Knowledge and practices about multidrug-resistant tuberculosis amongst healthcare workers in Maseru

Background: To date; no study has been found that described the knowledge and practices of healthcare workers surrounding multidrug-resistant tuberculosis (MDR-TB) in Lesotho.Aim and setting: This study was conducted to fill this gap by investigating the knowledge level and practices surrounding MDR-TB amongst healthcare workers at Botsabelo Hospital in Maseru; Lesotho.Method: This was a cross-sectional survey conducted by means of a questionnaire designed specifically for this study. Data collected included sociodemographic and professional details; and responses to questions about knowledge and practices regarding MDR-TB. The questions ranged from the definition of MDR-TB to its treatment. Respondents' practices such as the use of masks; guidelines and patient education were also assessed. Results: A response rate of 84.6%(110 out of 130) was achieved. The majority of participants were women (60%); married (71.8%) and nursing staff (74.5%). Overall; less than half (47.3%) of the participants had a good level of knowledge about MDR-TB. With regard to practice; about 83%of participants stated that they used protective masks whilst attending to MDR-TB patients. About two-thirds (66.4%) reported being personally involved in educating patients about MDR-TB; whilst about 55%stated that they referred to these guidelines.Conclusion: The level of knowledge about MDR-TB amongst healthcare workers at the study site was not at an acceptable level. Unsafe practices; such as not wearing protective masks and not referring to the MDR-TB treatment guidelines; were found to be associated with an insufficient level of knowledge about MDR-TB. An educational intervention is recommended for all healthcare providers at this facility

Tuberculosis and lactic acidosis as causes of death in adult patients from a regional hospital in Johannesburg

Background: Tuberculosis and adverse effects have been shown to affect both the quality of life and the survival of patients on antiretroviral treatment. This study sought to investigate the causes of death in a sample of adult HIV-infected patients on antiretroviral treatment at Thembisa Hospital, Johannesburg, South Africa. Methods: A retrospective study was conducted by examining the charts of 498 adult patients treated from January 2004 to December 2006 at the antiretroviral clinic of a regional hospital in Johannesburg. A data collection form was used to collate both sociodemographic and clinical data. Results: The majority of the patients were female (71.7%) with a mean age of 37.7 ± 11.6 years, and in the age group of 18­77 years. The greater number of the patients was South African citizens, with only 2.2% citizens of other Southern African countries. At baseline, 29.9% had been on anti-tuberculosis treatment. Most of the patients had been prescribed the regimen comprising stavudine, lamivudine, and nevirapine or efavirenz; two of them (0.4%) were on the second line regimen made of zidovudine, didanosine, and lopinavir­ritonavir. At least one side effect was documented in 82.1% of patients; the ten most documented side effects were skin rashes (62.9%), peripheral neuropathy (48.4%), headaches (38.2%), chest pain(21.9%), coughing (21.7%), anaemia (21.5%), diarrhoea (19.3%), vomiting (16.7%), dizziness (15.3%), and lactic acidosis (11.2%). A mortality rate of 3.6% was recorded during the 2-year study period. Although the cause of death was undetermined in 11.1% of patients, 50.0% and 38.9% of deaths respectively were a consequence of tuberculosis and lactic acidosis. Conclusions: In addition to tuberculosis, side effects in particular, lactic acidosis was the other main cause of death in patients treated at the study site. These findings suggest that patients on regimens containing drugs that cause lactic acidosis should be closely monitored when the first complaints suggesting lactic acidosis are reported or noticed