Tuberculosis among health care workers in hospitals in the Ethekwini Municipality of KwaZulu-Natal.
Tuberculosis is a disease of global importance and remains the leading cause of death in the developing world. In South Africa a weak notification system and poor occupational health services for health care workers has resulted in little information being available about the incidence of tuberculosis and the groups at highest risk of contracting tuberculosis amongst health care workers, the clinical presentation and management of workers infected with tuberculosis. The purpose of this study was to describe the incidence of tuberculosis, and the clinical and public health aspects of the management of tuberculosis among health care workers in eight public sector hospitals in the Ethekwini Municipality of KwaZulu-Natal. Data was collected through a retrospective review of hospital records for the study period January 1999 to June 2004. Study findings: Five hundred and eighty three (N=583) health care workers were diagnosed with tuberculosis for the period under review. The mean age of the HCWs was 38 years (95% Cl: 37-39). The mean cumulative incidence for the study period was 1040/100 000 HCW population (95% Cl: 838-1242). The mean cumulative incidence of TB was highest in males (1544/100 000 HCW population; 95% Cl 1228 -1859), the age group 25 to 34 years (1043/100 000 HCW population; 95% CI: 650 -1436) and in paramedical staff (1675/100 000 HCW population; 95%CI: 880-2470). The majority of health care workers presented with pulmonary tuberculosis (77%, n=322) and 3% (n=13) had multidrug resistant tuberculosis. Successful treatment outcomes were achieved in 63% (n=334) of health care workers. Only one hospital has a work place policy with regard tuberculosis in health care workers. Compensation for this occupational disease was sought as follows. Submissions of a first medical report were made in 107 (18%) of the 583 health care workers. In the 107 cases initially reported submission of progress reports (n=75; 70%) and final reports (n=60; 56%) decreased considerably. In conclusion, the incidence of tuberculosis in health care workers has increased annually since 1999 and the treatment outcomes among health care workers do not reach the targets set by the National Tuberculosis Control Programme. Recommendations based on the study findings include establishing a uniform provincial policy for the prevention and reduction of tuberculosis infections among health care workers for implementation in hospitals; the implementation of a medical surveillance system for health care workers with respect to tuberculosis and a provincial training programme for staff on the clinical and administrative management of TB in health care workers.