Journal of Community Medicine & Health Education
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Tuberculosis (TB) is an airborne infectious disease that can be transmitted from one person to another. Health Care Workers
(HCWs) in South Africa are at risk of acquiring TB infection from their work environments. Although Tuberculosis
Infection Control (TBIC) measures put in place in clinics may reduce infection transmission, implementation remains a major
challenge. This study assessed barriers to implementation of TBIC among HCWs in two South African primary care clinics in a
Cape Town township with a high TB prevalence.
Using a case study approach, among various cadres of HCWs, data was collected from multiple sources: direct observation
(5 working days per clinic), key informant interviews (n=3), semi-structured interviews (n=7), focus group discussions (n=3)
and review of previous TBIC clinic assessment reports. The data was analysed using thematic analysis and interpretive analysis.
Although most HCWs recognise the importance of TBIC in preventing nosocomial TB, they commonly believe that the TB
transmission risk is only significant in clinic areas where known TB patients are found, and as such emphasise TBIC measures
in those areas.
Measures such as use of respirators and masks are mostly prioritized by HCWs ahead of administrative and environmental
measures that are potentially more effective in reducing TB infection. Barriers to TBIC implementation include: inadequate
HCW training on TBIC, a non-responsive compensation policy and the perception that a busy clinic schedule leaves no time
for TBIC implementation. Resource availability, adequate human resources and leadership were identified as enablers for TBIC
Oluwatoyin is studying for a Masters in Public Health in University of Cape Town (UCT). She assumed the role of a relativist in this case study
research seeking to understand and relate HCWs experiences (content) to the health care facility (context). Her passion lies in improving health
systems for efficiency particularly among health workforce.
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