Evaluation of diagnosis and treatment of pulmonary tuberculosis among adult patients in Matlala District Hospital in Greater Marble Hall Sub-district in Limpopo Province

Thesis ( M Med( Family Medicine ))--University of Limpopo, 2010.

Tuberculosis (TB) is a major health problem in South Africa especially in this era of high prevalence of human immune deficiency virus (HIV) infection. South Africa is currently ranked fourth among the twenty-two high burden countries worldwide with an incidence of 940/100 000 population/year and mortality of 218/100 000 population/year. The notational tuberculosis control programme NTCP) was established in response to this growing burden. The aim of this study is to evaluate the TB programme at Matlala District hospital and to make recommendations that could improve its effectiveness. The study was a descriptive cross-sectional study. Retrospective data of all adults ≥15yrs diagnosed with pulmonary TB (PTB) were collated from the TB register and patients’ records between 01/01/2008 and 31/12/2008. Children <15years and extra-pulmonary TB were excluded because of the challenges in diagnosis. Follow-up was done until end of treatment to determine the outcome. The outcomes were cured, completed treatment, failed treatment, died, defaulted treatment, transferred out and not evaluated based on the NTCP criteria.A total of 482 patients (266 females and 216 males) were included in the study with a median age 40.91 (standard deviation (SD) 14.65; 95% CI 39.59-42.22). Women with mean age 38.35 years (SD 15.03; 95% CI 36.54-40.16) were significantly younger (P value <0.00001) than men with mean age 44.05 (SD 13.55; 95% CI 42.23-45.87). There were 399 (82.78%) new cases and 83 (17.22%) re-treatment cases. 130 (26.97%) patients were co-infected with HIV while 236 (48.96%) patients did not know their status. In all, 193 (40%) were cured, 63 (13.07%) completed treatment, 4 (0.83%) failed treatment, 43 (8.92%) died, 27 (5.60%) defaulted, 141 (29.25%) were transferred out and 11 (2.28%) were not evaluated. The treatment success rate was 53.11%. The treatment success rate in this study is well below the 85% target in the NTCP. A large number of the patients did not know their status and the outcome could not be determined in significant number of patients (not evaluated and transferred out). A systematic referral and recording process; and a collaborative effort between TB and HIV services is therefore necessary to face this challenge. It may also be important to re-open the TB ward to prevent nosocomial transmission.