Abstract
Background: Tuberculosis is a great public health issue in South Africa. The incidence of tuberculosis among health workers is rated ten times greater than that of the community.TB can firstly attack the lungs and can also be spread from one person to another via droplet spread. It increases the chances of getting infected to people with no TB infection who come into contact with infected and asymptomatic people. For this reason, health workers (HWs) are at a greater danger of acquiring tuberculosis (TB). The World Health Organization has raised the significance of finding" more appropriate ways to stop TB by executing them successfully, particularly for the target population with a greater threat of TB transmission. Several researchers have established that, unfortunately, HWs do not consistently have enough knowledge and good attitude to adopt adequate practices for stopping the transmission of TB and treating TB.
These studies do not adequately address, ascertain and evaluate practice of behavioural change and implementation to strengthen TB policies.
Aim: The study aimed to address HWs’ behavioural changes towards TB and strengthening of TB by assessing HWs’ behaviour towards TB at the health facilities and their knowledge about infection control and their attitude toward TB treatment. The study also focuses on evaluating existing controls and the treatment regime for TB and behaviours among HWs. Methods: A cross-sectional survey was conducted, using a self-administered questionnaire. This design was chosen because it is undemanding, low cost and easy to implement. It provides a snapshot of the threats for TB exposure and related controls in Mbombela facilities. The sample size was calculated using EpiInfo 7.2 for a population survey and included 304 HWs, representing the entire population of HWs. Purposive sampling was utilised to determine the participants due to the inclusion criteria and stratification. Health workers with different levels of experience in the field might have different opinions about this issue, and also, HWs from various departments are exposed differently. The participants included auxiliary nurses, professional nurses, general workers, focal tuberculosis control programme staff, and those who were never infected by TB and working full-time at the facility. Data was collected through a paper-based interview using a self-administered questionnaire comprising closed-ended questions. Results from the statistical analyses were presented in frequency distributions, cross-tables, binary and multivariate logistic regression models. Ethical clearance was granted from the University of Johannesburg Research Ethics Committee. All consenting respondents participated voluntarily and no financial incentives were provided.
Results: A response rate of 95 % was accomplished as responses were received from 304 out of 320 questionnaire-distributed respondents. The majority of respondents (39.1%) were between 29-39 years of age. Slightly more than a third (36.5%) of respondents worked in the chronic department. Surgical masks were the most used at Mbombela facilities at 89.8% and N95 respiratory respirators at 10.2%. Two-thirds (64.5%) of the respondents were screened for TB at their initial appointments. According to the respondents all the facilities have a TB management protocol. The majority (76%) of respondents were trained in using N95 respirators and 71.0% of respondents were trained in infection control. Only 10.2% of respondents used N95 respirators and of these 70.4% sometimes use it when entering rooms of individuals with suspected or confirmed infectious TB. At least 11.2% of the respondents suggest that they would not report if they were infected with TB. With regard to engineering controls, all consultation rooms were reported to be well-ventilated with openable windows and doors.
Conclusion: In conclusion, administrative control measures under the responsibility of managers were not well enforced (e.g. availability of personal protective equipment), impacting on the availability of needed resources like N95 respirators. Facilities were not well-resourced, which negatively impacted the control and treatment of TB and contributes to HWs attitude toward infection control. The level of TB knowledge was more satisfactory in medical staff than general workers and assistant nurses.. The greater level of TB knowledge among the medical staff is relevant due to the fact that TB and infection control factors are included in their studies and training.
Keywords: Tuberculosis, health workers, personal protective equipment, occupational health, infection control.