Institutional tuberculosis infection control in a rural sub-district in South Africa: A quality improvement study

Background: Tuberculosis (TB) is a major global health challenge, and South Africa is one of the high-burden countries. A national TB infection control (TBIC) guideline has stipulated three areas of infection control at health facilities: work practice and administrative control, environmental control, and personal protection for health workers. Aim: The aim of this study was to identify the gaps and address the challenges in institutional TBIC. Setting: The district hospital and a primary health care clinic within the Mossel Bay sub-district in the Western Cape. Methods: According to the national TBIC draft guideline, a quality improvement cycle was used to evaluate and improve TBIC. Each facility had an existing infection and prevention control and occupational health and safety team, which were used as the audit teams. Results: A baseline assessment was followed by a set of interventions, which did not show a significant improvement in TBIC. The difference between the pre- and post-intervention TB screening rate was not statistically significant. An assessment of time interval between 101 patients presenting with TB symptoms and diagnosed with TB was 4 days at baseline and post-intervention. Most of the anticipated improvements were dependent on the health workers' adherence to the local TBIC policies, which emerged as an unexpected finding. Conclusion: We found good managerial commitment reflected by the presence of various policies, guidelines, specific personnel and committees to deal with infection control in general. This study has created awareness about TBIC among staff and pointed out the complexity of health workers' behaviour towards adhering to policies

Pattern and Magnitude of Treatment Delay among TB Patients in Five States in Southern Nigeria

Prompt diagnosis and early treatment of Tuberculosis (TB) cases is an important strategy in TB prevention and control. Thus; passive case finding of TB suspects; sputum examination for diagnosis; and prompt treatment using Directly Observed Treatment Short Course (DOTS) are key elements in the national guideline for TB control programme. The aim of this study is to determine the time interval between diagnosis of smear-positive TB cases and the commencement of treatment in DOTS facilities in southern Nigeria. The study was carried out in 20 healthcare facilities supported by TB Control Assistance Program (TB-CAP) involved in TB management in southern Nigeria; which comprised tertiary; secondary; and primary healthcare facilities including public and private facilities. Data were collected through review of clients' and facility records covering July-September 2009. Data collected were sociodemographic characteristics; sputum-smear result; date of diagnosis; and date of commencement of treatment. Data were analyzed using SPSS version 15.0 software. Of the total 2;507 TB suspects examined for Acid-Fast Bacillus (AFB); 323 were diagnosed to be Sputum-Smear-Positive (SS+ve); However; 269 new smear positive cases were commenced on treatment within the period; thus 54 (17.0) of the new SS+ve cases defaulted initially. One hundred and two (38) of them commenced TB treatment within 3 days of smear examination for diagnosis; while 59 (22) commenced 4-6 days after diagnosis. The study revealed significant delay in commencement of TB treatment for most new smear positive TB cases in southern Nigeria and underlines the need to further explore factors responsible for delay in commencement of TB treatment following diagnosis

Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug­ and extreme drug-resistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with 'low cure' and 'high MDR' rates. Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens. Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities. Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50 (56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%). Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance

Methods of sputum decontamination with emphasis on local tuberculosis laboratories

One of the major goals for the global control of tuberculosis (TB) in humans is the laboratory diagnosis of Mycobacterium tuberculosis the causative agent of TB. This organism is present in sputum specimens which are often contaminated by other fast growing microflora. Therefore; the use of rapid and effective diagnostic methods for optimal detection of Mycobacterium tuberculosis is required through different decontamination methods. This review considers some of the decontamination methods that have been described for the recovery of M. tuberculosis based on published print and electronic articles. Some of these methods have limitations which may make them unsuitable for use in most local laboratories in the developing world; and these include unavailability of essential reagents and materials; cost of acquiring equipment; lack of skilled personnel and undue delay in the time of processing samples. Despite these challenges; there are some methods that have potentials of being adapted for use in clinical mycobacteriology laboratories in developing countries particularly Nigeria. With the correct laboratory logistics put in place; the simplified concentration; Kudoh-Kudoh; and modified Petroff methods may go a long way in achieving effective sputum decontaminations under local setting. The potentials and challenges of using other decontamination methods are discussed

Tuberculosis Registers in Africa: a Review

N/A

Tuberculosis Registers in Africa: a Review

N/A

Tuberculosis in Cameroon (2003-2008)

