High prevalence of comorbidity and need for up-referral among inpatients at a district-level hospital with specialist tuberculosis services in South Africa – the need for specialist support
Methods. A cross-sectional study of all hospitalised adult patients in Brooklyn Chest Hospital (a district-level hospital offering specialist TB services) from 27 - 30 October 2008. Outcome measures were: Type of TB and drug sensitivity, HIV co-infection, comorbidity, Karnofsky performance score, and frequency and reason for referral to other health care facilities.
Results. More than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant comorbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multi-drug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of comorbidity. Overall, one-fifth of patients required up-referral to higher levels of care.
Conclusions. District-level hospitals such as Brooklyn Chest Hospital that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required to optimise patient care.
Helen van der Plas, University of Cape Town
Marc Mendelson, University of Cape Town
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Date published: 2011-07-25
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