Submitted in fulfilment of the requirements of the Degree of Master of Technology: Environmental Health, Durban University of Technology, 2011. / Worldwide Tuberculosis (TB) is a major public health concern. The Directly Observed Treatment Strategy (DOTS) has been used widely internationally and in South Africa (SA) to control the disease yet defaulting on treatment has still not achieved its World Health Organization (WHO) guideline of 5.0%. The eThekwini Municipality reported a defaulter rate of 18.9% in 2007 even with the adoption of DOTS in 1996. This study aimed to investigate the predictors of default amongst informal dwellers of eThekwini and to evaluate the implementation and the efficiency of the DOTS programme within the eThekwini Municipality, KwaZulu-Natal (KZN), and SA. The study population comprised of 102 defaulters from informal settlement, 16 nurses and 5 health personnel that are involved in TB management and control. The study was a mixed method cross sectional descriptive study that generated both quantitative and qualitative data. The Cyril Zulu Communicable Disease Centre (CDC) Electronic TB Register was used to trace the defaulters from the informal settlements that were interviewed. Non-defaulters were matched from the CDC Electronic TB Register but could not be traced due to accessibility and financial issues. Due to the low response from nurses 16(53%), semi structured qualitative interviews were conducted with health personnel. The three sets of data generated were analysed using descriptive statistics and content analysis. Multivariate logistic regression models found smoking, drinking and having a family member with TB as statistical significant predictors of default. Based on the multivariate model with a 95% confidence interval (CI), smoking (OR: 11.23, CI: 5.79, 21.78; p<0.005), alcohol consumption (OR: 15.22; CI: 7.66, 30.25; p<0.005) and had family member with TB (OR: 4.60, CI: 2.34, 9.04; p<0.005) were all significantly associated with defaulting. It was apparent that DOTS implementation was partly implemented due to lack of human resources. Tracing of defaulters, DOTS supporters, DOTS sites and incentives to patients and volunteers were major challenges hindering the iv effective implementation of the DOTS programme in eThekwini. Defaulting occurs as a result of an association between patient and health care characteristics. This study provides useful information specific to predictors of default amongst informal dwellers and the implementation and efficiency of the DOTS programme specific to informal settlements. The results from this study could be used to improve TB control and management specifically in informal settlements addressing factors that predict default and tracing and supporting patients to ensure adherence to TB treatment. / DUT Finance

Thesis (M. A. (Clinical Psychology)) --University of the North, 2002 / The aim of this study was to ascertain base-line information on knowledge, beliefs and feelings about tuberculosis among hospitalized tuberculosis patients. The study was conducted at Dr Machupe Mphahlele Memorial Hospital in the Limpopo Province of South Africa. A sample of 40 tubercuJos is patients, 21 males (52,55%) and 19 women (47,5%), was interviewed. h ·om the sample of 40, 22 patients (55%) too k part in the focus group discussions. Fourteen members of the community, who are relatives of those patients who tookpart in thestud, y were also included in the focus group discussions. The focus group discussions were aimed at better understanding of both the community and the patients' beliefs and perceptions of tuberculosis. The study revealed that the participants studied had a reasonably go od knowledge of tuberculosis. However, there was some confusio n regarding causative and risk factors of tuberculosis and some misconceptions thereof. The study has also found that traditional beliefs tend to impact on the patient's health seeking behaviour, treatment and the overall understanding of the disease.Tuberculosis treatment is still perceived by the majo rity of participants to being long, agonizing and cumbersome and there are still so me doubts as to whether tuberculosis is curable. Participants believed that tuberculosis carries social stigma and thus patients feel isolated in their communities. The results also suggested that education does play a role in the perception of the disease. Participants who had tertiary and secondary education were found to be more knowledgeable on symptoms and health beliefs of tuberculosis than those participants who had primary education, and those who did not have education at all. Factors such as age and gender did not appear to have any influence on the knowledge and feelings of patients on tuberculosis. Therefore, based on the findings, culturally sensitive health education and consideration of the patients' educational level are important variables when dealing with tuberculosis patients.

