**6. Prevention of MDR TB**

2

To achieve success in the control of MDR TB, there would be a need to strengthen existing TB DOTS programs. To achieve this, some areas that should be focused on are the creation of infection control policies both within and outside institutions. Health education of how transmission of disease occurs from cases to vulnerable groups should be emphasized in communities. Community-based care should be strengthened with recruitment of staff for contact tracing of MDR cases, screening of the contacts, treatment administration, and identification of those who are defaulting on treatment or require institutionalized care. There should be expansion in the teams with involvement of all relevant health care partners to strengthen Public–Private Mix initiatives for TB care and control [48-52].

#### **6.1. Infection control**

estimated 1.3 billion USD in 2010 to 4.4 billion USD by 2015 [45]. Some of the common adverse effects might also require monitoring such as ototoxicity and renal failure. There is also the need to document improvement by follow-up of bacteriologic cultures. In addition to these, cases need to be monitored because some MDR TB cases are in advanced stages of disease with other end-stage organ failures. MDR TB therapy is often characterized by low treatment completion rates due to death (15%), default (14-23%), and treatment failure (8-9%) [46]. To

**Figure 3.** Treatment outcomes for patients diagnosed with MDR TB by WHO region, 2007-2011 cohorts.

The Americas 2007 2008

2009 2010

2011

2010

2011

2

Western Pacific 2007

 0 20 40 60 80 100 Percentage of cohort (%)

 Treatment success Failure Died Lost to follow up Not evaluated

Africa

10 An Overview of Tropical Diseases

Eastern Mediterranean

South−East Asia

2007 2008 2009

2010 2011

2010 2011

Percentage of cohort (%)

0 20 40 60 80 100

(Adapted from WHO Global TB Report, 2014)

This aims to prevent transmission from cases to other patients or health care workers. The following means could help to ensure the protection of health care staff: Use of N95 mask by all staff on medical and TB isolation wards and in the HIV clinics [53]; HIV testing of all staff with reallocation of those testing positive to lower-risk positions; Annual Chest Xray screening for TB for all staff [24,54].

Within health care institutions, TB control officers should be hired as well as cough officer in waiting areas who would identify those that are in hospital for other reasons but who may require TB screening. The duration of hospital admission and stay should be reduced. There should be environmental airflow control to ensure maximal ventilation (natural mechanical ventilation within the ward and the use of outdoor waiting areas for outpatients). MDR TB isolation wards should be created with attention paid to laminar airflow [55].

Infection control programs should be created with plans for intervention should transmission be proved.
