The Role Of Public Health Workers In Tuberculosis Management And Prevention

Project and Seminar Material for Public Health

The Role Of Public Health Workers In Tuberculosis Management And Prevention


Abstract


This study investigates the role of public health workers in tuberculosis management and prevention. Two hundred and twenty nine(229) randomly selected (stratification) health workers were administered a 54-item questionnaire. The questionnaire comprised sections designed to provide relevant information of concern to the study such as knowledge of Tuberculosis infection prevention and control, practices and challenges. Results showed that health workers had fairly good knowledge of Tuberculosis infection prevention and control. This was significantly influenced by participants’ sex, current ward of work and job title but not age and number of years of work. Practices used by the health workers were generally good and appropriate especially regular hand washing hygiene, education of Tuberculosis patients and use of information, education and communication materials. What was lacking was wearing of a N95(Non oil close fitted mask with 95% filter efficiency that protects from inhaling infectious droplet nuclei) and FFP2 (an oil and non oil aerosol mask or respirator with 94% filter efficiency that protects from inhaling infectious droplet nuclei) when working in high risk Tuberculosis areas, offering of surgical mask to Tuberculosis suspects or cases when they are in the hospital and separation of group suspected or confirmed Tuberculosis patients from other patients. Identified challenges included inadequate education/training programmes for health workers about Tuberculosis infection, prevention and control, improper ventilation due to overcrowding at the out patients department, lack of protective equipment (FFP2 or N95 masks, gloves), non availability of Tuberculosis wards for infected patients, stigmatization of staff working on Tuberculosis patients and poor resourced laboratory for Tuberculosis testing. It was concluded that health workers need to improve their knowledge on Tuberculosis infection prevention control whilst stakeholders institute measures geared to wards improvement of facility and logistic deficit.


Chapter One


Introduction

1.1 Background to the Study

Tuberculosis or TB is a common and often deadly infectious disease caused by various strains of Mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread when the bacteria get into the air, and when people who have the disease cough, sneeze, or spit. A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. People who are close to the infected person, are more likely to be infected when they breathe the bacteria into their lungs. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims. (Mims, 1993)

Persons with latent TB infection do not feel sick and do not have any symptoms, but usually have a positive reaction to the tuberculin skin test. They are infected with Mycobacterium tuberculosis, but do not have active TB disease. Those with latent TB infection are not infectious and cannot spread TB infection to others. However, persons with latent TB infection may develop active TB disease at some time in the future. About 10% of infected persons will develop active TB disease at some time in their lives, but the risk is considerably higher in the first two years of infection particularly for persons whose immune systems have been weakened by HIV infection. Persons with latent TB infection should be treated in good time, in order to prevent the infection from progressing to active disease. Those with active TB disease are considered infectious and can spread TB bacteria to others. The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Tuberculosis is diagnosed definitively by identifying thecausative organism (Mycobacterium tuberculosis) for example in sputum or pus. When this is not possible, a probable – although sometimes inconclusive diagnosis may be made using imaging such as X-rays or scans and/or a tuberculin skin test (Mantoux test).Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine.

With the discovery of chemotherapy in the 1940s and adoption of the standardized short course in the 1980s, it was believed that TB would decline globally. Although a declining trend was observed in most developed countries, this was not evident in many developing countries (Chadha, 2009). In developing countries; about 7% of all deaths are attributed to TB which is the most common cause of death from a single source of infection among adults. (Kaye et al., 1996).

The end TB Strategy target is to accelerate the annual decline of TB incidence rates from 2% in 2015 to 10% per year by 2025, WHO (2016). This strategy addresses the challenges facing many countries with high tuberculosis (TB) burden including Nigeria, which remains one of the worst TB affected countries in the world, Onyedum CC (2017). Evidence suggests that the TB prevalence and mortality rates in Nigeria were previous underestimated. Adamu AL (2017). Despite being ranked the 4th TB affected country in the world in 2009, it was estimated that 590,000 new TB cases were reported in 2015.WHO (2013). In order to stop the spread of TB in the country, the government of Nigeria has implemented various interventions aimed at early detection of TB and overall TB control. Pathmanathan I (2017). Although these initiatives contribute greatly to the management of TB, several studies carried out in Nigeria and other countries have presented TB related challenges. Kigozi G (2017), This includes patients’ related factors such as inadequate TB knowledge as well as perceptions and attitude towards treatment. Consistently, inadequate knowledge of TB treatment especially treatment duration has been associated with treatment interruption. Sub- optimal patients’ compliance is a practical implication of poor TB knowledge. In real terms, when patients observe improvement in their health arising from the effective use of TB-medications within few weeks of treatment at the DOT centres, they stop taking medication. Patients whose treatment is interrupted remain infectious for longer period. They are more likely to relapse or succumb to tuberculosis as a result of treatment failure, hence foster the emergence of drug-resistant tuberculosis.