Many countries in the world record annual summary statistics such as economic indicators like Gross Domestic Product (GDP) and vital statistics for example the number of births and deaths. In this thesis we focus on mortality data from various causes including Tuberculosis (TB) and HIV. TB is an infectious disease caused by bacteria called Mycobacterium tuberculosis. It is the main cause of death in the world among all infectious diseases. An additional complexity is that HIV/AIDS acts as a catalyst to the occurrence of TB. Vaidyanathan and Singh revealed that people infected with mycobacterium tuberculosis alone have an approximately 10% life time risk of developing active TB, compared to 60% or more in persons co-infected with HIV and mycobacterium tuberculosis. South Africa was ranked seventh highest by the World Health Organization among the 22 TB high burden countries in the world and fourth highest in Africa. The research work in this thesis uses the 2007 Statistics South Africa (STATSSA) data on TB and HIV as the primary cause of death to build statistical models that can be used to investigate factors associated with death due to TB. Logistic regression, Survey Logistic regression and generalized linear models (GLM) will be used to assess the effect of risk factors or predictors to the probability of deaths associated with TB and HIV. This study will be guided by a theoretical approach to understanding factors associated with TB and HIV deaths. Bayesian modeling using WINBUGS will be used to assess spatial modeling of relative risk and spatial prior distributions for disease mapping models. Of the 615312 deceased, 546917 (89%) died from natural death, 14179 (2%) were stillborn and 54216 (9%) from non-natural death possibly accidents, murder, suicide. Among those who died from natural death and disease, 65052 (12%) died of TB and 13718 (2%) died of HIV. The results of the analysis revealed risk factors associated with TB and HIV mortality. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Tuberculosis (TB) is the fifth largest cause of death in South Africa, with one in ten cases being resistant to treatment due to the development of multidrug-resistance and extensively drug-resistance in the agent responsible for this disease, Mycobacterium tuberculosis. This pathogen has developed mechanisms to evade killing by immune cells such as macrophages. Mycobacterium smegmatis, a non-pathogen, that does not evade killing by the macrophage, is often used to gain a better insight into the bacteriocidal pathways used to kill mycobacteria, and those potentially blocked by M.tuberculosis. In such studies nitric oxide and “lysosomal” proteases have emerged as major bacteriocidal pathways. Studies on the role of aspartic protease, cathepsin D, in killing green fluorescent protein- (GFP-) tagged-M.smegmatis in J774 macrophages required antibodies that would not cross-react with mycobacterial antigens. These were raised in chickens, using alum and saponin as adjuvants, and porcine and human cathepsin D. Using such antibodies, quantitative colocalization analysis using ImageJ and the JACoP colocalization plugins showed a greater degree of colocalization between cathepsin D and LysoTracker Red DND-99 in M.smegmatis-infected J774 macrophages than in uninfected cells. This indicates the possible presence of active, bacteriocidal cathepsin D in acidic, and hence matured phagosomes. A higher colocalization between cathepsin D and LAMP-1 and cathepsin D and LAMP-2 in uninfected cells possibly indicates the recycling of these two markers from vesicles not containing killed bacteria. Propidium iodide (PI) labelling and loss of GFP fluorescence appeared reliable indicators of M.smegmatis death or viability, respectively, as myobacteria that took up PI also lost green fluorescence, while M.smegmatis that exhibited green fluorescence (viable) were not observed to take up propidium iodide (dead). Faint colocalization between cathepsin D, LAMP-1 and -2 with dead, and to a lesser extent with live M.smegmatis occurred. Besides intensity correlation values other colocalization programs indicate the absence of colocalization between these markers and dead M.smegmatis, but, together with in vitro killing experiments (cathepsin D, 0.0098 units/ml resulting in 59% killing in 4 h) these appear to indicate a possible role of cathepsin D in killing of M.smegmatis. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Mycobacterium bovis and other species of Mycobacterium tuberculosis complex (MTBC) can result to a zoonotic infection known as Bovine tuberculosis (bTB). MTBC has members that may contaminate an extensive range of hosts, including wildlife. Diverse wild species are known to cause disease in domestic livestock and are acknowledged as TB reservoirs. It has been a main study worldwide to deliberate on bTB risk factors as a result some studies focused on particular parts of risk factors such as wildlife and herd management. The objectives of this study were to design questionnaires from commercial farms and smallholding farms; isolate and identify MTBC from collected samples using culture and PCR assays recovered from Fort Hare, Middledrift and Seven star dairy farms; and assessing genotypic drug resistance through detection of mutations conferring resistance to INH and RMP associated with first line treatment for MTBC infection. Questionnaires were administered to thirty (30) smallholding farm owners in the two villages (kwaMasele and Qungqwala) and three (3) three commercial farms (Fort Hare dairy farm, Middledrift dairy farm and Seven-star dairy farm). Detection of M. tuberculosis complex was achieved by Polymerase Chain Reaction using primers for IS6110; whereas a genotypic drug resistance mutation was detected using Genotype MTBDRplus assays. Nine percent (9 percent) of respondents had more than 40 cows in their herd, while 60 percent reported between 10 and 20 cows in their herd. Relationship between farm size and vaccination for TB differed from forty-one percent (41 percent) being the highest to the least five percent (5 percent). The highest number of respondents who knew about relationship between TB cases and cattle location was ninety-one percent (91 percent). Approximately fifty-one percent (51 percent) of respondents had knowledge about wild life access to the farms. Relationship between import of cattle and farm size ranged from nine percent (9 percent) to thirty-five percent (35 percent). Cattle sickness in relation to farm size differed from forty-three (43 percent) being the highest to the least three percent (3 percent); while thirty-three percent (33 percent) of respondents had knowledge about health management. Respondents with knowledge about the occurrence of TB infections in farms were forty-eight percent (48 percent). The frequency of DNA isolation from samples ranged from the highest forty-five percent (45 percent) from water to the least twenty-two percent (22 percent) from soil. Fort Hare dairy farm had the highest number of positive samples forty-four percent (44 percent) from water samples; whereas Middledrift dairy farm had the lowest positive from water, seventeen percent (17 percent). Twelve (22 percent) out of 55 isolates showed resistance to INH and RMP that is, multi-drug resistance (MDR) and nine percent (9 percent) were sensitive to either INH or RMP. The mutations at rpoB gene differed from 58 percent being the highest to the least (23 percent). Fifty-seven percent (57 percent) of samples showed a S315T1 mutation while only 14 percent possessed a S531L in the katG gene. The highest inhA mutations were detected in T8A (80 percent) eighty percent and the least was observed in A16G (17 percent). The results of this study reveals that risk factors for bTB in cattle and dairy farm workers is a serious issue abound in the Eastern Cape of South Africa; with the possibility of widespread dissemination of multidrug resistant determinants in MTBC from the environment.

Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2007 / Reinfection is an important mechanism leading to recurrent tuberculosis. Recently, molecular epidemiological studies have shown that in high incidence settings, recurrent tuberculosis may occur through reinfection. Animal model experiments have shown that a reinfecting mycobacterial strain is specifically targeted to existing granulomas and that these structures are more dynamic than was previously thought. In this study we hypothesised that primary infection with M. tuberculosis may reprogramme human macrophages thereby preventing or facilitating reinfection with a secondary mycobacterial strain. Two antibiotic-resistant M. tuberculosis H37Rv variants were generated by electrotransformation of marked plasmids, designated KanRand HygR . A THP1 human macrophage cell line was infected and reinfected with different combinations of these marked strains as well as a hypervirulent M. tuberculosis Beijing strain. Mycobacterial growth has been assessed by colony forming unit enumeration and confirmed with polymerase chain reaction (PCR) analysis. In vitro growth curves of wild-type and differentially marked M. tuberculosis H37Rv Kan Rand HygR strains were compared in the BACTECTM mycobacterial growth indicator tube (MGITTM) system in parallel with conventional liquid culturing. In vitro liquid culture growth curves of hypervirulent clinical Beijing strain isolates were also compared to M. tuberculosis H37Rv growth curves. Through this it was established that there was no fitness cost as result of plasmid integration and that these strains of varying virulence had similar growth curves. Competitive dynamics within THP1 human macrophage cells were then assessed and have shown that there were no significant differences in growth patterns between primary and secondary infecting strains during THP1 cell reinfection. The findings of this study answered fundamental questions regarding reinfection of mycobacterial strains. It was established here that human macrophages can indeed be reinfected with a second virulent mycobacterial strain.

Knowledge and safer practices regarding occupational exposure are crucial to all employees working in healthcare facilities, especially Tuberculosis (TB) hospitals. This study aimed to explore and describe the knowledge and practices of employees working in three specialised TB hospitals regarding occupational exposure to TB. The results of the study will be used to make recommendations to the Eastern Cape Department of Health (ECDOH) and hospital managers that could assist in reducing the prevalence of occupational TB. This quantitative, descriptive and contextual study was conducted in three specialised TB hospitals in the Nelson Mandela Bay Health District (NMBHD). Convenience sampling was used to select the research participants. The knowledge and practices of 181 employees towards occupational exposure to TB and infection control was measured through a self-administered questionnaire. The questionnaire covered areas such as the knowledge of TB and infection control, the infection control policy, infrastructure as well as patient transportation. The whole population was targeted and out of a potential 253 employees, 181 were on duty during the stage of data collection and agreed to willingly participate in the study. The data was analysed descriptively using MS excel and MS word. This study revealed that 69% (n=124/181) of employees in the three specialised TB hospitals in the NMBHD have adequate knowledge of infection control. However, only 10% (n=18/181) of employees reported appropriate infection control practices, while almost half of the participants 42% (n=76) apparently practice infection control poorly. The majority (78%, n=141) of the employees in the three specialised TB hospitals in the NMBHD reported knowing about the availability of an infection control policy in their respective hospitals, however only 42 % (n=76) have reportedly read the policy. In conclusion, knowledge and practices regarding occupational exposure in specialised TB hospitals in the NMBHD is not optimal. It is however, important to note that the majority of employees have knowledge about the TB disease itself and its symptoms. Recommendations were made in order to improve infection control knowledge and practices. These include the development of a plan for purchasing of equipment to address infection control, development of a curriculum specific for non-nursing personnel and the establishment of a plan to ensure the availability of patient consultation rooms and dining halls. A further recommendation deemed important by the researcher was isolation glass as a compulsory specification when purchasing patient transportation vehicles, in order to provide protection for the drivers transporting patients to and from the hospital.

