No beds, so infectious TB patients go home

2012-03-17 15:58

A severe shortage of hospital beds across South Africa means patients with multidrug-resistant tuberculosis are being sent home while they are still highly infectious.

Some MDR-TB patients are having to wait as long as four months to get a bed in a state hospital.

The national department of health admits this is not an “ideal situation”, but insists it’s better to get people on treatment and manage them in their own homes than to let them die while waiting for a bed.

It has acknowledged, though, that its new “out of hospital” treatment plan poses a risk to the public.

According to the department’s own guidelines for treating MDR-TB, patients infected with this dangerous strain should be in hospital for at least the first six months of treatment.

This is to prevent them from infecting others with the highly contagious disease.

The guidelines also state that during the first six months of treatment, patients are supposed to receive five different drugs a day, intravenously. These injections must be administered by a nurse.

Dr David Mametja, the department’s chief director for TB control and management, said this week: “It would be ideal to hospitalise all MDR-TB patients but it is impossible because the demand (for beds) is too high and treatment duration is long.”

“It is better to manage patients outside of hospitals than to make them wait for a bed when we do not know when it would be available,” said Mametja.

Dr Iqbal Master, a leading MDR-TB expert based at the King George V Hospital in Durban, echoed Mametja’s sentiments.

Master said that before the department’s out-of-hospital management policy was adopted by the provincial government, “patients were dying while on a waiting list to start with treatment”.

“Treatment was available but the beds were the problem. Some patients would wait as long as four months to get a bed and by the time they do it is too late,” Master explained.

Until recently no patient was allowed to start with MDR-TB treatment unless they were also to be admitted to hospital for at least six months.

Master and Mametja both acknowledged that the new policy posed a potential risk to the public.

The World Health Organisation says a person infected with MDR-TB can infect up to 15 other people and the figure could be higher in countries with a high prevalence of HIV, like South Africa.

About 7 400 people were diagnosed with MDR-TB in South Africa in 2010, 45% of whom had no history of TB treatment.

Mametja said this was an alarming aspect of MDR-TB in South Africa.

“In the past, resistant tuberculosis was reported in people who defaulted in TB treatment. But now we are seeing more people who have been infected by others,” he said.

Clinical studies have shown that the only way to prevent further MDR-TB infection is by detecting it early and successfully treating not only infected people but those they have been in close contact with.

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