The research objectives were to describe the age and gender of adult HIV positive clients on ART who received IPT; the incidence of tuberculosis among clients that received IPT and the defaulter rate among those that were commenced on IPT. Quantitative non-experimental descriptive retrospective cohort study was undertaken to ascertain the incidence of tuberculosis among adult HIV positive clients who received IPT. 104 clinic records of HIV positive adult clients accessing care at Isithebe Clinic, iLembe-South Africa who were commenced on IPT between 01 July 2010 and 30 November 2011 were analysed. The study found that 66 of 104 (63.5%) study respondents completed the course of IPT and the majority of those that defaulted were due to poor quality of care. Gender was statistically found to have played a role on whether a patient completes IPT. None of the study respondents that completed IPT was diagnosed with TB disease. / Health Studies / M.P.H.

The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.

A cross-sectional study was conducted from February 2011 to August 2012 to investigate the status and identify risk factors for Bovine Tuberculosis (BTB) and cattle Brucellosis. A total of 1277 cattle from 6 selected dairy farms were tested. The farms were purposively selected on suspected risk. Samples were analysed using Rose Bengal Test (RBPT) and Complement Fixation Test (CFT) for Brucellosis and Comparative Intradermal Tuberculin Test (CITT) for BTB. The results revealed the overall prevalence of 1.6% for Brucellosis and no BTB was found. Logistic regression analysis revealed that age of cattle, herd size and number of calves a cow has had significant association with Brucellosis with p-values 0.0071, 0.0490 and 0.000 respectively. The role of location (p>0.05), gender (p>0.05) and breed (p>0.05) in the occurrence of the disease was not statistically significant at α=0.05, although higher rates were obtained in females and Jersey breed. Questionnaires were also administered to 47 individuals a total of 12 females and 35 males. Most respondents were not aware about cattle brucellosis and cattle tuberculosis. Consumption of raw or unpasteurized milk still occurs with 74.75% of respondents revealed.

PHD (Health Sciences) / Department of Advanced Nursing Sciences

MCur / Department of Advanced Nursing Science

MPH / Department of Public Health / Background: TB and HIV/AIDS were identified as priority healthcare problems of current years worldwide. Notable concerns (2878) were raised in Vhembe District Municipality because of an increase in patients with TB, including re-treatment patients (Department of Health, 2017). Purpose: The main aim of the study was to investigate the factors associated with the increase of new TB infection among clients in Thulamela Municipality, South Africa. Methodology: A quantitative descriptive survey design was used to conduct this study. Census sampling or total population sampling technique was used to select the respondents who were patients seeking treatment for TB from the designated clinics within Thulamela. Self-administered questionnaire was used to collect data from respondents. Data were analyzed using statistical package for social sciences version 25.0. Results: out of a high proportion of the respondents 45 % (n=98) respondents were taking ARV treatment while 27% (n=58) were taking respiratory disease treatment at the time of TB diagnosis. Moreover, 59% (n=169) respondents reported being next to a coughing person before diagnosed with Tuberculosis. Conclusion and recommendations: The results discovered that most respondents stayed in the dusty area for more than three years. Educating the community about how staying and working in dusty areas contribute to TB infection may decrease the rate of infection. / NRF

Tuberculosis (TB) has become a serious South African health problem because it is the most common opportunistic disease that leads to death in people with HIV/AIDS. Due to the airborne nature of the disease it can easily be spread to anyone including healthy people. A lack of compliance to treatment by TB patients explains why prevalence rates of the disease are high and why there is an emergence of drug resistant strains such as XDR-TB and MDR-TB. Information on existing knowledge, attitudes and perceptions regarding TB can provide a crucial foundation for the development of educational programmes and interventions aimed at reducing the further spread of the disease. This study aimed at understanding the knowledge, attitudes and perceptions towards TB and relating these to the current prevalence of HIV/AIDS. A face-to-face interview survey was conducted among adult Grahamstown East residents (n=1020). The Health Belief Model (Rosenstock et al., 1994) and Bandura’s (1986) Social Cognitive Theory formed the theoretical framework of the data collection and analysis. The data generated from the field work was first descriptively analysed providing frequency tables. Thereafter cross tabulations were calculated for relevant items using independent variables, namely gender, level of education, and experience of dealing with TB. The results of the study show that, in general, knowledge concerning TB was sufficient to provide a foundation for the adoption of healthier behaviours in the female respondents. Few of the respondents reported feeling personally susceptible although the majority of the respondents acknowledged the severity of the disease. The cues to action lacked the influence to persuade people to adopt positive health related behaviours. The perceived benefits of adopting preventative behaviour were not very influential in the adoption of healthier behavioural changes in the respondents. Disease stigma regarding the dual association of TB and HIV/AIDS was the main barrier for the adoption of healthier behavioural attitudes. Perceived self-efficacy in preventative behaviours was generally low in the less educated respondents. Recommendations regarding areas for future research and change interventions are provided.