In this treatise a SEIR model for the transmission of tuberculosis was proposed. It assumes that the latent infected individuals progress to active tuberculosis through endogenous reactivation and exogenous re-infection and that the individuals who have recovered from the disease through treatment are not immune to tuberculosis re-infection. While most features of the original model were kept, the model was modified to incorporate two control measures in the form of post-exposure tuberculosis prophylaxis for the treatment of latent individuals and tuberculosis therapeutics for the treatmentof individuals with active tuberculosis. Mathematical analysis of the modelwas done under the assumption that the two control measures are positiveconstants. The disease-free equilibrium point was locally asymptotically stable when the basic reproduction number was less than unity and unstable when this epidemic threshold exceeds unity. An optimal control problem was formulated and the necessary conditions for optimality were derived.The numerical results based on data from Port Elizabeth suggest that using both forms of control measures simultaneously is more effective in reducing the total number of infected individuals than applying single controls separately.

M.A. (Political Science) / Although an effective cure for tuberculosis exists, the incidence and mortality rate for TB in South Africa remain exceptionally high. The reason for this is both medical as well as sociopolitical. The purpose of this dissertation is to examine the inter-action of various differential variables which influence the control of TB in this country. TB whilst caused by a germ, is adversely affected by socioeconomic deprivation, which in turn has distinct political connotations in South Africa. The dissertation therefore examines the inter-play of the historical and present influences of sociopolitical factors on the TB situation at present. Another important aspect of TB control is the State's efforts to control TB through the TB Control Programme (TBCP). This dissertation discusses the objectives of the TBCP and meaSures its effectivity against the socio-political context in which it functions. This is followed by a series of suggestions including an examination of the financial implications of these. A non-governmental organisation (NGO), SANTA ( The South African National TB Association) is a further actor in the control of TB. As specified delegates of the State for TB health education, it is essential that their role be examined both in terms of the TBCP as well as in terms of their own stated objectives for TB control. This includes an examination of the role of NGOs in complimenting the activities of the State and their believability in the community they claim to serve. Further proposals are put forward with regard to ways in which SANTA can improve their believability, relevance and effectivity within TB control in South Africa. Further influencing factors are the impact of AIDS and political violence on TB and the ability of the various actors to control TB. These two aspects are discussed briefly and constitute areas for further research. In addition it would be relevant for some form of cost-benefit analysis to be conducted, in order to extend the scope of the policy analysis conducted here.

Thesis (MPH.) -- University of Limpopo, 2019 / The purpose of this study was to investigate the challenges faced by health care workers caring for patients diagnosed with Tuberculosis at Tertiary 1 Military Hospital, Gauteng Province, South Africa. The quantitative research study was conducted and data was collected from 56 respondents who participated in this study conducted at Tertiary 1 Military Hospital, Gauteng Province, South Africa. Self-administered questionnaires were used to collect data from the respondents through a self-administered questionnaire. Data was then analysed using statistical STATISTICA 7, Software SPSS 23, as well as Microsoft Excel for presentation of tables and graphs. Respondents consisted of 59% females, compared to 41% of males. Majority of respondents (76.4%) were between the ages of 23-32. Respondents who were single were 66% compared to 32.1% married and 1.8% widowed. The findings of this study indicates that the health care workers, work in challenging environment with a lack of resources and need to be supported, as they experience more negative than positive experiences whilst caring for patients diagnosed with TB, further, revealed that, the health care workers did not get support from management. The analysis of the data has shown that management seemed not to understand fully what health care workers at grass-roots level are experiencing. Furthermore, findings of this research revealed that health care workers have never received any formal training on management of patients diagnosed with TB, wherein at times they have questions they have to ask their colleagues/friends, which at times they felt frustrated, the findings of this study furthermore revealed the lack of in-service training. The study concluded that, the respondents fears contracting TB from patients diagnosed of TB: there is compromised TB infection control measures, such as failure to wear protective masks (N95), and lack of adequate resources was also revealed by several respondents. The general findings of this research demonstrate that there should be adequate resources allocated to healthcare workers caring for TB, there should also be an initiatives to establish the health care worker‟s training regarding TB management and regular in-service training especially on TB management. This was also demonstrated in the study conducted by Chung et al, 2005, on the experiences of nurses while caring for Severe Acute Respiratory Syndrome (SARS) patients, the findings revealed a variety of emotions that were experienced, whereby, health care workers considered themselves vulnerable and at risk of contracting the disease themselves especially airborne diseases.