Structured assessment of healthcare facilities and knowledge, attitudes and practices of healthcare workers regarding tuberculosis infection control in Moyen-Ogooué, Gabon

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Dokumentart: PhDThesis
Date: 2019-12-10
Language: English
Faculty: 4 Medizinische Fakultät
Department: Medizin
Advisor: Adegnika, Ayola Akim (Prof. Dr.)
Day of Oral Examination: 2018-12-06
DDC Classifikation: 610 - Medicine and health
Keywords: Tuberkulose , Gabun
Other Keywords:
healthcare workers
infection control
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Background: Due to their interaction with infectious TB patients, HCW are at greater risk to develop TB than the general population. TB transmission in healthcare settings does not only threaten HCW, but also other patients and visitors in the hospital. Although Gabon ranks among the top-ten high incidence countries in the world, there are currently no national guidelines available for TBIC and several TB cases have already been notified among HCW. In the Moyen-Ogooué province, where resources are limited and evidence of a high MDR-TB prevalence is accumulating, effective TB control remains a challenge. The aim of this study was to assess the current TBIC practices in different healthcare facilities in the Moyen-Ogooué province and to provide insight into the knowledge, attitude and practices of HCW regarding TB. Methods: Twenty healthcare facilities, including two hospitals, one ambulatory HIV-clinic and 17 dispensaries, were assessed using a standardized tool. The assessments were conducted by direct observation, reviewing documents and in-depth interviews with the head of the facility or department. Current TBIC practices in the Moyen-Ogooué province were evaluated in comparison to the WHO recommendations on TBIC in healthcare facilities in limited-resource settings. In addition, the knowledge, attitude and practices of HCW were investigated by means of an interviewer-administered questionnaire which was particularly designed for this study. Results: The study revealed a complete absence of managerial TBIC controls such as infection control guidelines or committees. The implementation of administrative and environmental control measures was generally low. The MDR-TB department of one of the assessed hospitals was the only department that provided regular TB screening for its personnel. A total of 103 KAP survey questionnaires were completed by HCW. According to predefined categories, 40.8% of the respondents had “rather poor” knowledge about TB. However, all doctors had “good” or “excellent” knowledge. The professional category, level of education and former training on TB were found to be significantly associated with good knowledge levels. Attitudes towards TB and TBIC were overall positive. With 72.8%, the majority of HCW was scared of getting TB and 97.1% would be willing to be screened for TB regularly. Reported TBIC practice rates were rather low, especially regarding triaging of presumed TB cases and environmental controls. Good knowledge about TB was not statistically associated with good TBIC practice. Conclusions: The study results provided evidence for the urgent need of national TBIC guidelines, as HCW in the Moyen-Ogooué province are not sufficiently protected from occupational TB transmission. The assessment results can serve as a reference point for elaborating feasible guidelines and monitoring their implementation. The KAP survey results suggest, that effective TBIC does not only depend on good knowledge about TB, but also requires adequate facility structures, manpower and financing. However, particularly HCW with a lower professional degree, who represent the peripheral healthcare system, must receive training on TB and TBIC, as basic knowledge about TB is crucial for the early identification of TB patients.

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