serves a population with an extremely high incidence of TB and HIV
and these two diseases account for a large amount of the work load
of the health services.
At present (2007),
the HIV positivity rate amongst our Antenatal Clinic attendees runs
between 24%-28% every month. (Compare to RSA -29%, KwaZulu-Natal
- 39% and Umkhanyakude District _36%). The rate of HIV amongst the
general population (all age groups) is estimated to be at 10%, whilst
in population >15yrs it is estimated to be 18%. Approximately
70% of all in-patient deaths are HIV-related. Nevirapine is used
in the PMTCT program with disappointing results - 24% of the babies
that were tested, are still HIV positive - we have started a dual
regimen in August 2007, which should (hopefully) reduce it to 5%.
The ARV program was started in 2004 - currently there are 2,600
patients on treatment - approximately 70% of the total estimated
eligible patients. The ARV program has been rolled out to all PHC
clinics, which necessitated more frequent visits by doctors. The
burden that AIDS patients places on the hospital is significant
both in quantity, cost and also in the type of care they require.
Many patients require full time 100% nursing care (bathing, feeding,
turning) in the terminal stages. They often have prolonged hospital
stays (prolonging our average length of stay) and also require longer
courses of antibiotics /more expensive treatments.
The ARV programme was started in July 2004. As of October 2007 over
2600 adults and children have been started on these life saving
medications. This programme has been fully decentralized to the
Primary Health Care level with al l 10 clinics initiating and managing
patients on ARVs. There is much opportunity for doctors to be involved
in this programme and training and support is readily available.
ARV patients constitute 10% of total outpatients and the medicine
cost is 50% of the total hospital medicine budget.
We have a Home
Based Care (HBC) unit in the hospital, but the lack of a hospice
for those patients that fall "in the gap" (not needing
acute hospital admission but not well enough to be cared for at
home) mean that they are often admitted for "HBC"/hospice
care. This situation is changing now with more patients on ARV.
is an important cause of morbidity and mortality amongst adults
and children. The TB programme currently registers over 1000 new
TB patients each month. More chilling besides the sheer numbers
of TB patients (250 in 1993, 800 in 2002 and 1052 in 2006), are
the epidemics within the epidemic. The cure rate of sputum positive
individuals is 77% as at June to August 2007. Patients receive 6
to 8 months supervised treatment in the community by trained DOTS
Multi drug resistant TB (MDR) is on the rapid increase, currently
(2007), we have 146 MDR TB cases on treatment (6%). We register
approximately 12 new patients each month. A small MDR unit (16beds)
was established in late 2006. Patients are admitted for 6 months
at hospital for daily injections or receive these at home if they
live near a clinic. The hospital has participated with the MRC in
a research trial in assessing the usefulness of a rapid diagnostic
test for MDR. The hospital has been identified to become a district
referral centre for MDR TB and will receive a dedicated 40 bed unit.
Retreatment cases are also concerning, constituting approximately
10% of all TB patients. Extra-pulmonary TB is often causing difficulty
in diagnosis. Approximately 70% of TB patients are co-infected with
HIV. The TB Control Program is getting good results with a 77% cure
rate in 2006 (RSA 59%, KZN 50%), and a defaulter rate of 1%. The
death rate of 18% is mainly due to HIV co-infection. DOTS is followed,
2 tracer teams are in place and all close contacts less than 5 years
are screened. All patients eligible for ARV treatment are also screened
for active TB, before ARV treatment is started. PHC clinics are
diagnosing and treating sputum positive PTB.