Tuberculosis among health care workers in KwaZulu-Natal, South Africa: a retrospective cohort analysis

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  • Tudor, Carrie
    • Affiliation: University of North Carolina at Chapel Hill
  • Van der Walt, Martie
    • Other Affiliation: South African Medical Research Council
  • Margot, Bruce
    • Other Affiliation: KwaZulu-Natal Department of Health
  • Dorman, Susan E
    • Other Affiliation: Johns Hopkins University School of Medicine
  • Pan, William K
    • Other Affiliation: Duke University Nicholas School of Environment
  • Yenokyan, Gayane
    • Other Affiliation: Johns Hopkins University Bloomberg School of Public Health
  • Farley, Jason E
    • Other Affiliation: Johns Hopkins University School of Nursing
Abstract
  • Background Tuberculosis (TB) is an occupational hazard for health care workers (HCWs) who are at greater risk of developing TB than the general population. The objective of this study was to compare the difference in TB incidence among HCWs with versus without a history of working in TB wards, to estimate the incidence of TB among HCWs, and to identify risk factors for TB disease in HCWs. Methods A retrospective cohort study (January 2006 to December 2010) was conducted in three district hospitals in KwaZulu-Natal, South Africa. Data were abstracted via chart review from occupational health medical records. Bivariate and multivariate analyses were performed using a Poisson multilevel mixed model. Results Of 1,313 (92%) medical charts reviewed with data on location of work documented, 112 (9%) cases of TB were identified. Among HCWs with TB 14 (13%) had multidrug-resistant TB. Thirty-six (32%) were cured, 33 (29%) completed treatment, and 13 (12%) died. An increased incidence of TB was reported for HCWs with a history of working in TB wards (incidence rate ratio [IRR] 2.03, 95% CI 1.11-3.71), pediatric wards (IRR 1.82 95% CI 1.07-3.10), outpatient departments (IRR 2.08 95% CI 1.23-3.52), and stores/workshop (IRR 2.38 95% CI 1.06-5.34) compared with those without such a history. HCWs living with HIV had a greater incidence of TB (IRR 3.2, 95% CI 1.54-6.66) than HIV-negative HCWs. TB incidence among HCWs was approximately two-fold greater than that of the general population over the study period. Conclusions HCWs working in a TB ward had an increased incidence of TB. However, a greater incidence of TB was also found in HCWs working in other wards including pediatric wards, outpatient departments and stores. We also identified a greater incidence of TB among HCWs than the general population. These findings further support the need for improved infection control measures not only in TB or drug-resistant TB wards or areas perceived to be at high-risk but also throughout hospitals to protect HCWs. Additionally, it is recommended for occupational health services to routinely screen HCWs for TB and provide HCWs with access to care for TB and HIV.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • Carrie Tudor et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Public Health
Journal volume
  • 14
Journal issue
  • 1
Page start
  • 891
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2458
Bibliographic citation
  • BMC Public Health. 2014 Aug 30;14(1):891
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • August 26, 2015

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