title: Tuberculosis risk among staff of a large public hospital in Kenya.
abstract: METHODS
  In sub-Saharan Africa, high rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection pose a serious threat for occupationally acquired TB among health care workers.
  
  
  OBJECTIVE
  To identify factors associated with TB disease among staff of an 1800-bed hospital in Kenya.
  
  
  METHODS
  We calculated TB incidence among staff and conducted a case-control study where cases (n = 65) were staff diagnosed with TB and controls (n = 316) were randomly selected staff without recent TB.
  
  
  RESULTS
  The annual incidence of TB from 2001 to 2005 ranged from 645 to 1115 per 100000 population. Factors associated with TB disease were additional daily hours spent in rooms with patients (adjusted odds ratio [aOR] 1.3, 95%CI 1.2-1.5), working in areas where TB patients received care (aOR 2.1, 95%CI 1.1-4.2), HIV infection (aOR 29.1, 95%CI 5.1-167) and living in a slum (aOR 4.7, 95%CI 1.8-12.5) or hospital-provided low-income housing (aOR 2.6, 95%CI 1.2-5.6).
  
  
  CONCLUSIONS
  Hospital exposures were associated with TB disease among staff at this hospital regardless of their job designation, even after controlling for living conditions, suggesting transmission from patients. Health care facilities should improve infection control practices, provide quality occupational health services and encourage staff testing for HIV infection to address the TB burden in hospital staff.
authors.affiliation: Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: T
authors.initials: T
authors.lastname: Galgalo
authors.forename: S
authors.initials: S
authors.lastname: Dalal
authors.forename: K P
authors.initials: KP
authors.lastname: Cain
authors.forename: J
authors.initials: J
authors.lastname: Oeltmann
authors.forename: C
authors.initials: C
authors.lastname: Tetteh
authors.forename: J G
authors.initials: JG
authors.lastname: Kamau
authors.forename: M K
authors.initials: MK
authors.lastname: Njenga
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: J M
authors.initials: JM
authors.lastname: Chakaya
authors.forename: H M
authors.initials: HM
authors.lastname: Irimu
authors.forename: B
authors.initials: B
authors.lastname: Miller
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
authors.forename: N N
authors.initials: NN
authors.lastname: Bock
authors.forename: K
authors.initials: K
authors.lastname: Ijaz
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications; D006282:Health Personnel; D006779:Hospitals, Public; D006798:Housing; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D007630:Kenya; D008297:Male; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000635:transmission*; D055815:Young Adult