1. NURSES ROLE IN THE CARE AND MANAGEMENT OF MDR-TB
PRESENTER: DRAJORU CLARE
PRINCIPAL NURSING OFFICER
MULAGO NATIONAL REFERRAL HOSPITAL AT
HOTEL AFRICANA- 9TH SEPTEMBER 2011

2. MDR T.B prevalence to 2.3% both new and retreatment cases
INTRODUCTION
Multi-drug resistant T.B is reality in Uganda so far 171cases have been notified to the National T.B leprosy Programme since 2008 t0 July 2011.
MDR T.B prevalence to 2.3% both new and retreatment cases

3. MULTI DRUG RESISTANT RESISTANT EXTENSIVE DRUG RESISTANT TB
TYPES OF RESISTANT T.B
MONO- RESISTANT TB
Mono Resistant TB ,TB in patient whose infecting isolates of Macbaterium tuberculosis are confirmed to resistant in vitro one first line anti TB drug
POLY RESISTANT TB
T.B in patient whose infecting isolates are resistant in Vitro to more than one other than isoniazid and Rifampicin
MULTI DRUG RESISTANT RESISTANT
T.B is active TB involving mycobacterium tuberculosis organisms that are resistant to at to at least both isonizedand rifampicin the two most powerful anti TB agents.An MDR TB strai n can be resistant to more than these two antibiotics and in most cases it is resistant to first line drugs
EXTENSIVE DRUG RESISTANT TB
Defined as resistant to at least rifampicin and isoniazid in addition to any fluoroquinolone and at least one of the injectable in second line drug(SLD) e.g amikacin Kanamycin and Capremycin

4. NURSES’ ROLES
NURSING IS THE PROTECTION, PROMOTION AND OPTIMIZATION OF HEALTH AND ABILITIES, PREVENTION OF ILLNESS AND INJURY, ALLEVIATION OF SUFFERING THROUGH DIAGNOSIS AND TREATMENT OF HUMAN RESPONSE AND ADVOCACY IN THE CARE OF INDIVIDUALS, FAMILIES AND COMMUNITIES

5. Management of MDR-TB patients presents several challenges to Nurses.
ROLES CONT’D
Nurses are responsible for educating and supporting patients with T.B, detecting medication side effects.
Management of MDR-TB patients presents several challenges to Nurses.

6. Objective of the presentation
To share the experience in the care & management of MDR-T.B patients in Mulago a pilot treatment program .

7. Over 50 patients were screened and confirmed with MDR-TB.
Cont’d
The pilot MDR-TB treat project was carried out between 2003 – 2007 under the welcome trust research project.
Over 50 patients were screened and confirmed with MDR-TB.

8. Who are involved in MDR-TB case management
Patients with MDR-TB
Multidisciplinary team of Health workers
Peers/ relatives of the person with MDR-TB
Members of the community

9. Treatment course in pilot project
Enrolled 13 patients: 5(42%)females/8(58%) males
Treatment was individualized regimen of 5 to 6 second line drugs (SLD) with at least an injection and fluoroquinolone
Treatment lasted for months
IM injections of Amikacin ( )
Strict DOT was observed-Each swallowed or not was marked on a therapy sheet and signed.

10. What was done to support patients during treatment
Continuous counseling to patients/ care takers
Weekly weight monitoring
Regular ward rounds to discuss individual patient progress
Provisional of nutritional support (WFP)

11. Achievements 100% cure rate in all the 13 patients
Nurses gained competencies in the care and management of MDR-TB patients
No injection Abscesses encountered

12. Challenges in MDR-TB Management
Pill burden
Painful injection sites
Socio-economical difficulties
Stigma
Patient/staff motivation
Lack of man power
Work conflicts
Space

13. MDR-TB patients isolated.
INFECTION CONTROL
MDR-TB patients isolated.
N95 masks were used.
Patients educated to cover their mouth / nose when moving out and coughing.

14. Way forward National survey required urgently
Indentified cases treated urgently.
strengthen human resource to manage MDR-TB
Health care providers with compromised immunity should not be allocated to attend to MDR-TB patients.
A register has been opened for all identified MDR-TB cases awaiting treatment on ward 5 & 6.
Risk allowances required

15. conclusion
It’s hard for patients to take anti-TB drugs regularly during the 6-8 months but harder in case of MDR-TB which lasts months.
Early detection and proper treatment of TB should be observed.
MDR-TB is curable with determination and commitment.

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