A description of patients with recurrence of Pulmonary Tuberculosis in a Tuberculosis Hospital, Ermelo

Abstract

Background: Retreatment TB (tuberculosis) is a serious category of pulmonary TB with a treatment outcome that could include MDR-TB (multidrug resistant TB). In the Msukaligwa municipality of Mpumalanga Province, South Africa, the burden of TB is high with poor treatment outcome indicators, thus creating some preconditions for retreatment TB. Knowledge of the characteristics of the patients and related health system factors would help in designing interventions to improve the care for patients, the adherence to medication and the prevention of retreatment TB.

Aim of the study: The aim was to describe the occurrence, characteristics and management outcome of retreatment pulmonary tuberculosis in patients in a TB hospital in Ermelo.

Objectives: The specific objectives were to describe the socio-demographic, behavioural and clinical factors related to recurrence of TB in patients; to determine the contribution of defaulting treatment to recurrence of TB in the study population; to identify the prevalence of resistance to TB medication amongst patients with retreatment TB; and to identify treatment outcomes in patients who have been followed up for the duration of retreatment TB.

This study was set in the 58-bed TB hospital in Ermelo.

The study design was cross-sectional and descriptive, and the study population comprised of patients admitted with TB at the Ermelo TB hospital between 01 January 2005 and 31 December 2007. Data were collected from the patients’ medical records and the TB registers by using a predesigned form. Data were analysed with Microsoft Excel Spreadsheet at the Centre for Statistical Consultation at the University of Stellenbosch.

Results: All of the 388 patient records with retreatment TB, which formed 19.6% of TB patients admitted between 2005 and 2007, were reviewed. This comprised 66% male patients with a mean age of 41.4, and 34% female patients with a mean age of 35.3. They were mostly unemployed, and 93% had a primary education; 43% were unmarried and 34% were married. Retreatment TB was diagnosed with sputum smear microscopy in 71%, with a bacilli load of 3+ in 45% of the patients. Almost three-quarters (74%) of the patients have been afflicted by TB, 1–3 years before the episode under study. Retreatment TB categories were: ‘after treatment completed’, 69%; ‘default’, 19%; ‘after cure, 8%, and ‘treatment failure’, 4%. The majority, that is, 98% (169/172) of patients tested, had a HIV-positive status; the median CD4 cell count was 106 cells/μL at the time of retreatment, and very few (5%) were on ART (antiretroviral drug treatment). Drug resistance to primary TB drugs was as follows: Rifampicin (16%), Isoniazid (29%), Ethambutol (19%), and Streptomycin (23%). The treatment outcomes for those for whom data were available were: ‘successful’ (49.1%), ‘death’ (23.8%); and ‘treatment default’ (22.9%). MDR-TB caused complications in 3.3% of the patients.

Conclusion: The majority of the retreatment TB patients were male patients with an average age of 41, and unemployed. More than two-thirds of the patients had completed TB treatment previously, and defaulting treatment accounted for less than one-quarter of retreatment categories. The process of care was better in terms of the diagnosis of TB with sputum smear. Improvement in the documentation of key factors such as smoking, alcohol, drug use amongst patients and co-morbidity, as well as counselling and testing for HIV and provision of ARTs, is required. Treatment outcomes with regard to successful outcomes should be monitored and improved.