Thesis (MScMedSc (Biomedical Sciences. Molecular Biology and Human Genetics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: South Africa is currently facing a major multidrug-resistant tuberculosis (MDR-TB) epidemic and has one of the highest incidences in the world. Aminoglycoside antibiotics are commonly used in this country as a treatment against MDR-TB. A well known side-effect of aminoglycosides is permanent hearing loss and this is thought to have a significant genetic component. To date, at least six mutations in the mitochondrial genome are known to confer susceptibility to aminoglycosideinduced hearing loss. It is imperative that we investigate the frequency of these mutations in our populations and determine whether certain sub-groups are at increased risk. The aim of the present study was therefore to investigate the genetic aetiology of aminoglycoside-induced hearing loss in the South African population. A multiplex method using the ABI Prism® SNaPshotTM Multiplex system was optimised to screen for six mutations in the MT-RNR1: A1555G, C1494T, T1095C, 961delT+C(n), A827G and T1291C. A total of 115 MDR-TB patients from the Brooklyn Chest Hospital in Cape Town who were receiving high doses of either streptomycin, kanamycin or capreomycin were recruited for this study. Furthermore, 439 control samples, comprising of 93 Afrikaner, 104 Caucasian, 112 Black and 130 Mixed Ancestry individuals were recruited and screened for the presence of the six mutations. Identification of novel variants in the MT-RNR1 and the entire mitochondrial genome was performed using High Resolution Melt analysis (HRM) and whole mitochondrial DNA sequencing, respectively. A total of 97 family members from a South African family known to harbour the A1555G mutation were recruited and genotyped using SNaPshot analysis. In addition, mitochondrial functioning in the presence of different streptomycin drug concentrations, in transformed lymphoblasts of an individual harbouring the A1555G, was assessed by means of the MTT colorimetric assay. Detection of heteroplasmic mutations was performed using PCRRestriction Fragment Length Polymorphism (RFLP) analysis and UN-SCAN-IT software. We successfully developed a robust and cost-effective method that detects the presence of all six mutations simultaneously. The method worked equally well on both blood (from adults) and buccal swabs (from children). The C1494T, T1095C and T1291C mutations were not detected in any of the MDR-TB or control groups. Alarmingly, the A1555G mutation was detected in 0.9% of the Black control samples and in 1.1% of the Afrikaner controls (in one sample in the heteroplasmic state 25%). The A827G mutation was present at a frequency of 0.9% in the MDR-TB patients and in 1.1% of the Afrikaner controls. The 961delT + insC(n) mutation was found in relatively high frequencies in both the MDR-TB patients (3.5%) and control groups (1.1% of the Afrikaner, 1.5% of the Mixed Ancestry and 7.1% of the Black samples). Similarly, the T961G mutation was III detected at high frequencies in the Caucasian (2.9%) and Afrikaner (3.2%) controls. Screening for novel variants in MT-RNR1 in MDR-TB patients experiencing ototoxicity revealed two novel variants (G719A and T1040C). However, G719A and T1040C are not likely to be pathogenic since they were detected in ethnic-matched controls: Mixed Ancestry (20.7%) and Black (1.8%) controls. Furthermore, a total of 50 novel variants were identified within the mitochondrial genome of eight MDR-TB patients with ototoxicity. Only five of the 50 variants (one in the MT-TH, ND3, COX3 and two in the CYTB gene) were shown to reside at positions that are evolutionarily conserved across five species from human to frog, and the four variants in the protein coding genes resulted in missense changes. A total of 76 of the 97 family members recruited were