Block 5: TB and occupation in South Africa - TB As A Problem In SA And Globally

TB AS A PROBLEM IN SA AND GLOBALLY:

South Africa is a high burden TB country (7 of 22) according to the WHO. These case rates illustrate some differences:

• TB rate (All Cases) = 339/100000 population;
• Estimated TB rate (All cases) = 556/100000 population;
• Western Cape ?? = 1200/100000 population;
• USA (a low burden TB country) has a TB rate (All Cases) = 6/100000 population.
• United Kingdom (another low burden TB country) has a TB rate (All Cases) = 10/100000 population.

M. Tuberculosis as an Occupational Disease in SA:

In Schedule 3 of the COID Act Pulmonary Tuberculosis is mentioned in connection with:

• Healthcare workers (Circular Instruction);
• Silica exposed workers (no qualifications for time or intensity).

Tuberculosis in SA gold miners has been compensable since the 1920’s and in all miners since the 1950’s. The ODMW Act currently compensates:

• "Cardiorespiratory" tuberculosis;
• Miners qualify after 200 shifts of commencing "risk" work and for 365 days after leaving work; or
• for silico-tuberculosis at any date (= "Second Degree").

M. Tuberculosis as an Occupational Disease in Healthcare workers:

Healthcare workers have been repeatedly been shown to be a group at increased risk of M.Tb, including MDR TB.

Effective preventive measures for healthcare workers are important in high risk contexts. Such measures include:

• Good ventilation and sunlight.
• High efficiency respirators/masks in higher risk contexts.
• Isolation of infectious patients (with laminar flow, negative pressure ventilation.
• Isolation of higher risk procedures (e.g. hypertonic saline, ultrasonic nebuliser collection of sputum samples, bronchoscopy, etc.).
• Ultraviolet light sources.

The Department of Labour has a Circular Instruction concerning Compensation of Pulmonary Tuberculosis in Healthcare workers. In this context it is notable that:

• Costs of diagnosis are paid.
• Treatment of TB is provided by the state.
• Cure without disability is the best outcome.
• Registration of cases is primarily because of possible complications.