The purpose of this study was to establish empirical evidence on risk factors influencing drug-resistant tuberculosis (DR-TB) in Swaziland. Globally factors have been identified and specific programmatic interventions were implemented to counter the emergence of DR-TB, but the case still remains with Swaziland. The research question was “What are the risk factors influencing the epidemiology of DR-TB patients enrolled for treatment at the National Tuberculosis Referral Hospital? The research objectives were to investigate factors that influence the emergence of DR-TB in Swaziland, to establish the relationship between DR-TB and HIV and to develop a poster that will exhibit the findings on the study on risk factors influencing the epidemiology of DR-TB. A mixed method was used. A qualitative study of participants using the in-depth one on one interview with a grand tour question “ What are the risk factors that resulted in you having DR-TB” and probing questions. The quantitative retrospective part was utilised to review medical records. Convenience sampling was utilised to recruit participants using an interview guide to collect data and random sampling for the quantitative aspect using a checklist to collect data. Risk factors influencing the development of DR-TB were identified to be previous treatment with anti-tuberculosis drugs, human immunodeficiency virus (HIV). The findings showed that the prevalence of HIV in DR-TB was 61% for HIV positive and 39% for negative and the quantitative data showed 77% HIV positive and 23% negative to HIV. Lack of education for patients and their families on precautionary measures to take when caring for a family member, and what to do in cases of developing side effects. This study concludes that both the need to ensure that bacteriologically confirmed patients are initiated to treatment, adhere to their treatment and complete treatment and due to the number of direct cases being infected with DR-TB ensuring that infection control strategies are put in place at work and at home settings / Health Studies / M.A. (Public Health)

The purpose of the study was to develop best practice guidelines to prevent permanent hearing loss associated with the management of multi-drug resistant tuberculosis (MDR-TB) through raised awareness and monitoring. The Human Immunodeficiency Virus (HIV) and MDR-TB are global public health problems requiring urgent scale-up of treatment services. Irreversible sensorineural hearing loss (SNHL) is one of the adverse drug reactions of the current World Health Organization (WHO) recommended MDR-TB chemotherapy fuelling another public health problem, that disabling hearing loss, which is the second highest contributor of Years Lived with Disability (YLD) according to the World Health Report (2003). Expansion of MDR-TB treatment threatens to increase incidence of SNHL unless there is urgent implementation of intervention towards preservation of hearing for patients on treatment. This empirical study determined and documented the incidence of SNHL in HIV positive and HIV negative patients on MDR-TB treatment, the risk factors for SNHL, from the time treatment initiation to SNHL. Based on the findings, developed and improved the understanding of best practice guidelines for monitoring and prevention of MDR-TB treatment-related SNHL. The empirical study recruited a cohort of 173 patients with normal hearing status, after diagnosis with MDR-TB and enrolled on MDR-TB therapy over thirteen month period. Patients in the cohort received monthly hearing sensitivity testing during the intensive MDR-TB therapy when injectable aminoglycoside antibiotics are part of the treatment regimen. The three study endpoints included completion of the eight-month intensive treatment phase without developing hearing loss, development incident hearing loss or loss to follow up. Data was analysed using STATA statistical software and summarised using frequencies, means, proportions, and rates. The study documented incidence of SNHL, time to hearing loss and risk factors for hearing loss. Recommendations to prevent and monitor hearing loss are made based on the the study findings. / Health Studies / D. Litt. et Phil. (Health Studies)