found to be A1555Gpositive (on mitochondrial haplogroup L0d) and are therefore at risk of developing irreversible hearing loss. Genes and variants known to act as genetic modifiers: tRNASer(UCN), homozygous A10S in TRMU and 35delG in GJB2 were not present in this family. For the MTT assay, decreased mitochondrial functioning of cells harbouring the A1555G mutation in the presence of streptomycin were (compared to wild type) observed but this was not statistically significant (p-value: 0.615- 0.999). The high frequency of the A1555G mutation (0.9%) in the Black population in South Africa is of concern given the high incidence of MDR-TB in this particular ethnic group. However, future studies with larger numbers of samples are warranted to determine the true frequencies of the aminoglycoside deafness mutations in the general South African population. Our data suggests that the 961delT + insC(n) and T961G variants are common non-pathogenic polymorphisms due to the high frequencies observed in controls (>1%). The identification of the first novel variants within protein coding genes that could possibly be associated with aminoglycoside-induced hearing loss holds great possibilities with regards to the identification of a second gene involved in drug induced hearing loss. Future studies where the possible effect of these variants on the normal functioning of these genes could be assessed would contribute greatly to this field of research. All 76 A1555Gpositive members of the family were given genetic reports and counseled about their risk and that of their children for developing hearing loss due to aminoglycoside use. The development of a rapid and cost-effective genetic method facilitates the identification of individuals at high risk of developing hearing loss prior to the start of aminoglycoside therapy. This is of critical important in a low-resource country like South Africa where, despite their adverse sideeffects, aminoglycosides will be continue to be used routinely and are accompanied with very limited or no audiological monitoring. Future studies and greater public awareness is therefore needed to address this serious problem. / AFRIKAANSE OPSOMMING: Suid Afrika beleef tans „n grootskaalse tuberculose epidemie (veral weerstandige vorme van tuberculose) (MDR-TB), met een van die hoogste voorkomssyfers in die wêreld. Aminoglikosied antibiotikums word baie algemeen gebruik in Suid Afrika vir die behandeling van MDR-TB. ‟n Bekende newe effek van die middels is permanente gehoor verlies en dit is van mening dat dit gekoppel is aan „n genetiese component. Daar is tans ses mutasies in die mitochondriale genoom wat vatbaarheid tot aminoglikosied-geinduseerde gehoor verlies veroorsaak. Daarom is dit van uiterse belang dat die frekwensie van die mutasies in ons populasies bepaal word sodat daar vasgestel kan word watter groepe „n hoë risiko het om gehoor verlies te kan ontwikkel. Die ABI Prism® SNaPshotTM Multipleks sisteem is gebruik en geoptimiseer om te toets vir die ses mutasies in die MT-RNR1: C1494T, T1095C, 961delT+C(n), A827G and T1291C. „n Totaal van 115 MDR-TB pasiente van die Brooklyn Chest Hospital in Kaap Stad is gewerf vir die studie. Hierdie pasiente ontvang daaglikse hoë dosese van een van die volgende aminoglikosiede: streptomycin, kanamycin of capreomycin. Verder is „n totaal van 439 kontrole DNA monsters gewerf vanuit die volgende etniese groepe: 93 Afrikaner, 104 Blank, 112 Swart and 130 Kleurling. Hierdie monsters is ook getoets vir die ses mutatsies. Hoë Resolusie Smelt analise (HRS) is gebruik om nuwe DNS volgorde veranderinge in die MT-RNR geen te identifiseer. Die hele mitochondriale genoom is blootgestel aan DNA volgorde bepaling in „n poging om nuwe DNS volgorde verandering in die genoom te identifiseer wat moontlik betrokke kan wees by aminoglikosied-geinduseerde gehoor verlies. „n Total