- Title
- Short regimen in the management of multi drug resistant tuberculosis in Buffalo City Metropolitan, Eastern Cape, South Africa
- Creator
- Somfongo, Nomawethu Constance
- Subject
- Tuberculosis Disease management
- Date Issued
- 2019
- Date
- 2019
- Type
- Thesis
- Type
- Masters
- Type
- MPH
- Identifier
- http://hdl.handle.net/10353/16814
- Identifier
- vital:40776
- Description
- Tuberculosis is an epidemic disease which is regarded as the tenth leading cause of death in the world (World Health Organization, 2014). New 580 000 cases of multidrug resistant tuberculosis have been reported by WHO (2014). Patients diagnosed with rifampicin/multi-drug resistant tuberculosis were usually treated for 18-24 months if they convert within the designated period of 4-6 months. Several trials were conducted in other countries like Burundi, Cameroon, Central African Republic, etc. on the use of short regimen of 9-12 months. Short regimen was introduced in January 2017 in South Africa and it has not been evaluated for its effectiveness in Buffalo City Metropolitan, South Africa. This study was conducted to examine RR/MDR TB outcomes following the introduction of a short regimen and the outcomes were based on the set target of 50% MDR TB success rate and 5.4% TB client lost to follow up rate as per the Annual Performance Plan (APP) of 2017/18. The conversion rate was also examined though the target was not set in APP. A retrospective study using a descriptive design was used to collect data at Nkqubela TB and Duncan Village Day hospitals which are in Buffalo City Metropolitan. The population of the study were all records of patients diagnosed, registered and initiated on rifampicin/multi-drug resistant TB in a short regimen in Nkqubela TB Hospital and Duncan Village Day Hospital between January 2017 and July 2017. All 118 patient records that met the inclusion criteria were enrolled in the study therefore convenience sampling was used. Ethical approval was obtained from the University of Fort Hare (ethical clearance number: MUP101SSOM01). Approval to conduct the study was also approved by the Eastern Cape Department of Health Ethics, BCM Health District Manager and two public hospitals. Two research assistants and one data capture signed oath of confidentiality prior data extraction. Unique codes were used to ensure anonymity and privacy and all data was treated in a confidential manner. Data was collected using a self-designed structured questionnaire which was tested for validity and reliability through pilot study. Data analysis was done by a statistician using Statistical Packages for Social Sciences version 24. RR/MDR TB outcomes of participants who were initiated on short regimen between January and July 2017 were examined between January and July 2018 at the end of 12 months. Findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%) with males (n=71) being highly affected than females (n=47). Bisho/King William’s Town sub-district was the most affected in Buffalo City Metropolitan (n=61). The majority of participants that were affected were the Africans (98.3%), unemployed (51.7%), people living with HIV/AIDS (62.7%) and those previously treated for TB (57.6%). Records revealed that participants living with HIV had a mean CD4 count of 194.5 and 202.4 and mean viral load of 203183.0 and 651888.7. Smokers and alcohol users were higher in males (20.3% and 16.9% respectively) than in females (2.5% and 5.1% respectively). Two patient records were missing and other four patient records were incompletely recorded to determine data on smoking and alcohol consumption. Findings revealed a smear conversion rate of 68.5% excluding 47 participants who had negative baseline smear results and one participant who had extra-pulmonary TB. Twenty one percent of the participants did not have consecutive smear results during the intensive phase. TB client lost to follow up rate was 13.5% (n=16) and 10 of all TB clients lost to follow up interrupted treatment for ≥5 months. Eleven TB clients lost to follow up were from Buffalo City Municipality Metropolitan. TB client lost to follow up was high in males (n=13). Rifampicin/multidrug resistant TB treatment success rate was 72.9% with mean response to treatment of 17.2 weeks. Weight (p0.005 and CI 2.750, 15.189) and body mass index (p0.004 and CI 1.232, 6.242) as well as duration of treatment interruption (p0.000 and CI -14.785, -8. 644) and duration of treatment (p0.001 and CI -65.385, -16.403) were statistically significant to treatment success. Based on these findings, it is therefore concluded that short regimen is effective in the management of RR/MDR TB despite high TB client lost to follow up rate. Decentralisation of drug resistant TB management; primary health care reengineering; use of NIMDR-trained nurses; tracing of TB interrupters; HIV management; electronic patient management system and review of how EDR register works; proper record keeping and proper recording; extensive and ongoing counselling, patient support, health education and patient monitoring; and political involvement; is recommended. Further research is recommended to identify patient and service related factors that affect TB treatment outcomes.
- Format
- 78 leaves
- Format
- Publisher
- University of Fort Hare
- Publisher
- Faculty OF Health Science
- Language
- English
- Rights
- University of Fort Hare
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