TUBERCULOSIS: SOUTH AFRICA: Poor MDR-TB knowledge among nurses

DURBAN, 15 June 2010 (PLUSNEWS) - South Africa has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB), but a study has found that many nurses have not been trained to handle this deadly, difficult-to-treat strain of the disease. The research, presented at the recent South African TB Conference in the coastal city of Durban, found that only about 19 percent of the 16 health facilities surveyed in rural and urban areas of Limpopo and KwaZulu-Natal provinces had nurses with formal training in MDR-TB management. Dr Tsholofelo Mhlaba, of Health Systems Trust, a health research NGO, said some nurses who had been trained to handle MDR-TB demonstrated similar levels of knowledge as those who were untrained. Some nurses tried to fill this knowledge gap with reading and internet research, but many considered MDR-TB a rare problem, even in KwaZulu-Natal, which has the highest incidence of drug-resistant TB in the country. Inadequate understanding of the disease led to poorly recorded patient histories and failure to follow up on people who had been in close contact with MDR-TB patients, such as household members. MDR-TB is resistant to the two most common first-line TB drugs, isoniazid and rifampicin, and can develop when patients do not complete their six-month course of first-line TB treatment. Globally, about five percent of TB patients have the MDR strain, but Mhlaba estimated that in South Africa around 14 percent of previously treated TB patients later developed MDR-TB. The study also found that many nurses were unsure about how to treat MDR-TB patients whose sputum samples still contained TB bacteria after three months of treatment, and that a shortage of beds in specialised care centres made referrals problematic. It recommended specific MDR-TB training for nurses, and that South Africa start treating MDR-TB patients as outpatients, as in neighbouring Botswana.