1.2 Statement of the Problem

The World Health Organization (WHO) in 1993 declared TB a global emergency in recognition of its growing importance as a public health problem. In 2009, WHO revised TB Infection Prevention Control policy, guidelines and implementation strategies. The WHO stipulated guidelines adopted by Nigeria were to ensure safe practices among health care workers, patients and families. This was disseminated in all the states in 2010 to ensure that TB control strategies are implemented in all health institutions throughout the country including the ability to control nosocomial infections as part of quality health care service to the people (WHO, 2006). TB Infection Prevention Control is one of the major strategies to prevent and control TB disease in patients and healthcare workers (HCWs) in the health care setting (Federal Ministry of Health, 2010). However, tuberculosis transmission among HCWs, patients and families is still a threat especially to nurses who have the closest and longest contact with patients than other care givers (Lopez, 2008).

In the state where the current study was conducted, there was no available official data on students infected with TB. The TB coordinator of the school clinic indicated that this was so because the TB reporting format does not include the patients‘ occupation (personal communication).The researcher, a student has observed that some practices among students were contrary to the recommended standard guidelines and strategies on TB infection control despite the adoption and dissemination of TB infection prevention control in Nigeria two years ago. However, the question is what is the role of public health workers in tuberculosis management and prevention?.


1.3 Objectives of the Study

The main objective of the study was to assess the the role of public health workers in tuberculosis management and prevention. In line with this objective, the study considered the following specific objectives are to;

  1. Assess the knowledge of public health workers on tuberculosis disease prevention and control in Federal medical center.
  2. Describe the practices employed by public health workers for the prevention of TB disease in Federal medical center.
  3. Identify challenges encountered by health care workers in implementation of the TB- IPC strategies in Federal medical center.

1.4 Significance of the Study

This study is expected to pioneer research into the awareness and perception of TB and other respiratory infections in particular as well as nosocomial infections in general. It is also relevant to the intellectual community; the facts and information that come out of this study provide useful knowledge for learning. It will further improve the steps in the practices that will be employed by health care workers to reduce the transmission of TB and other respiratory infections among health workers, clients, patients in hospitals and clinics. The findings of this research will also be useful to the hospital management in making decisions regarding TB and prevention of respiratory diseases in general.

This study is expected to set a pace to delineate the roles and responsibilities of all stakeholders at every level of the provision of health care. It is to provide guidance on which activities or measures are to be implemented at health facilities to prevent and control nosocomial TB transmission among health workers, patients and relatives.


1.5 Research Questions

The current study therefore sets out to find answers to the following research questions:

  1. What knowledge do public health workers have regarding TB infection prevention and control strategies?
  2. What are the practices employed by public health workers in the Federal medical center in implementing infection prevention and control of TB?
  3. What are the challenges healthcare workers encounter in the implementation of TB infection prevention and control strategies?

1.6 Hypothesis

There is no significant association between gender and awareness and perception of tuberculosis.


1.7 Scope of the Study

The study was limited to all public health workers Federal medical center. The variables to be studied include the prevalence of TB, according to sex and age and treatment outcome of patients within the period under review.


1.7 Operational Definition of Terms

Prevalence of Tuberculosis:

This refers to the number of cases of tuberculosis.

Knowledge:

Information the public health workers have on TB and its prevention measures. Practices: These are the activities and behaviours of public health workers towards prevention of TB at Federal medical center.

Health Care Workers:

Trained Nurses, Laboratory Technologists and technicians, X-ray technicians and technologists, Doctors, Health Assistants/Health Aides

Infection Prevention:

The necessary actions or any precautionary measures taken to stop the invasion and multiplication of micro-organisms (TB bacilli) and transmission from one person to another.

Infection Control:

The necessary actions or any precautionary measures taken to reduce the invasion and multiplication of micro-organism (TB bacilli) and transmission from one person to another.

Assessment:

To evaluate health workers on the subject of TB infection prevention and control practices.


Chapter Five


Summary and Conclusion

5.1. Summary

This chapter outlines the summary and conclusion, implications of findings and suggestions and recommendations of the research. The study was on the assessment of tuberculosis infection prevention and control practices among health care workers in Federal medical center.

