High rates of TB and HIV infection in sub-Saharan Africa increase the risk of healthworkers of catching TB from their patients. In mid-1998, Malawi’s National Tuberculosis Control Programme produced guidelines for hospitals on TB control. Are hospitals sticking to the guidelines? Are they having any effect?
Each hospital received a copy of these guidelines and held a seminar on them for healthworkers. The guidelines include:
- rapidly diagnosing people with the most infectious form of TB infection in the lungs
- attempting to isolate infectious patients
- educating patients about cough hygiene
- offering confidential counselling and HIV testing to staff.
A year later, researchers from the Programme returned to all 40 district and mission hospitals to assess the impact of the guidelines. They found that:
- In over 90 per cent of hospitals, ward staff say they have introduced a system of rapid sample collections. Laboratory workers say that they process these samples promptly.
- However, limited laboratory staff and facilities mean that only 35 per cent of laboratories test samples five days a week.
- Over 70 per cent of hospitals follow guidelines about ventilation and cough hygiene education.
- Hospitals are less successful in scheduling chest x-rays for quiet times and requiring TB patients to wear face masks.
- Introduction of the guidelines has not reduced the interval between admission and TB diagnosis, which is usually around four days, with treatment starting a day later.
- 3.2 per cent of healthworkers were registered with TB in 1999. This is higher than the rate of 1.8 per cent among 4367 primary school teachers in the same year. 3.2 per cent of healthworkers in 1999 is little different to the rate in 1996 (3.7 per cent).
In settings where resources are very scarce, rapid diagnosis of infectious TB is one of the most important ways of reducing spread of the infection. So what can hospitals in poorer countries do to protect their staff from TB? Recommendations include:
- providing additional support for the hospitals beyond written documents and a one-off seminar
- appointing an individual or committee to be responsible for infection control procedures
- employing more laboratory staff to run tests on samples every day
- setting up occupational health and safety services, including confidential voluntary counselling and care for healthworkers with HIV
- allocating work away from general wards and TB wards for HIV-positive healthworkers.
Source(s):
‘Preventing tuberculosis among health workers in Malawi’, Bulletin of the
World Health Organization 80 (7): 526-531, by A. Harries, N. Hargreaves, F.
Gausi, J. Kwanjana and F. Salaniponi, 2002
Funded by:
UK Department for International Development; Norwegian Agency for
Development Co-operation; Royal Dutch Tuberculosis Association
id21 Research Highlight: 24 October 2002
Further Information:
Anthony Harries
National Tuberculosis Control Programme
Community Health Science Unit
Private Bag 65
Lilongwe
Malawi
Contact the contributor: adharries@malawi.net
National Tuberculosis Control Programme, Malawi
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