How can TB affect your family and your nanny?
South Africa, in the past 10 years, has seen a resurgence in cases of tuberculosis or TB. It may be worrying to think that an airborne disease is so prevalent in the country in which you are raising your children, but knowledge is one of the first steps to combating TB.
It is important that we as parents have an understanding of how TB can affect our family, our children, and our employees – our nannies. As parents we need to know what our risks are when hiring someone to care for our children, and how to help and support our nanny if she does become sick with tuberculosis.
Contrary to popular belief, anyone can get TB and it is not a disease that only affects the poor. Famous people like President Nelson Mandela and Archbishop Desmond Tutu have had TB and now are cured.
What is TB?
TB is a disease that mainly affects the lungs, but can also affect other parts of the body. TB is transmitted when small drops of saliva or spit are coughed into the air by people who have TB, and are breathed in by people who do not have TB. However, breathing in the TB germ does not mean you will become sick. In most cases, when a person’s immune system is strong, the body will keep the TB germ in check and cause it to become inactive or ‘latent’. In this form, the TB germ can stay within the body without ever causing the person it has infected to become sick. Someone with a latent TB infection cannot infect anyone else. If, however, the person’s immune system becomes weak, which can happen for a variety of reasons including stress, hypertension, HIV infection, diabetes or poor nutrition, the TB bacterium will activate and start to multiply. At this point, the person will develop the signs and symptoms of TB and will be infectious to others.
Typical symptoms of TB include:
- Appetite Loss
- Chest pain
- Tiredness
- Night Sweats
- Ongoing couch for more than 2 weeks, or coughing up blood
- Weight loss
Hiring a nanny with TB and HIV in mind
As a parent and an employer, most of us will want to have a healthy nanny. However, forcing your employee to reveal his or her HIV status is illegal, and not employing someone because of their HIV status is considered discriminatory. Asking your nanny about her health during an interview can be a highly sensitive matter, and the answers you get will be subjective. Your best source will be past references as they will be able to indicate if she was unusually absent and if she does have the right constitution to handle your family’s workload and schedule in her role as a childcarer and cleaner.
We recommend that the best approach is to discuss the precautionary health measures you expect your nanny to take with your children, and to make sure that both you and your nanny are well-informed about TB and HIV. In this way, both of you will know the symptoms of TB and be able to spot any potential problems early.
A guideline for nannies and families regarding the symptom of coughing
If a nanny or anyone in the family is HIV positive, they need to be extra careful about looking after their own health. Even a day’s ongoing cough can be a cause for concern and they should visit a clinic for a TB test as soon as possible. It is important to remember, however, that this is the choice of the person concerned.
If anyone, whether HIV positive or negative, has been coughing for more than two weeks, they should also consider having a TB test at a local clinic.
Besides coughing, there are other symptoms of TB that should also be investigated at a clinic – appetite loss, chest pain, tiredness, night sweats and fever, and weight loss.
How do you or your nanny go about testing for TB?
A TB test can be performed at any clinic – whether near your home or work or your nanny’s. A nurse at the clinic may ask the person being tested questions about their symptoms and ask them to cough and spit into a bottle. It is best for the person being tested to spit from the chest as early as possible in the morning to achieve the most accurate results. The sputum sample is then sent to the laboratory for testing using smear microscopy. The smear microscopy test may take 2 days and the result will then be sent back to the clinic the person visited.
If TB bacteria are detected in the sputum, the smear microscopy test result will be positive. If none are detected the test result will be negative. However, TB can be difficult to diagnose, and if the symptoms persist despite a negative result from this test and no other obvious causes, further tests may be performed. These include a chest x-ray and the attempt to culture TB bacteria from a sputum sample. The person being tested may be referred to a larger clinic where an x-ray machine is available. The culture tests can take from 6 to 8 weeks to get a result.
How does this affect my family’s schedule?