Findings of this study pointed out that knowledge about TB infection prevention and control is fairly/moderately good. Demographic variables such as sex, current ward of work and job title had a significant influence on participants‘ knowledge of TB infection prevention and control. Age of participants and number of years of work did not have any significant influence on participants‘ knowledge. Findings further showed that participants engaged in appropriate practices of TB infection prevention and control. Practices were significantly influenced by participants‘ age, current ward of work and job title but not sex and number of years of work. Professional education, experience, in-service training/short course and mentorship played valuable roles in the preparedness for TB infection prevention and control. Though knowledge and practices of TB infection prevention and control were fairly good, they were not without challenges such as overcrowding at the OPD leading to improper ventilation, no TB wards for infected patients, lack of protective equipment (FFP2 or N-95 masks, gloves) among others. Suggestions were made by participants geared towards addressing some of these challenges. These findings have certain implications which are considered below.


5.2 Implications for Nursing

Implications of the findings for nursing derived from this study are reported in four main areas of nursing: management, research, education and practice.

5.2.1 Nursing Management

Challenges enumerated by participants in this study such as overcrowding at the OPD which leads to improper ventilation, no TB wards for infected patients, lack of protective equipment (FFP2 or N-95 masks, gloves) imply that much cannot be achieved in the implementation of TB infection prevention and control unless Nursing administrators and managers develop and implement policies directed towards addressing these challenges. Further, participants considered in-service training as valuable in the preparation towards TB infection prevention and control. Short courses relevant to the subject area must be organized regularly to ensure that best practice is ensured. Supervision of nurses in this area must be done to ensure strict adherence to policies.

5.2.2 Nursing Research

The current research points out that though knowledge was fairly good, more needs to be done in unearthing health workers knowledge of TB infection prevention and control. The use of observational method which would ensure researchers observing practices rather than the use of questionnaire is paramount. Nurses must be encouraged to pursue research areas pertaining to TB prevention and control to enhance and enrich the existing literature based upon which policies would be formulated and implemented in order to improve TB infection prevention and control. There is the need for more research in this area to throw more light on health workers knowledge of TB infection prevention and control in the whole country.

5.2.3 Nursing Education

Professional education was considered the most valuable factor in the preparation for TB infection prevention and control. This is an indirect call for the inclusion of this in the curriculum of nursing training especially professional nursing training. This will ensure that professional nurses are well equipped in this area. Further, knowledge of TB infection prevention and control was fairly good which also imply that more education and training is needed.

5.2.4 Nursing Practice

Literature reveals that the rate of nosocomial infections has been a challenge for infection control programmes in many countries. Challenges encountered and mentioned by participants especially regarding lack of protective equipment (FFP2 or N-95 masks, gloves) is a pointer to the possibility of high rate of nosocomial infections. Health workers must be monitored, supervised and encouraged to work professionally so as to prevent this.


5.3 Suggestions and Recommendations

Regular and frequent in-service training and short courses must be organized to equip and improve the knowledge of health workers on TB infection prevention and control.

Provision of adequate logistics to ensure smooth working environment for the health workers is recommended.
Health workers directly linked to TB prevention and control must be trained in educating and helping patients to adhere to the protocols.

There is the need for the expansion of health facilities in order to ensure separation of suspected and infected TB patients from other patients to reduce the rate of inaction.

Research needs to be conducted on adherence and compliance to TB infection prevention and control in all health facilities in the country.


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Frequently Asked Questions


What is the role of Public Health in TB control?

State and local health departments have the primary responsibility for preventing and controlling tuberculosis (TB). Roles and Responsibilities of the Public Health Sector Providers. The essential role of the public health sector in TB control is to plan, coordinate, and evaluate TB. control and prevention efforts.

What is the who Field Manual for tuberculosis (TB) care and control?

Tuberculosis care and control in refugee and displaced populations: an interagency field manual, second edition. Geneva, World Health Organization, 2007 (WHO/HTM/TB/2007.377). 88. Guidelines for workplace TB control activities: the contribution of workplace TB control activities to TB control in the community.

What does a tuberculosis nurse practitioner do?

Assist in development, implementation, and evaluation of tuberculosis (TB) screening, testing, and treatment programs for both latent TB infection (LTBI) and TB disease. Establish priorities for prevention and control activities. Protect the public’s health by isolating and treating persons with infectious TB disease.

What are the three priority strategies for tuberculosis prevention and control?

There are three priority strategies for tuberculosis prevention and control in the United States: (i) identifying and treating p … Because tuberculosis is caused by an infectious organism that is spread from person to person through the air, public health measures are essential to control the disease. 

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