Tuberculosis infection control measures in healthcare facilities, and their implementation in sub-Saharan Africa: A scoping review

Abstract

Background: Tuberculosis (TB) is one of the top 10 causes of mortality and the leading cause of death from a single infectious agent globally. In 2019, the World Health Organization (WHO) African Region accounted for 25% of global TB incidence and occupational transmission of TB in healthcare facilities is considered one of the most important transmission factors. It is, therefore, important to address TB infection control measures that limit transmission in healthcare facilities, especially in light of increasing prevalence and new drug resistant strains. The aim of this review is to discuss TB infection control measures in healthcare facilities, and explore their implementation status in one of high TB burden regions: sub-Saharan Africa.

Methods: A scoping review was conducted, allowing the inclusion of different study designs which was necessary for answering the broad research questions. Intervention studies, literature reviews and grey literature were included to identify descriptions of TB infection control measures and their contribution to TB prevention. Cross-sectional and observational studies were included to explore the implementation of these measures in sub-Saharan Africa. The WHO guidance on TB infection control measures (2009) was used as a framework for description of the measures.

Results: Twenty-seven studies were included in the scoping review. Twelve studies (grey literature and traditional reviews) provided information about TB infection control measures, six intervention studies provided information on impact of some TB control measures on TB transmission, and nine studies provided information about the implementation status of the measures in sub-Saharan Africa. Four categories of TB control measures were identified: managerial; administrative; environmental; and personal protective. The review found poor implementation and reporting of the these measures in healthcare facilities in sub-Saharan Africa including low levels screening of coughing patients for TB, and poor  implementation of environmental measures such as UV light, and personal protective measures such N95 respirators.

Conclusions: Despite the presence of well-designed WHO guidelines for TB infection control measures in healthcare facilities, there is poor implementation of them in sub-Saharan Africa. Therefore, a rapid global response to infection control in healthcare facilities is required for controlling TB.