If you or your nanny suspect that she or someone else in your family may have TB, it is important to go for a test as soon as possible. If your nanny is having a TB test, you can discuss her taking sick leave during this period, which could be from 2 days up to a week in length depending on the clinic involved. While the person is waiting for their result, in case they do have TB, they should avoid children, especially those under five, practice good cough hygiene by covering their cough with their sleeve, and spend time outdoors in the sun and in well-ventilated areas.
If your nanny or any other adult in your family tests positive for TB, they will be put off work by the doctor for two weeks to limit the potential of spreading the infection. This is as a precaution to avoid spreading infection and to give the person time to recover from their symptoms and the side effects of the medication. However, once someone has been on effective treatment for 2 days, they are no longer infectious to others. Within these two weeks, the person should follow the guidelines mentioned above at home to avoid infecting anyone else.
How does TB affect children?
TB affects children differently to adults. It is very difficult, for example, for a child to transmit TB to another child, and an adult is almost always the source of infection. TB can also be difficult to diagnose in a child because they find it difficult to cough up sputum.
If your child is under five and has been in close contact with someone, whether this is your nanny or someone in the family, who is diagnosed as having TB, the child will probably be put onto isoniazid preventative therapy (IPT). IPT is a precaution taken to ensure that any latent TB that may have infected the child is eliminated.
Can TB be cured?
Yes. The good news is that unlike HIV, TB is curable. It is very important that anyone who has TB takes their TB medicine exactly as the doctor, nurse or counselor prescribes. A TB patient will be given several drugs to kill the TB germs. The patient’s sputum will be tested during the course of the treatment period to make sure that the medication is working. The TB germ dies very slowly and it will take at least six months for the drugs to kill all the TB germs. This, and the side-effects of the medication, can make it a challenge to finish treatment, but doing so is critical. A TB patient must not stop taking their medication when they feel better as this will mean that they will become sick again, and it will take even longer and they will have to take even more medication to cure them.
What to do if someone in your family or your nanny is diagnosed with TB?
Don’t panic. Because of the high prevalence of TB in South Africa, many of us have already been exposed to the TB germ many times. It is estimated that around 60% of adults in the Western Cape have a latent TB infection; in other words they cannot transmit TB and are not sick, but already carry the TB germ in their bodies. If you are an adult who has had close contact with someone with TB, but do not have a compromised immune system and are not displaying any symptoms of TB, you do not need to have a TB test.
Remember that anyone who is has been on effective TB treatment for 2 weeks is no longer infectious.
Try to find out as much as you can about TB so that you have something factual and concrete to work with. Learn the symptoms of TB so that you know when someone should go for a TB test. Consult your clinic, family doctor or TB/HIV Care Association on 021 425 0050 if you are unsure of anything.
How can you the employer help your nanny if she is diagnosed with TB?
Your nanny can come back to work after being on effective treatment for 2 weeks. She would no longer be infectious. Your nanny will need your support and understanding. Firing her because you are afraid that your children could get infected is irrational and illegal. Many nannies are the breadwinners of their own family and you could devastate a whole family by rash actions.
There is a possibility that you could act as a treatment supporter for your nanny, but this is ultimately something both of you must choose. Being a treatment supporter would mean that you would learn about TB and the medication she will be taking, and that you will remind your nanny to take her medication daily, and support her through any issues that arise.
In the first month of treatment, the person diagnosed may have to go to the clinic daily to get their medication. Thereafter they may have to go every two weeks, and finally monthly. Although people often start to feel better after the first few weeks, it is critical that the full course of treatment is completed or the disease will not be cured, and the TB germs will become more difficult to cure. It is also advisable for anyone diagnosed with TB to live a healthy lifestyle, to exercise and to eat healthy food.
It is important as an employer to be aware of how much time you may have to allocate for her to go and fetch or take her medication and how this may affect your family schedule so that you can plan effectively.
How should I deal with the fear of TB as a parent?
