THE RISE OF DRUG-RESISTANT TUBERCULOSIS IN SOUTHERN AFRICA: ARE WE LEARNING FROM HISTORY OR REPEATING IT?
Journal Title:International Journal of Medical Studies
Background and Objective
The tuberculosis epidemic has reached astronomic and emergency proportions, particularly in Southern Africa, despite efforts by key stakeholders in implementing necessary control strategies. The diagnosis of TB is still based on smear microscopy in many parts of Africa while the emergence of drug-resistant TB is increasing. We are reporting on the outcomes of samples received in a TB reference laboratory in Swaziland and results from an assessment of non-clinical staff’s knowledge, attitudes, and beliefs towards TB and IPC related issues in public health facilities in South Africa.
A self-administered close-ended questionnaire was used to collect cross-sectional data among non-clinical staff in 5 public hospitals in KwaZulu-Natal between April 2011 and November 2011. In a TB reference laboratory in Swaziland, using MGIT automated instrument, sputum samples were screened for TB from June 2011 to December 2011. Positive cultures were confirmed as MTB complex using ZN smears and TB Ag MPT64 and then, the drug susceptibility testing was done on RIF, INH, Streptomycin, and Ethambutol using the 1% proportion method.
Of the 79 non-clinical staff, 67.4% were of the opinion that a surgical face mask protects the wearer from contracting TB while 44.3% did not understand the rationale behind triage and fast-tracking of patients in the TB control program. Of great concern, 25% of non-clinical respondents perceived no risk of contracting TB in the hospital environment and believed that TB was caused by drinking and smoking. Whilst 10% of these respondents desperately felt that there is no means of protection against TB; they also expressed that there is no need to implement a screening program for staff.
Samples were obtained from 6163 patients of which 22.3% were culture positive and of these culture positives, 90% were MTB complex and 10% were NTM. Among patients diagnosed with TB, 52% were smear-positive and 48% were smeared negative. Sixty-six percent of these cases were MDR follow up cases with 3.4% relapse cases, and 4.5% failure to convert.
While knowledge of staff about TB Infection Control is still very low, DR-TB cases are increasing. The study underlines the need to prevent DR-TB by bridging knowledge gaps among HCWs and the necessity to improve laboratory capacity to support TB control efforts.