van 97 lede van „n Suid Afrikaanse familie waar die A1555G mutasie teenwoordig is, is deur middle van die SNaPshot metode gegenotipeer. Verder is die normale funcitoneering van die mitochondrion in getransformeerde witbloed selle, getoets in die teenwoordigheid van verskillende konsentrasies streptomycin met behulp van die MTT kleurmetrie toets. Deteksie van heteroplasmiese mutasies is gedoen deur middle van die PCR-RFLP tegniek en alle analises is gedoen op die UN-SCAN-IT program. Ons was suksesvol in die ontwikkeling van „n vinnige, koste effektiewe en kragtige tegniek wat al ses die mutasies in MT-RNR1 in een reaksie kan optel. Hierdie tegniek het goed gewerk met DNA monsters van bloed en van selle verkry vanuit die wangholte (geneem van kinders jonger as 12 jaar). Die C1494T, T1095C en T1291C mutasies is glad nie waargeneem in enige van ons MDR-TB patiente of kontroles nie. Skrikwekkend is die hoë frekwensie (0.9%) waarby die A1555G mutasie in die Swart kontrole groep waargeneem is. Hierdie mutasie is ook in 1.1% van die Afrikaner kontrole groep opgemerk in heteroplasmie van 25%. Die A827G mutasie was teenwoordig in 0.9% en 1.1% van die MDR-TB patiente en Afrikaner kontrole monsters, onerskeidelik. Die 961delT + insC(n) mutasie is opgemerk in baie hoë frekwensies in beide die MDR-TB (3.5%) en kontrole groepe (1.1% van die Afrikaner, 1.5% van die Kleurling en 7.1% van die Swart monsters). Die T961G mutasie is ook in hoë frekwensies in slegs die Blanke (2.9%) en die Afrikaner (3.2%) kontrole groepe waargeneem. Nuwe DNS volgorde veranderinge in MT-RNR1 is gesoek in „n groep MDR-TB patiente wat gehoor verlies ondervind. Slegs twee nuwe verandering is ontdek (G719A en T1040C). Dit is onwaarskynlik dat hierdie veranderinge patogenies is siende dat hulle teen frekwensies van 20.7% en 1.8% waargeneem is in die Kleurling en Swart kontrole groepe onderskeidelik. Tydens die soeke na nuwe DNS volgorde veranderinge wat moontlik geassosieer is met aminoglikosied-geinduseerde gehoor verlies in die mitochondriale genoom is 50 onbekende veranderinge ontdek (een in die MT-TH, ND3, COX3 en twee in die CYTB gene). Die veranderinge is verder ondersoek vir evolusionêre konservasie op beide die nukliotied en amino suur vlak van mens to padda. Dit is bevind dat 76 uit die 97 familie lede positief is vir die A1555G mutasie en het dus „n hoë risiko om aminoglikosied-geinduseerde gehoor verlies te ontwikkel as hul bloot gestel word aan hierdie antibiotikums. Verder is gevind dat hierdie familie op die L0d mitochondriale haplogroep lê. Geen van die sogenaamde genetiese modifiseerde gene of DNS volgorde veranderinge in hierdie gene (tRNASer(UCN), A10S in TRMU in homosigotiese vorm en die 35delG in GJB2) is gevind in die familie nie. Die MTT toets het „n afname in die mitochondriale funksioneering van selle waar die A1555G mutasie teenwoordig was getoon, alhoewel die verskil tussen selle wat nie die A1555G mutasie het nie, nie statisties betekenisvol was nie (p-waarde: 0.615-0.999). Die hoë frekwensie van die A1555G mutasie (0.9%) in die Swart populasie van Suid Afrika is skrikwekkend siende dat die voorkomssyfer van MDR-TB in hierdie groep baie hoog is. Toekomstige studies met grooter getalle is nodig om die ware frekwensie van die mutasies geassosieer met aminoglikosied-geinduseerde gehoor verlies in die algemende Suid Afrikaanse populasie te bepaal. Ons data dui aan dat die 961delT + insC(n) en die T961G mutasies slegs algemene nie-patogeniese polimorphismis is siende dat dit in sulke hoë frekwensies (>1%) in kontroles opgemerk is. Die identifiseering van die eerste DNS volgorde veranderinge in proteïen kodeerende gene wat moontlik geassosieer is met aminoglikosied-geinduseerde gehoor verlies hou groot en belowende moontlikehede in, interme van die identifiseering van „n tweede geen. Toekomstige studies waarin die effek van hierdie