Setting: Tuberculosis is one of the most important causes of disease in Morocco, with an annual incidence of 100 cases per 100,000 population. There is a permanent risk of tuberculosis for health care workers in contact with bacillary positive tuberculosis patients.
Objective: To evaluate the risk and incidence of tuberculosis in health care workers and to study its distribution by cohort analysis.
Methods: A questionnaire was sent to all of the provinces and prefectures of the kingdom to gather information on tuberculosis cases notified between 1994 and 1997 in health care workers.
Results: Over the 4-year period, 130 new cases of tuberculosis were notified among health care workers in 30 provinces and prefectures: 73 men (56%) and 57 women (44%), with a mean age of 41.3 +/- 8.9 and 38.6 +/- 8.4 years, respectively (P = 0.093). The mean cumulative incidence was 85.3/100 000 health care workers; for doctors in specialist diagnostic centres for tuberculosis it was 1,094.8/100,000. The survey showed no significant difference between the mean annual cumulative incidences for doctors (83.4), nurses (78.5) and administrative staff (94.3). The cohort analysis indicated a mean annual success rate of 89.2%, failure rate of 0.9%, lost to follow-up 0.8%, death 3.8% and transfer out 3.1%. Several studies have shown weaknesses in the conditions of hygiene and security in the health centres (such as lack of gloves and masks, and meals taken within the workplace).
Conclusion: The risk of tuberculosis is not much higher in health care workers in general than in the general population; however, it is significantly higher in the specialist diagnostic centres for tuberculosis. The recent creation of health units for personnel working in the health centres should result in improvements in working conditions if the recommended preventive measures are respected.