Background Cameroon re-established a National Tuberculosis Control Programme (NTCP) in 1997.The NTCP was restructured and recognized as a priority programme in 2002. Objective to present the organisation of the NTPC and the evaluation of its control activities from 2003 to 2008 after it's restructure. Design information and data were collected from TB policy documents of the Ministry of Health and from annual activity reports of the NTCP and analysed. Major achievements in TB control are highlighted and weaknesses and gaps identified .Results- The NTCP in a vertical programme with its activities organized at three levels .Forms 2003 to 2008; the number of detected smear positive pulmonary TB (ss+PTB) cases increased from 10;661 to 14;232 and that of TB from of 16;478 to 25;107 cases .The treatment success rate for new ss+PTB cases rose from 73in 76in 2007.The TB/HIV co-infection rate in 2008 was 40and 36for all forms of TB and for new ss+ PTB cases respectively. TB in prison is a major public health problem and multi -drug resistant TB (MDR-TR) is emerging .Several weaknesses and gaps in the programme have been identified. Conclusion: The activities of the NTCP from 2003 have been quite successful particularly in the area of the detection of new ss+PTB cases which has suppassed the 70target set by the programme.Treatment success rates even though improving fall below the 85NTCP target. The NTCP has several weaknesses and gaps which have to be tackled to make it more efficient. However the most important challenge remains a reliable source of funding to guarantee the programme's activities

Management of TB in the Private Sector in Khartoum; Sudan: Quality and Impact on TB Control

Introduction: Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state; whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1of the interviewed physicians correctly mentioned the TB treatment regimens; only 8(12.3) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly; only 10(15.4) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector

Success of the Control of Tuberculosis in Nigeria: a Review

Tuberculosis (TB) has emerged as the single leading cause of death from any single infectious agent and has continued to be a major public health problem all over the world. Of the over 14 million cases worldwide reported by World Health Organisation (WHO) in 2008; Nigeria ranked fifth in terms of incidence. Depending on the prevailing social factors such as socio-economic status of the people; malnutrition; crowded living conditions; incidence of HIV/AIDS; level of development of health infrastructures; quality of available control programmes; degree of drug resistance to anti-tuberculous agents; etc; prevalence; patterns of presentation; and outcomes of treatment from TB can vary from one country to another and from one region of a country to the other. Attempts to deal with the problems of the disease led to the development of Directly Observed Treatment Short Course (DOTS) by WHO in 1995; and more recently the Stop TB strategy in 2006. In Nigeria; the DOTS programme has been implemented in all States and local government areas in the country and 3;000 DOTS centres have been operating across the country since 2006. This article reviewed the available information on the success of the control of TB in Nigeria has observed a significant improvement in TB detection and treatment. However; neither the set target for the detection rate nor the cure rate have been achieved nationally as several challenges have militated against the effective implementation of the DOTS programme

History of TB in the Sudan

Introduction: Medical history in Sudan is far from being complete. There are no reliable records.Attempt to write on the projects and development of history of TB in the Sudan is a difficult task.Objective:To study and trace the progress of TB in Sudan during the last century through their historical development.Design: A retrospective study.Methods:Data were collected from the annual reports of the Sudan Medical Services.Libraries and a number of previous studies were consulted.Results: The route of entry of TB in the Sudan is mainly from the North.The South was virgin from TB up to 1930s. Northern Sudanese tribes have a high susceptibility and incidence of TB during 1925-1932 (3.7/1000). The south and the Nuba Mountains were almost free from infection or disease. The infectivity rate was highest in North 4.3while Khartoum showed 3. In the South;Rumbek district; no TB cases were reported before the age of puberty up to 1930.Prevalence of tuberculosis in 1959/1960 was 26.0and the detection rate was only 30.Conclusion: Northern Sudanese contracted tuberculosis while serving in the Egyptian army and cities. The Southern and Western tribes who were almost free from TB infection became highly susceptible to both infection and disease. The infectivity rate remains static during the last 50 years

A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults

Background : Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods : Literature on TB; HIV and their co-infection; especially in sub-Saharan Africa; including Nigeria; is reviewed. Results : Burden of TB is fueled by the HIV epidemic; and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality; while the principles of TB prevention in HIV infection can be summarized with the three I's: intensive TB case finding and surveillance; isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth 'I;' viz.; instituting ART. Clinical complications like drug resistance; toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT; IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa; and appropriate measures are recommended. Conclusions : Many barriers exist for optimizing the care of the two diseases; but the aim should be strengthening capacities; collaborations; linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented

Implementing a community-based tuberculosis programme in the Omaheke region of Namibia: nurses' perceived challenges