veranderinge op die normale funktioneering van hierdie gene ondersoek word sal „n besondere groot bydrae lewer tot hierdie veld van navorsing. Al 76 van die A1555G positiewe familie lede is voorsien van genetiese verslae en het berading ontvang in verband met hul risiko en die risiko van hul kinders om aminoglikosied-geinduseerde gehoor verlies te ontwikkel. Die ontwikkeling van „n kragtige, vinnige en koste-effektiewe genetiese metode vergemaklik die vinnige identifiseering van hoë risiko individue vir die ontwikkeling van gehoor verlies voordat hulle met hul aminoglikosiede behandeling begin. Dit is veral noodsaaklik in „n derde wêreld land soos Suid Afrika waar, ten spyte van hul gevaarlike newe effekte, aminoglikosied antibiotikums steeds gebruik sal word. Daarom is grooter publieke bewusmaking nodig om hierdie problem te probeer oplos en te verhoed.

Thesis (MPhil (Communicable Diseases)) (Dept of Interdisciplinary Health Sciences. Community Health))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Global control of the tuberculosis (TB) epidemic remains one of the greatest health challenges of the 21st century, despite the availability of effective treatment over the past 50 years. The rising incidence of transmitted (primary) drug resistant TB threatens the very fabric of conventional TB control efforts, which are already strained by a rampant human immunodeficiency virus (HIV) epidemic. Ongoing transmission of Mycobacterium tuberculosis is a key factor that sustains the TB epidemic in endemic areas such as the socio-economically deprived townships of Cape Town, South Africa. My research explores the disease context, or social terrain, of TB in this endemic setting. It is primarily concerned with how the social terrain of endemic TB may contribute to ongoing transmission and the potential that it holds for enhancing TB control efforts. Analyses of qualitative data from eight township research sites in and around Cape Town show that pragmatic and novel approaches are required to pierce through the enormity of TB as a political and economic problem. Broadening the current biomedical focus on treating individual patients, to include more holistic community-based interventions, can and should be developed. Data were collected as part of qualitative pre-intervention community surveys conducted in 2005 and 2006 for a public health intervention trial (ZAMSTAR) performed in Zambia and South Africa. Twenty-four communities were selected as research sites and this study draws on the survey data collected in the trial’s eight South African sites. Although the data were collected for the ZAMSTAR trial, the aims and analyses presented in this study - which seek to improve our understanding of how the social terrain is meaningful for TB control - remain independent of ZAMSTAR. Through a retrospective analysis of the South African data, I inductively present three distinctive ways in which the social terrain is meaningful for TB control. First, the interaction between social cohesion and social diversity may be an important variable that predicts community response to public health interventions aimed at reducing the prevalence of TB in these endemic areas. This is demonstrated by triangulating ZAMSTAR’S adaptation of a social systems model with further analysis of the research sites. Second, the study identifies a common discourse running through the sites that stigmatizes TB as both a dirty and HIV-related disease. It is argued that this may be significantly contributing to TB diagnostic delay and I call for more holistic approaches to TB control that can reduce perceived marginalization and TB-HIV stigma. Third, congregate settings emerge as noteworthy visible features of social terrain that clearly have the potential to facilitate TB transmission within communities. The pre-intervention surveys qualitatively