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UBC Theses and Dissertations

Perspectives of Botswana policy-makers and healthcare workers towards tuberculosis infection control and occupational health measures : an interpretive description study Gamontle, Bojosi Moitsemang


Mycobacterium tuberculosis (TB) infection results in over 2 million deaths worldwide annually, with low and middle-income countries disproportionately affected. According to the World Health Organization, Botswana, a middle-income country, had a TB notification rate of 478 cases per 100 000 in the general population in 2012. High rates of TB in patients are directly correlated with a greater risk of infection in healthcare workers. The control of occupational TB is important as TB disease can lead to increased morbidity in healthcare workers, which can lead to compromised healthcare provision. The aim of our study was to explore perspectives of policy-makers and healthcare workers regarding formulation and implementation of occupational health and infection prevention measures used to control occupational TB. Our nine-month data collection period was based in Botswana, in four health institutions (two public and one private hospital, and one administrative). We conducted semi-structured in-depth interviews with twenty-one personnel in leadership positions in areas of infection control, occupational health, and TB program coordination. We conducted five focus groups with healthcare workers who have direct contact with TB patients, to explore their perspectives towards implementing TB guidelines. Theoretical sampling was used in recruiting participants. We chose the qualitative methodology interpretive description to analyze participants’ responses. The primary findings were conceptualized under four major themes; occupational health services, infection control, guidelines and policies, and barriers to implementation. There was uniformity and agreement among policy-makers and program leaders that there were limited occupational health and infection control measures. Most were also of the perspective that if healthcare workers were diagnosed with TB, there was inadequate evidence to support nosocomial acquisition. Healthcare workers identified their challenges in preventing TB in their workplaces, some of the barriers were guideline related, while others were related to institutional structures. A concept original to this study, ‘Armouring’ revealed lack of communication and disparity of control measures between professional healthcare workers and cleaners and drivers. Evaluating the guidelines using the AGREE II tool demonstrated that the guidelines did not contain all the important elements that the AGREE II tool required to make up robust, effective and implementable guidelines.

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