DELAYS IN DIAGNOSIS AND TREATMENT OF SMEAR-POSITIVE TUBERCULOSIS AND THE INCIDENCE OF TUBERCULOSIS IN-HOSPITAL NURSES IN BLANTYRE, MALAWI

There is little information about nosocomial transmission of tuberculo sis (TB) in sub-Saharan Africa. A study was carried out to examine the process of diagnosis and treatment of smear positive pulmonary TB pat ients in Queen Elizabeth Central Hospital, Blantyre, Malawi, and the i ncidence of TB in nurses working in specific departments of the hospit al. Case notes of 1365 patients with smear-positive pulmonary TB, diag nosed and treated at the hospital in 1993 and 1994, were analysed. The number of qualified nurses who worked in specific departments of the hospital between 1993 and 1994 and the number who were diagnosed and t reated for TB during this period were obtained from nursing records. 7 87 patients (58%) were diagnosed as out-patients and 578 (42%) were di agnosed in hospital wards, 544 from medical wards. In medical wards, t here were long delays from the time of admission to diagnosis and star t of anti-TB treatment in new and previously treated TB patients. Of 3 10 qualified nurses, 12 (4%) were treated for TB in 1993-1994; 4 (14%) of 29 nurses working in the medical wards developed TB. The results i ndicate the importance of finding simple measures in resource-poor cou ntries to improve the diagnosis and treatment of TB in hospital patien ts in order to decrease the risk of nosocomial TB transmission.