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CURBING CROSS-INFECTION OF DRUG-RESISTANT TB THROUGH HEALTH INFRASTRUCTURE In brief South Africa has insufficient health infrastructure to cope with the growing tuberculosis (TB) epidemic. Extensively drug-resistant (XDR) TB now adds to increasing numbers of multi-drug resistant (MDR) TB patients. The CSIR has set out to address the lack of appropriate infrastructure to address TB infection and cross-infection, a key constraint in the effective treatment and rehabilitation of patients. The challenge The sheer number of TB cases in South Africa is a stark reality. The country has the highest incidence rate for TB infection in the world and over 70% of TB patients are co-infected with HIV/ Aids. South Africa does not have sufficient health infrastructure to cope with the TB epidemic. This is compounded by the fact that the layout of many of the facilities increases infection with TB. Drug-resistant TB is a very serious problem in South Africa. MDR-TB can be treated with medication, but at very high costs, while the recovery rate from XDR-TB is very low. CSIR research In the country’s fight against TB, the CSIR has been instrumental in supporting the design, development and construction of dedicated, long-term accommodation units for drug-resistant TB patients. A key requirement is to reduce the risk of patientto-patient cross-infection and patient-tocaregiver infection. This project has received at least R92 million from The Global Fund and more than R115 million from seven provincial Departments of Health with a total of nine newly-designed TB facilities being constructed. In addition to guidelines for design, development and construction, the CSIR also provides technical advice and training to the teams at the hospitals to ensure the successful roll-out of the TB units. For improved quality of life of longterm drug-resistant TB patients, the CSIR guidelines recommend provision of recreational spaces for sports, visitor areas, physiotherapy facilities, a business hub for patients, and classrooms for younger patients. CSIR architects and mechanical engineers used computational fluid dynamics (CFD) to study and model the airflow in buildings to improve the design for natural ventilation. For improved TB units at hospitals, the CSIR focused on developing low-cost and low-maintenance, yet fully functional, facilities that will contribute to the prevention and control of airborne TB infection. As the implementing agent on behalf of the national Department of Health, the CSIR also provides technical and financial management. Researchers work with the provincial teams, firstly by teaching them about airborne infection control and recommending design ideas. This is followed by a number of working sessions to fine-tune their designs. The CSIR’s research includes CFD modelling to test the designs. In this way, the CSIR aims to empower the teams by giving them an understanding of the dynamics of designing to reduce the risk of airborne disease transmission. Outcomes An operational TB unit was inaugurated in April 2011 by Deputy President Kgalema Motlanthe. This is a dedicated, long-term accommodation unit for drug-resistant TB-infected patients at the Catherine Booth Hospital in rural KwaZulu-Natal (KZN). Other units are already in use at Manguzi Hospital (also in KZN), Kopano Hospital Computational fluid dynamics modelling by the CSIR, with the image illustrating a typical TB unit ward block showing air flow patterns and velocity vectors. An exploded view of a typical TB ward block showing materials, construction technology and natural ventilation principles that have been applied. (Welkom, Free State) and Tshepong Hospital (Klerksdorp, North West). The other five TB units will be ready to accommodate patients with drug-resistant TB before the end of 2011. These units are at Jose Pearson Hospital (Port Elizabeth, Eastern Cape), Nkqubela Hospital (East London, Eastern Cape), Modimolle Hospital (Limpopo), West End Hospital (Kimberley, Northern Cape), and at Bongani Hospital (Hazyview, Mpumalanga). The KZN Department of Health is building additional long-term accommodation units on other sites, based on the Catherine Booth TB unit. 12
uilt environment Getting to grips Incidence and incidence rate: Terms used with disease and TB are incidence (case load) and incidence rate (rate of spread). Incidence refers to the total number of infections in a population, whereas incidence rate refers to the number of new cases occurring in a population per year, usually expressed as cases per 100 000 per year. South Africa, with an incidence rate of 980/100 000 (WHO 2008), has the highest rate of growth of TB in the world. This is far higher than the average for Africa (about 350/100 000) or incidence rates in other high-burden countries such as China or India. Reducing the number of new TB infections through safer health facilities (as it is an airborne disease) can have a major positive impact. The Western Cape Department of Health recently contracted the CSIR for support with the development of new MDR- TB accommodation at Brooklyn Chest Hospital. South Africa has 0.6% of the world’s population, while it has 17% of the world’s HIV infections and 11% of the world’s TB cases. Based on the R&D of this project, CSIR researchers have delivered numerous invited presentations at national and international conferences, and a number of research articles and reports have been published. In terms of human capital development, the CSIR conducted awareness and training sessions for the professional teams at each of the nine TB units that form part of The Global Fund project, as well as for the new Brooklyn Chest Hospital project. The professional teams consisted of about 20 people per TB unit. Some provincial training sessions had up to 50 participants per session. A typical MDR-TB block at Modimolle Hospital. Deputy President Kgalema Motlanthe opening the dedicated TB ward unit at Catherine Booth Hospital in KwaZulu-Natal. With him is Dr Aaron Motswaledi, Minister of Health. 13 PROJECT HIGHLIGHTS
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Wright C. 2010. Children’s sight
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CORPORATE GOVERNANCE 93
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are fairly presented in conformity
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CSIR. All subsidiary companies are
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CSIR Board Members (1 April 2010 -
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CSIR leadership team The CSIR manag
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Meetings 7 October 2010 24 March 20
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Report of the Audit and Risk Commit
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Role in the National System of Inno
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25 RELATED PARTY TRANSACTIONS (cont
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26 SUBSEQUENT EVENTS 26.1 Satellite
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Interests of the CSIR Net indebtnes
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169 2010 FIFA SOCCER WORLD CUP
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ACCESS Applied Centre for Climate a
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Printed on Hi-Q Titan Plus environm
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