Tuberculosis (TB) is a resurgent disease in many regions of the world; including Namibia; fuelled by poor TB control programmes; human immunodeficiency virus (HIV) and poverty. The purpose of this survey was to identify nurses' perceived challenges in implementing a community-based TB programme in the Omaheke region of Namibia. Structu- red interviews were conducted with 40 nurses involved in providing TB treatment and care in the Omaheke region. Patient-related challenges which hampered TB treatment included alcohol and drug abuse; poverty and stigma. Lack of transport for nurses to do community-based TB work; centralised TB services and patients' lack of transport were access-related challenges. Knowledge-related challenges involved a lack of TB knowledge by both nurses and community members. The HIV pandemic has increased the number of TB patients and increased nurses' workloads; aggravating the burden of TB as a resurgent disease in this region. Decentralisation of TB care to community and family levels would be necessary to reduce the number of people with active TB in the community; and to enhance the TB cure rates; in the Omaheke region of Namibia. In order to implement a successful communitybased TB programme; the patient-related; access-related and knowledge-related challenges; perceived by the nurses; need to be addressed effectively

Knowledge; Attitudes and Compliance With Tuberculosis Treatment; Lusaka; Zambia

More than 1.5 million TB cases occur in sub-Saharan Africa every year. Lack of compliance to TB treatment has contributed to the steady rise of TB incidence in Zambia. The prevalence of TB was 511 per 100;000 populations in 2000. Much of the increase in incidence has been attributed to co-infection with HIV; there are HIV rates of 70-80in TB patients Objectives: To determine knowledge; attitude and compliance with TB treatment by PTB patients attending chest clinic at a tertiary hospital. Design and Measures: A descriptive study was conducted on a convenience sample of 104 pulmonary PTB patients receiving health care at chest clinic of a tertiary hospital in Lusaka; Zambia. An Interview Schedule comprising of four sections (d e m o g r a p h i c ; k n o w l e d g e ; a t t i t u d e ; a n d compliance) was used to collect data. Results: A total of 104 respondents aged 18 to 66 years took part in the study. Forty-nine percent were female; 51.9were married and 42.3had primary education only. About half of the respondents (49) had no monthly income and majority of those with no income were female. Two thirds of the respondents (76) lived in high-density areas. Half of the respondents (49) had average knowledge of TB treatment. Majority of the respondents (89.4) had positive attitude towards TB treatment rating high in all the attitude subscales; 74in commitment; 84.6in challenge and 55.8in control. Most of the respondents' (80.8) reported complying with TB treatment regimens. There was a positive relationship between compliance and attitude; indicating that as the level of attitude increases; compliance level also increases (r = 0.59; p 0.001). The results further showed that there was a significant positive correlation between knowledge and attitude (r

Prevention and Control of Tuberculosis

Tuberculosis is again becoming a major public health problem. In order to control this complex disease; case-management; chemoprophylaxis and vaccination are used. The aim of case-management is to virtually stop transmission of tuberculosis infection by multidrug chemotherapy. This is; however; hampered by poor drug compliance and the high cost of the most effective drugs. Bacilli-Calmette-Guerin (BCG) vaccination has been used for a long time but with contentious efficacy. Though recent studies put the efficacy at 50; its cost-effectiveness has yet to be established. Isoniazid preventive therapy (1PT) for control of tuberculosis is also rapidly gaining acceptance. In patients who adhere to 80of medication taken; the efficacy is usually high. As for the control of tuberculosis among health care workers; engineering; administrative and personal respiratory measures have been introduced. Following the introduction of these measures in USA; dramatic decline in the risk of tuberculosis among these workers has occurred

Mycobacterial Drug Resistance in Uganda

This study was to determine the level of initial anti-tuberculosis drug resistance in Uganda; and to establish a routine system of surveillance for resistance. In conclusion the results here demonstrate a relatively low prevalence of initial drug resistance in Uganda. Multi-drug resistance was rare. With effective TB treatment; especially with DOTS; it should be possible to maintain these low rates. The results will be discussed in relation to other previous findings and the implications for the NTLP will be emphasised

La lutte antituberculeuse au Togo

Au Togo; la lutte contre la tuberculose s'organise a trois niveaux: central; regional et prefectoral. L'effort de l'Etat est soutenu par la DAHW dans cette organisation

Manual of the National Tuberculosis Control Programme in Ghana

This is a manual of the National Tuberculosis Control Programme. It gives an account of what the disease is; modes of transmission; and ways to combat the disease