described public spaces within each research site and the use thereof. Basic principles of TB transmission are applied to these descriptions, developing a novel method of mapping the relative transmission risk possibly posed. Innovative use of similar approaches could identify likely transmission “hot spots” that may serve as focal points for targeted interventions, such as adjustments that increase ventilation or encourage TB suspects to seek urgent medical diagnosis and treatment. / AFRIKAANSE OPSOMMING: Die beheer van tuberkulose (TB) bly steeds een van die grootste gesondheids uitdagings van die 21ste eeu, ten spyte van die beskikbaarheid van effektiewe behandeling vir die afgelope 50 jaar. Die stygende insidensie van oorgedraagde (primêre) middelweerstandige TB bedreig die wese van konvensionele TB kontrole programme, wat reeds gebuk gaan onder die oorweldigende impak van die menslike immuungebrek virus (MIV) epidemie. Ononderbroke oordrag van Mycobacterium tuberculosis is ‘n kardinale faktor wat die epidemie onderhou in areas soos die sosioekonomies agtergeblewe dele van Kaapstad, Suid-Afrika. My navorsing ondersoek sosiale terrein (konteks) van TB in hierdie hiperendemiese konteks. Dit is primêr gemoeid met die moontlike bydrae van die sosiale terrein tot voortgaande TB oordrag en die potensiaal wat dit mag inhou om TB kontrole te verbeter. Analise van kwalitatiewe data van agt agtergeblewe gemeenskappe in en om Kaapstad wys dat nuwe en pragmatiese benaderings benodig word om die volle omvang van TB as ‘n politieke en ekonomiese problem aan te spreek. Data is versamel as deel van kwalitatiewe pre-intervensie gemeenskapsopnames wat gedoen is gedurende 2005 en 2006 vir ‘n publieke gesondheid intervensie studie (ZAMSTAR) in Zambië en Suid-Afrika. Die studie sou poog om die TB prevalensie betekenisvol te verlaag in gemeenskappe wat erg geaffekteer word deur MIV. Vir navorsings doeleindes is vier-en-twintig gemeenskappe geselekteer, waaronder agt Suid-Afrikaanse gemeenskappe. My studie analiseer kwalitatiewe data wat versamel is in hierdie agt gemeenskappe, wat verskeie observasie en deelnemende tegnieke ingespan het. Die studie poog om algemene begrip te verbeter van hoe die sosiale terrein betekenisvol kan wees in TB kontrole; dit is my eie werk en is totaal onafhanklik van die groter ZAMSTAR studie. Induktiewe retrospektiewe analise van data identifiseer drie voorbeelde wat illustreer hoe die sosiale terrein betekenisvol mag wees vir TB kontrole. Eerstens, die interaksie tusses sosiale kohesie en sosiale diversiteit mag ‘n belangrike verandelike wees wat gemeenskapsrespons tot publieke gesondheidsintervensies voorspel. Dit word geïllustreer deur die toepassing van ‘n sosiale sisteme model (soos aangepas deur ZAMSTAR) en analise van ander aanvullende data. Tweedens, identifiseer die studie ‘n gemeenskaplike diskoers in alle navorsings gemeenskappe wat TB stigmatiseer as beide ‘n vuil en MIV-verwante siekte. Dit word geargumenteer dat hierdie verskynsel moontlik betekenisvol bydra tot vertraging van TB diagnose en die nodigheid vir meer holistiese benaderings wat marginalisasie en TB-HIV stigma kan verminder word uitgewys. Derdens blyk dit dat openbare vergaderplekke ‘n belangrike deel van die sosiale terrein vorm en duidelik die potensiaal het om TB oordrag binne gemeenskappe te fasiliteer. Die pre-intervensie opnames het alle openbare vergaderplekke sorgvuldig beskryf en basiese beginsels van TB oordrag is gebruik om vergaderplekke geografies te kaart volgens die moontlike transmissie risiko wat dit mag inhou. Innoverende gebruik van GIS-gebasseerde benaderings, soortgelyk aan die metode wat gebruik is om potensiële “transmission hot spots” te kaart, mag bydra om intervensies beter te fokus, deur bv. verbeterde ventilasie te verskaf of mense met simptome van TB aan te moedig om dringend mediese hulp te soek.

