A Study to Determine the Contributing Factors to the High Prevalence of Tuberculosis among Nurses in the University Teaching Hospital in Lusaka, Zambia
Chanda, Dorothy Chinwendu Osigwe
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This study was undertaken in order to identify the contributing factors to the high prevalence of Tuberculosis among nurses in UTH in order to design strategies for prevention of tuberculosis among nurses. It was noted that the rate of tuberculosis morbidity and mortality among nurses was increasing drastically. UTH personnel records showed that 8 nurses were treated successfully from tuberculosis between 1982 to 1984 when the nurses population was 1045. Comparatively, between 1993 to 1995, 64 nurses died from tuberculosis when the nurses population decreased to 849. So proportionately more nurses are dying now than before. The objectives of study were:-•To identify both service and community factors that contribute to nurses developing tuberculosis.•To establish the opinion of nurses towards tuberculosis prevention.•To make recommendations to policy-makers regarding prevention strategies.Literature reviewed were based on issues like socio-economic factors, management of tuberculosis patients and care of the health care providers.The study was conducted at University Teaching Hospital in Lusaka with an establishment of 2656 workers. Data was collected using self-administered interview schedule, retrospective record review, observation of infection, prevention and control measures in the hospital and focus group discussion with 12 nurses.Results showed that socio-economic factors did not significantly affect the outcome of tuberculosis, confirming the correct status of unconventional tuberculosis. There was irregular supply of items required to maintain basic hygiene practices. Mycobacterium tuberculosis was isolated from nursing care equipment like suction tubing, a pillow and a locker in ward environment. Focus group discussions showed that nurses believe that instituting primary preventive measures and better nutrition schedule are much more important and meaningful than ward rotations as one can be rotated from one high risk ward to another. The study also showed that the level of exposure does determine the outcome of tuberculosis (P. value 0.0107868). Illustrated in the study is the fact that BCG does not guarantee protection against the acquisition of tuberculosis among nurses (P. value 0.04238011).Retrospective case review showed that 4 (80%) out of 5 tuberculosis patients who defaulted had a relapse which could have been a multi-drug-resistant tuberculosis which is easily transmissible and difficult to treat.The study also found out that, community and health-care work place factors seem to synergistically contribute to nurses acquiring tuberculosis. It was noted, though, that sometimes when the factors are analysed singly, they seem not to affect the outcome of tuberculosis. It is for this reason that recommendations made for preventing and controlling tuberculosis should be multi faceted embracing the strengthening of the capacity of the health care delivery system to identify multi-drug resistant strains of mycobacterium tuberculosis in patients with tuberculosis relapse, improvement of the infection prevention measures in the health-care work place, abiding by the recommendations of the HICC, proper patient management and follow-up in the community and updating nurses knowledge on the latest issues on tuberculosis and caring for the carers by the hospital management board.
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