M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Background: In Gauteng Province, South Africa, Sizwe Tropical Hospital (STH) is the designated centre for the specialized management of MDR-TB. But during the period covered by this study (2001-2002), all cases of TB (MDR-TB and NMDR-TB) were treated at STH. This was not according to the prescript of the National guidelines. This study describes the socio-demographic, treatment profile and treatment outcomes of MDR-TB patients seen and treated at STH during 2001 and 2002.
Method: This was a cross sectional study involving retrospective review of records at STH. 281 systematically-sampled MDR-TB patient records were included in this study. Descriptive statistics were used to summarize the socio-demographic and treatment history characteristics and these were further analyzed to evaluate their relationship with MDR-TB treatment outcomes using Chi squared test of association. Means were compared using simple t-test.
Results: The patients were majority black, unemployed, and living in townships and informal settlements. Sputum tests alone or combined with x-ray were most commonly used to diagnose MDR-TB (98%) at referring facilities; and the majority of patients arrived at STH with a referral note (98%). The median duration of stay at STH was 56 weeks (IQR 21-89). The majority of patients had a successful treatment outcome (75%); and amongst those with unsuccessful outcomes, a significant number had died (17%). Factors associated with poor
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outcomes in terms of death, default, treatment failure and transfer out were age groups (1-9 and 30-39), race, employment status, place of residence, housing structure, referral systems (referral note and feedback procedures) and HIV status.
Discussion: The patients in this study had socio-demographic characteristics that facilitate TB transmission. There is a commendable referral system but various methods used to confirm MDR-TB and unjustified long duration of treatment prior to referral.
Although in general the majority of patients have successful treatment outcomes, the policy guidelines of the management of MDR-TB are not implemented fully, and several factors associated to poor outcome are related to the health service and referral system.
Recommendation: Effective adherence to the policy guidelines by health care providers and patients is recommended to improve treatment outcomes.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/11419 |
| Date | 12 March 2012 |
| Creators | Likibi, Mupata Lelwi |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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