A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa, in partial fulfilment of the requirements for the degree of Masters in Public Health-Social and Behaviour Change Communication.November 2012 / Aim of the study: The main aim of this study was to determine socio-demographic characteristics associated with being diagnosed with TB by a health care worker among adult males and females aged between18-49 years in Ntcheu district, Malawi. Method: This was a descriptive and analytical cross-sectional study. A total of 121 adult women and men were sampled using a three-stage simple sampling technique. The 2008 Population and Housing Census enumeration areas (EAs) were used as a sampling frame. The first stage involved simple sampling of two Traditional Authorities (TAs) out of nine (9). Stage two involved selection of ten villages in each sampled TA. The third level of sampling was a selection of six households from each selected village where the first dwelling was also sampled. A structured questionnaire was developed in English and translated into Chichewa. The questionnaire was administered by a trained interviewer at each respondent’s household. Three research assistants were employed to collect data. Results The awareness of TB was universal with every participant reporting that they had heard about TB. Of the 121 participants, more than half were male (53.7%; n=65).The median age of the respondents was 28 years (range 18-49 years) and approximately a third of the respondents (34.4%; n=31) had 1-2 children. The study found that higher education (p=0.01), higher ownership of household assets (p=0.01), higher average monthly household income (p=0.02) and higher socio-economic status of the respondents (p=0.01) were significantly associated with higher knowledge of causes of TB. It was found that education was also associated with knowledge of the transmission of TB (P=0.01). The lower the level of education the lower the knowledge level on the correct modes of TB transmission. There was also an association between knowledge of symptoms of TB and occupation (p=0.05). It was found that farmers were less likely to know symptoms of the disease compared to other forms of occupation namely: business persons, those participants who were employed and those not employed. The study found that women had significantly lower risk perceptions of the disease (p=0.01). No association was found between socio-economic and cultural factors of the respondent and self-reported TB diagnosis. Conclusion The findings of this study show that a comprehensive health promotion programme is required in order to address significant gaps on knowledge of causes of TB, transmission, symptoms and risk perceptions and other related socio-economic and cultural factors in Ntcheu district.

Introduction The association between tuberculosis (TB) and malnutrition is well known. Malnutrition also weakens the immune system increasing the chance of latent TB progressing to active disease. Nutritional interventions can help improve overall quality of life and can reduce susceptibility to opportunistic infections including all forms of Oral Candidiasis (OC) which includes: (1) pseudomembranous candidiasis (oral thrush), (2) atrophic (erythematous) candidiasis, (3) hyperplastic candidiasis, and (4) angular cheilitis. This secondary data analysis of a longitudinal follow-up study evaluates the impact of a fortified supplementary food on OC among adult TB patients over a three month period. Results At baseline, an overall prevalence of 33% of OC (27 out of 83) was found in 83 adult TB patients; (pseudo-membranous 46% (16 out of 35), erythematous 26% (9 out 35), angular chelitis 20% (7 out 35) and hyperplastic 8% (3 out of 35). Thirty five different types of OC were found in 27 of the subjects some of whom manifested with more than one type of OC. Almost 89% of these TB patients had low levels of malnutrition (8% for selenium, 55% for iron, 62% for Vit-A, 42% for albumin, 47% for Vit-D and 34% for zinc). Their p values related to OC were (p=0.64 for selenium, p=0.74 for iron, p=0.19 for Vit-A, p=1 for albumin, p=1 for Vit-D and p=0.09 for zinc) showing no statistically significant difference for malnutrition in each different type of micronutrient related to OC at baseline. However, there was a statistically significant difference in HIV status (p=0.01) related to OC among factors such as sex (p=0.34), employment status (p=0.74), ARV status (p=0.46) and wellbeing (p=0.18) at baseline. OC was statistically significant at both 2nd and 3rd visits using univariate analysis p=0.04 (95%CI 0.22 to 0.97) and p=0.00 (95%CI 0.06 to 0.43) and also multivariate analysis p=0.01(95%CI 0.17 to 0.85) and p=0.00 (95%CI 0.04 to 0.34) with reference to the 1st visit (the prevalence of OC was significantly decreased in both 2nd and 3rd visits). For different types of clinical OC, pseudomembranous candidiasis was the only type of OC that showed statistically significant difference at the 3rd visit in both univariate analysis (p= 0.01, 95%CI 0.01 to 0.46) and multivariate analysis (p= 0.00, 95%CI 0.01 to 0.38) with reference to 1st visit. Discussion and Conclusions This study found no significant association between overall micronutrient level and the presence of OC at baseline. However, micronutrient interventions to the 83 adult TB patients receiving treatment at Johannesburg city clinics located in Alexandra showed a decrease in prevalence of different types of OC in both 2nd and 3rd visits. This analysis showed encouraging results which indicated a beneficial effect of e’Pap in adult TB patients.

