South Africa is ranked by the world Health Organization among the top countries with a high tuberculosis strain. Studies have shown that the highest prevalence of TB is at the Western Cape Province. A significant risk has been noted in healthcare facilities
at Tygerberg hospital in Kwa Zulu natal province where a considerable risk in nosocomial transmission of tuberculosis has been noted. An infection prevention and controls programme in the country has established that although there is an adequate supply of protective training, great emphasis needs to be directed on training and understanding of the infection and controls programs. Studies have continued to indicate that concurrent human immunodeficiency virus, poverty, ignorance, overcrowding and other related factors have continued to hamper the control efforts from those tasked with the responsibility of controlling the disease.
Consequently, high treatment interruption rates, the HIV epidemic, low cure rates have contributed to the emergence of multi drug resistance tuberculosis in South Africa; this has been blamed on the adoption of inappropriate treatment programmes as well as patient factors that include a lack of adherence to the treatment regimen. The emergence of the multi drug resistance strain of TB can be adduced to a systematic failure in the global community to contain the disease which is curable (Gandhi, et al, 2006).
Efforts have been directed in the prevention and containment of TB in South Africa. Primary prevention aims to stop communicable diseases from spreading. This effort is therefore directed at people in the community who have not yet been infected. The most notable aspect of primary prevention is through vaccination this helps in the abolition of the routes of disease transmission. Other measures such as behavioral counseling have been high in a bid to contain transmission.
That coupled with early diagnoses, risk counseling, training of prevention services are primary strategies that have been adopted to contain new infections in the highly affected areas and most vulnerable groups of South Africa. However, a lack of systematic health behavior training, patient resistance to change and a low self efficacy has been challenges that have affected the adequate deployment of effective primary strategies (Weyer, 2006).
Secondary prevention strategies in South Africa have been aimed in trying to impede the spread of the disease from already infected persons. This has been directed at early detection, isolation of the patients and subsequent treatments of infected persons. This has been through evaluation and diagnosis by means of sputum examination and chest X-ray to diagnose the disease, ensuring the collection of sputum for microscopy as the basic means of detection and monitoring of treatment in health facilities while also ensuring that patients with a productive cough are subjected to sputum test for TB in designated laboratories; this has always been followed by the isolation and confinement of TB suspects in specialized facilities for treatment.
An emphasis has also been placed in communication where patients already infected have been informed that TB is curable hence the importance of complete treatment as well as seeking medical attention incase of the symptoms occur. Nutrition interventions come in handy due to the change in metabolism, the compromised immunity and lack of appetite. Health care facilities have also been instrumental in the provision of therapy during the continuation phase of treatment this has made it possible for filing reports on any complications that arise from the treatment (Gandhi, et al, 2006).
Tertiary prevention efforts are directed toward people living with TB and are intended to reduce the negative and challenging effects of the illness. This may include rehabilitation and patient education for example on the importance of cough etiquette so as to minimize infectious droplet nuclei the use of surgical masks though not efficient in eliminating infectious nuclei has been encouraged so as to prevent the generation of the nuclei. This is also involves counseling due to the stigma attached on TB patients.
A number of complex environmental control have been used to reduce the number of infectious droplets, the simplest method being ventilation through open windows other methods include mechanical ventilation using exhaust ventilation systems in health facilities, filtration of air and germicidal irradiation as well as the use of HEPA filtration These measures are useful in wards, TB clinic waiting and inpatient areas (Fourie, 1996).
Reference
Gandhi, N., Moll, A., Pawinski, R., Zeller, K., Lalloo, U. et al. (2006). Favorable Outcomes of Integration of TB and HIV Treatment in a Rural South Africa. New York: Oxford University Press
Weyer, K. (2006). Centers for Disease Control and Prevention Emergence of Mycobacterium Tuberculosis with Extensive Resistance to Second-Line Drug Worldwide. New York: Oxford University Press.
Fourie, P. (1996). WHO review of the tuberculosis situation in South Africa. Epidemiology Journal, 34 (2), 54-6.