Thesis (MMed)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction: The morbidity and mortality associated with tuberculosis (TB) disease is of grave consequences for the health and employment of afflicted individuals. Healthcare workers are identified amongst high risk groups in communities. The prevalence/incidence of TB is dependent on the presence of associated risk factors which varies in diversity and intensity in different communities and workplaces. Understanding the risk factors operating in any given environment is indispensable to any tuberculosis control programme. Objective: The objective of this study was to describe the occurrence and trends of TB disease as well as to determine the risk factors associated with the disease among Tygerberg hospital employees. Method: A cross-sectional descriptive study design with a nested case-control component was used to determine the occurrence (and trends) and risk factors of TB disease respectively. Occurrence and trends of tuberculosis: The frequencies, distribution and trends of TB disease from 2008 to 2011 were obtained by calculating and comparing the annual incidence rates for each variable. Cases were identified from the occupational health clinic TB register, while the various denominator data were obtained from the Human Resource database. Determination of risk factors: Cases were recruited from the occupational health clinic TB register and controls were randomly selected from unaffected workers during the study period. Self-administered risk factor questionnaires were completed by both cases and controls. Multivariate logistic regression analysis was used to determine the association between known and suspected risk factors and the occurrence of TB disease amongst employees. Results: Sixty six cases of TB disease occurred in the workforce during the study period resulting in an annual average incidence rate of 397/100,000 population (95% CI: 307/100,000-505/100,000). Twenty three (34.8%) of the 66 cases occurred in Housekeeping staff, making them the most affected sub-group [1181/100,000 population (95% CI: 747/100,000-1768/100,000)]. The rate of TB disease in nurses was 1.7 times (95%CI: 1.4-2.0) that of doctors. Workers in the 40-49 years age-group experienced the highest incidence [490/100,000 population (95%CI: 329.6/100,000-706.8/100,000)] of TB disease compared to the other age-groups. There was no obvious difference in gender occurrences. Disease rates varied among different racial groups, with the highest rate in black employees [1473/100,000 population, (95%CI: 924/100,000-1981/100,000)]. Distribution of TB disease in the institution was widespread, with security department being the most affected [2500/100,000 population (95%CI: 311/100,000- 9262/100,000)]. There was a downward but statistically insignificant (annual range 9-23; p=0.28) trend in the rate of disease occurrence over the study period. No previous training on TB prevention (OR: 2.97, 95% CI: 1.15 - 7.71), HIV (OR: 67.08, 95% CI: 7.54 – 596.64) and working without knowledge of TB risk profile of the workplace (OR: 8.66, 95% CI: 1.10 – 67.96) were associated with TB disease occurrence. Conclusion: Occurrence of TB disease among Tygerberg hospital employees was low compared to that of the general population of its drainage areas. Disease occurrence in the facility was wide and varied with respect to occupational groups, workplaces and time. Well-established risk factors for TB infection (and disease) were found to be determinants of disease occurrence in the facility.