Cape Town med students at high risk of contracting TB

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Undergraduate medical students in Cape Town are at high risk of occupationally acquired tuberculosis (TB), with an unmet need for comprehensive occupational health services and support.

These were the findings of a study conducted by experts from Stellenbosch University and NGO, TB Proof. Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years, the study says.

A questionnaire was distributed via e-mail and social media to medical students and recently graduated doctors at two medical schools in Cape Town and 3 500 individuals were approached to participate. Twelve of those who responded and were interviewed, reported a diagnosis of TB. Ten were female. Two had contracted drug-resistant TB (DR-TB). The average diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnosis being 
correct.

The report says most consulted private health-care providers and nine underwent invasive procedures. Health-care costs were incurred from R25,000 for drug-sensitive TB, up to R104, 000 for DR-TB.

The report says students struggled to get treatment, incurred high transport costs and missed academic time. Some had side effects including gastrointestinal issues, difficulty concentrating, hearing loss, depression and decreased visual acuity. Two participants with DR-TB, wanted to leave medical school. Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB.

University of Cape Town Health Sciences faculty spokesperson Linda Rhoda said since 2014, the faculty has had 11 students who are reported to have had TB. “All of the students diagnosed with TB were successfully treated with the appropriate medication and protocols. Our measures appear to be effective, as the figures indicate a more than 50% decline in cases over the past two years.

“We cannot be certain that the TB infections were contracted in the workplace, as TB is ubiquitous in South Africa. However, it is widely acknowledged that health professionals are at increased risk due to patient exposure,” she said.

Western Cape Health Department spokesperson Mark van Der Heever said if a student contracts TB, one cannot automatically conclude that 
he or she contracted it at a health facility. He said the department has no accurate information on the number of students who have been affected in the last few years as their health status is confidential.

“All undergraduate health science students are educated around the risks of TB as part of their training, specifically around the signs and symptoms they might experience should they contract TB.

They are encouraged to use the protective clothing offered to them or to seek medical help if they develop symptoms, either through their general practitioner, or through their nearest clinic,” he said.

Abstract
Background. Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown.
Methods. A self-administered questionnaire was distributed via email and social media to current medical students and recently graduated doctors (2010 – 2015) at two medical schools in Cape Town. Individuals who had developed TB disease as undergraduate students were eligible to participate. Quantitative and qualitative data collected from the questionnaire and semi-structured interviews were analysed with descriptive statistics and a framework approach to identify emerging themes.
Results. Twelve individuals (10 female) reported a diagnosis of TB: pulmonary TB (n=6), pleural TB (n=3), TB lymphadenitis (n=2) and TB spine (n=1); 2/12 (17%) had drug-resistant disease (DR-TB). Mean diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnoses being correct. Most consulted private healthcare providers (general practitioners (n=7); pulmonologists (n=4)), and nine underwent invasive procedures (bronchoscopy, pleural fluid aspiration and tissue biopsy). Substantial healthcare costs were incurred (mean ZAR25 000 for drug-sensitive TB, up to ZAR104 000 for DR-TB). Students struggled to obtain treatment, incurred high transport costs and missed academic time. Students with DR-TB interrupted their studies and experienced severe side-effects (hepatotoxicity, depression and permanent ototoxicity). Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB.
Conclusions. Undergraduate medical students in Cape Town are at high risk of occupationally acquired TB, with an unmet need for comprehensive occupational health services and support.

Authors
Helene-Mari van der Westhuizen, Angela Dramowski

Cape Times report
SAMJ abstract


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