Background: The success of tuberculosis (TB) treatment largely depends on healthcare team factors within a healthcare system, as healthcare workers play a vital role in fostering patient adherence to TB treatment. Strengthening motivation amongst Kenya’s TB healthcare workers should thus be reinforced in order to improve on clinical outcomes of TB treatment in Kenya. Objectives: To determine motivational needs of TB healthcare staff at a district hospital in Kenya and to provide recommendations on how to enhance their motivation. Design: TB healthcare workers including nurses, doctors, pharmacists and community healthcare workers were purposively sampled from a district hospital in Kenya. Their motivational levels were measured using a questionnaire adapted from Bennet and colleagues (2000). Key Findings: A high level of job satisfaction was present in more than 50 percent of the employees, although the ‘extrinsic job satisfaction’ sub-scale stood out as scoring relatively poorly in comparison to the other ‘job satisfaction’ sub-scales. Cognitive motivation yielded mixed results with 44 percent of respondents rating themselves as being satisfied, and 56 percent between neutral and very dissatisfied. The overall organisational commitment was positive, with the majority (60 percent) of respondents rating themselves as being committed to their organisation. The majority (96 percent) of workers rated their performance at work as very high. Conclusion: Improvement in staff motivation can be attributed to how well a hospital's management organises and runs its hospital. It was recommended that hospitals should provide an environment where motivational strategies are continuously implemented and where change is positively rewarded. This may, in turn, have a positive impact on TB treatment outcomes. The study may be of interest to key decision makers in Kenya’s healthcare system as well as TB programme managers, hospital managers and health managers in general. Further investigations are needed in order to determine whether Kenya’s public healthcare system has a staff retention strategy that is up to date with the motivational needs of Kenya’s health workforce.

Thesis (MScMedSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Drug resistance in Mycobacterium tuberculosis is an increasing global problem. Drug resistance is mostly caused by single nucleotide polymorphisms (SNPs) within the bacterial genome. This observed increase in global incidence of drug resistant tuberculosis (TB) has sparked the search for new anti-TB drugs and the repurposing of drugs that are currently used against other organisms or species of mycobacteria. One such repurposed drug, clofazimine (CFZ), is currently used for the treatment of leprosy, caused by Mycobacterium leprae. The mechanism of action of CFZ is not clear, but it is hypothesized that CFZ is reduced by a mycobacterial type II NADH oxidoreductase (NDH-2). The reduction of CFZ drives the production of reactive oxygen species (ROS) which is toxic to the pathogen. The aim of this study was to elucidate the mechanism of CFZ resistance. Towards this aim, spontaneous in vitro CFZ resistant mutants were selected, characterized and whole genome was used identify SNPs which may cause CFZ resistance. Mutations were identified in a transcriptional regulator encoded by Rv0678, fatty-acid-AMP ligase, or FadD28 (Rv2941) and glycerol kinase or GlpK (Rv3696c). Mutations in Rv0678 have previously been shown to play a role in both CFZ resistance and bedaquiline (BDQ) cross-resistance, while no link has been found between CFZ resistance and mutations in fadD28 and glpK. The novel, non-synonymous SNP identified in Rv0678 resulted in the replacement of an alanine residue with threonine at codon 84, which is located in the DNA binding domain. Virtual modelling of the mutated Rv0678 protein showed that the A84T mutation may influence DNA binding, possibly due to its proximity to the DNA binding domain. This mutation caused a change in hydrophobicity, which may influence binding to DNA. Previous studies showed that mutations in Rv0678 resulted in the upregulation of mmpL5, a putative efflux pump. However, the mechanism whereby CFZ resistance occurs via increased abundance of this efflux pump in the cell wall is not clear and needs further investigation. The cross-resistance between CFZ and BDQ, caused by mutations in Rv0678, is of concern and may influence the planning of anti-TB drug regimens for the future. The roles of the other two mutations identified in this study in CFZ resistance is also not clear and requires further investigation. Finally, the findings of this study support the role of Rv0678 in CFZ resistance thereby suggesting that this gene could be useful as a diagnostic marker to test for CFZ resistance in clinical isolates. / AFRIKAANSE OPSOMMING: Middelweerstandigheid in Mycobacterium tuberculosis is 'n wêreldwye toenemende probleem. Middelweerstandigheid word meestal veroorsaak deur enkel nukleotied polimorfismes (SNPs) in die bakteriële genoom. Hierdie toename in middelweerstandige tuberkulose (TB) het gelei tot die soektog na nuwe anti-TB-middels en die alternatiewe aanwending van middels wat tans teen ander organismes of spesies van mikobakterieë gebruik word. Een so 'n alternatiewe middel, clofazimine (CFZ), word tans gebruik vir die behandeling van melaatsheid wat veroorsaak word deur Mycobacterium leprae. CFZ se meganisme van werking is nie duidelik nie, maar dit word vermoed dat CFZ gereduseer word deur 'n mikobakteriële tipe II NADH oksidoreduktase (NDH-2). Die reduksie van CFZ dryf die produksie van reaktiewe suurstof spesies wat giftig is vir die patogeen. Die doel van hierdie studie was om die meganisme van CFZ weerstandigheid te ondersoek. Om hierdie doel te bereik was spontane in vitro CFZ weerstandige mutante gekies, gekarakteriseer en heel genoom volgorde bepaling is gebruik om SNPs te identifiseer wat CFZ weerstandigheid veroorsaak. Mutasies in Rv0678, 'n transkripsie reguleerder, vetsuur-AMP ligase, of FadD28 (Rv2941) en gliserol kinase of GlpK (Rv3696c) geïdentifiseer. Dit is al voorheen gevind dat mutasies in Rv0678 ‘n rol speel in beide CFZ weerstandigheid en bedaquiline (BDQ) kruis-weerstandigheid, terwyl geen verband gevind is tussen CFZ weerstandigheid en mutasies in fadD28 en glpK nie. Die nuwe, nie-sinonieme SNP, geïdentifiseer in Rv0678 het gelei to die vervanging van 'n alanien aminosuur met treonien by kodon 84, wat geleë is in die DNS bindings domein. Virtuele modellering van die gemuteerde Rv0678 proteïen het getoon dat die A84T mutasie DNS binding moontlik kan beïnvloed, as gevolg van sy nabyheid aan die DNS bindings domein. Hierdie mutasie veroorsaak 'n verandering in die hidrofobiese natuur, wat DNS binding kan beïnvloed. Vorige studies het getoon dat mutasies in Rv0678 lei tot die opregulering van mmpL5, 'n waarskynlike uitvloei pomp. Die meganisme waardeur CFZ weerstandigheid veroorsaak, deur ‘n groot aantal van hierdie uitvloei pompe in die selwand, is nie duidelik nie en moet verder ondersoek word. Die kruis-weerstandigheid tussen CFZ en BDQ, wat veroorsaak word deur mutasies in Rv0678, is van belang en kan die beplanning van anti-TB middel behandeling vir die toekoms beïnvloed. Die rolle van die ander twee mutasies, wat in hierdie studie geïdentifiseer is, in CFZ weerstandigheid is ook nie duidelik nie en vereis verdere ondersoek. Ten slotte, die bevindinge van hierdie studie steun die rol van Rv0678 in CFZ weerstandigheid en dit dui daarop dat hierdie geen gebruik kan word as 'n diagnostiese merker om vir CFZ weerstandigheid te toets in kliniese isolate.

Magister Public Health - MPH / Background: TB is one of the most common opportunistic infections in the HIV infected population. In 2014, of the 9.6 million people estimated to have TB globally, 1.2 million were also infected with HIV. In the same year WHO reported 400 000 TB deaths in HIV infected people worldwide. TB Prevention strategies include ensuring HIV infected people take ART, TB infection control, treatment of TB cases and pharmacological prevention of primary TB infection or progression of latent TB into active TB. Isoniazid preventive therapy for a minimum of six months has been recommended to reduce the risk of TB in people living with HIV. Aim: The study’s aim was to determine the programmatic outcomes of isoniazid preventive therapy (IPT) and factors associated with treatment completion among people living with HIV aged 15 years and above at the AIDS Healthcare Foundation LaMvelase clinic in Manzini Swaziland, who were enrolled for IPT during the period March to December 2014. Methodology: This was a quantitative retrospective analytical cohort study that reviewed 3642 patient care records. IBM SPSS 20 was used for descriptive and statistical analysis of the data. Descriptive statistics were calculated and reported as frequencies and percentages. Bivariate statistics were carried out to test independent associations between socio-demographic and clinical characteristics, and IPT completion. Further multiple logistic regression analysis was done to determine the nature of association between the dependent and independent variables which had p < 0.1.

Thesis (M. Cur.) -- University of Limpopo, 2014 / The present study presents data about the factors that are affecting the implementation of the National Tuberculosis Control Programme by the professional nurses in the Mogalakwena Municipality of the Waterberg District in the Limpopo Province. Despite the intervention by the then Waterberg District Department of Health and Social Development through continual training and workshops of professional nurses in respect of the NTCP, there are still more challenges observed in terms of TB management. Aim of the study The aim of the study was to identify and describe the factors that are affecting the implementation of the NTCP and the findings may be utilised to describe the strategies to increase TB cure rate in the Mogalakwena Municipality of the Waterberg District. Research Methodology A quantitative research approach was used to conduct this study. One hundred and thirty one professional nurses employed at 28 clinics of the Mogalakwena Municipality were selected to participate in the study. The researcher distributed the questionnaires at the clinics. A structured questionnaire with both open and closed-ended questions was administered. The questionnaire was pretested in the Mahwelereng Local Area which did not form part of the main study. Results Of the 131 respondents, 33.6% were the largest age group of between 40 – 50 years followed by 24.4% who were older than 50 years in contrast with the smallest age group of 18 – 28 years that comprised 18.3% of the population. Sixteen per cent of the respondents were male while 84.0% were female. The findings show that 83.2% of respondents held a diploma in nursing while 16.8% had a degree in nursing. The findings indicate that 98.4% of the respondents were reported to be having knowledge about TB while 1.6% reported not having knowledge. The findings v indicate that 98.4% of the respondents had knowledge about TB suspect screening according to the NTCP in contrast with 1.6% of the participants who did not have knowledge about TB screening. About 95.4% of the respondents reported tracing of TB defaulters while 4.6% of the respondents reported that TB defaulters were not traced. Sixty point three per cent 63.3% of the respondents thought that a negative attitude of professional nurses was the main cause of poor implementation of the NTCP while 30.5% of them disagreed with the statement. Conclusion Respondents demonstrated non-compliance to the implementation of the NTCP, ignorance to acquire skills and negative attitude towards the programme that was consistently significant with other similar studies. The study recommends an updated training programme of all TB trained nurses, as well as values clarification about the importance of the implementation of the NTCP in the management of the TB disease.

No description available.

The epidemiological study of tuberculosis (TB) has been ongoing for several decades, but the most effective control strategy is yet to be completely understood. The basic reproduction number, R₀, has been found to be plausible indicator for TB control rate. The R₀ value is the average number of secondary TB cases produced by a typical infective individual in a completely susceptible population during its entire infectious period. In this study we develop two SEIR models for TB transmission; one involving treatment of active TB only, with the second incorporating both active TB treatment and post-exposure prophylaxis (PEP) treatment for latent TB. Using the next generation matrix method we obtain R₀. We determine the disease free equilibrium (DFE) point and the endemic equilibrium (EE) point. Global stability conditions of DFE are determined using the Castillo-Chavez theorem. Through model analysis of the reproduction number, R₀, we find that for R₀ < 1, the infection will die out. The value of R₀ > 1 implies that the disease will spread within the population. Through stability analysis, we show that the model exhibits backward bifurcation, a phenomenon allowing multiple stable states for fixed model parameter value. MATLAB ode45 solver was used to simulate the model numerically. Using the Latin Hypercube Sampling technique the model is sensitive to treatment and disease transmission parameters, suggesting that to control the disease, more emphasis should be placed on treatment and on reducing TB transmission. For the second model, which incorporated treatment with post-exposure prophylaxis for latently infected individuals, by means of simulations, we found that treatment of latently infected individuals may reduce R₀. Numerical simulations on the latter model also showed that it may be better to introduce a hybrid of active treatment and post-exposure treatment of the latent class. The force of infection was found to reduce when this hybrid control strategy is present. Contour plots and PRCC values highlighted the important parameters that influence the size of the Infective class. The implications of these findings are that TB control measures should emphasise on treatment. Our simplified models assume that there is homogeneous mixing. The model used have not been validated against empirical data. / M.Sc. University of KwaZulu-Natal, Pietermaritzburg 2014.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2009. / At the request of the South African Department of Health's Western Cape Provincial Tuberculosis Control Directorate, the Cape Peninsula University of Technology, a Higher Education Institution, developed and implemented a Tuberculosis and Human Immunodeficiency Virus community outreach train the trainer project to train community members about Tuberculosis and Human Immunodeficiency Virus. This study aimed to provide a historical overview of the Cape Peninsula University of Technology Tuberculosis and Human Immunodeficiency Virus project and describe the experiences of the trainers involved. A descriptive case study design, using a qualitative approach was applied during this study. The historical overview of the project showed the need for a broad base of networking, securing funding and a project facilitator from the outset of such a project. This study found that trainers had experienced self-development in terms of knowledge, skills and self confidence and that the training had far reaching effects by spreading Tuberculosis and Human Immunodeficiency Virus information in diverse community settings, despite notable challenges experienced in the community settings. Community outreach training projects from a recognized training institution have a positive impact at community level. However, political commitment and development of the course content into a registered learnership are required for sustainability.

Department of Public Health / MPH