However as a parent myself, I understand the concern and fear when it comes to our offspring.
Knowledge and education are the first steps to dealing with the anxiety and stigmas attached to the TB disease. Stigma is normally a negative attitude that people have about something they are scared of, but do not know very much about.
Looking ahead in the face of TB in South Africa
While there are many new technological developments in the field of TB diagnostics, vaccines and drugs, these are unlikely to be widely available very soon. It is still best to prevent TB by covering our coughs, keeping small areas well-ventilated by opening windows, by being vigilant for the symptoms of TB, and by being supportive of those who are diagnosed with TB.
The information for the above article is obtained from the TB/HIV Care Association and USAID’s TB programme. The article is co -authored by Super Nannies and the TB/Care Association.
How can TB affect your family and your nanny?
How can TB affect your family and your nanny?
South Africa, in the past 10 years, has seen a resurgence in cases of tuberculosis or TB. It may be worrying to think that an airborne disease is so prevalent in the country in which you are raising your children, but knowledge is one of the first steps to combating TB.
It is important that we as parents have an understanding of how TB can affect our family, our children, and our employees – our nannies. As parents we need to know what our risks are when hiring someone to care for our children, and how to help and support our nanny if she does become sick with tuberculosis.
Contrary to popular belief, anyone can get TB and it is not a disease that only affects the poor. Famous people like President Nelson Mandela and Archbishop Desmond Tutu have had TB and now are cured.
What is TB?
TB is a disease that mainly affects the lungs, but can also affect other parts of the body. TB is transmitted when small drops of saliva or spit are coughed into the air by people who have TB, and are breathed in by people who do not have TB. However, breathing in the TB germ does not mean you will become sick. In most cases, when a person’s immune system is strong, the body will keep the TB germ in check and cause it to become inactive or ‘latent’. In this form, the TB germ can stay within the body without ever causing the person it has infected to become sick. Someone with a latent TB infection cannot infect anyone else. If, however, the person’s immune system becomes weak, which can happen for a variety of reasons including stress, hypertension, HIV infection, diabetes or poor nutrition, the TB bacterium will activate and start to multiply. At this point, the person will develop the signs and symptoms of TB and will be infectious to others.
Typical symptoms of TB include:
Hiring a nanny with TB and HIV in mind
As a parent and an employer, most of us will want to have a healthy nanny. However, forcing your employee to reveal his or her HIV status is illegal, and not employing someone because of their HIV status is considered discriminatory. Asking your nanny about her health during an interview can be a highly sensitive matter, and the answers you get will be subjective. Your best source will be past references as they will be able to indicate if she was unusually absent and if she does have the right constitution to handle your family’s workload and schedule in her role as a childcarer and cleaner.
We recommend that the best approach is to discuss the precautionary health measures you expect your nanny to take with your children, and to make sure that both you and your nanny are well-informed about TB and HIV. In this way, both of you will know the symptoms of TB and be able to spot any potential problems early.
A guideline for nannies and families regarding the symptom of coughing
If a nanny or anyone in the family is HIV positive, they need to be extra careful about looking after their own health. Even a day’s ongoing cough can be a cause for concern and they should visit a clinic for a TB test as soon as possible. It is important to remember, however, that this is the choice of the person concerned.
If anyone, whether HIV positive or negative, has been coughing for more than two weeks, they should also consider having a TB test at a local clinic.
Besides coughing, there are other symptoms of TB that should also be investigated at a clinic – appetite loss, chest pain, tiredness, night sweats and fever, and weight loss.
How do you or your nanny go about testing for TB?
A TB test can be performed at any clinic – whether near your home or work or your nanny’s. A nurse at the clinic may ask the person being tested questions about their symptoms and ask them to cough and spit into a bottle. It is best for the person being tested to spit from the chest as early as possible in the morning to achieve the most accurate results. The sputum sample is then sent to the laboratory for testing using smear microscopy. The smear microscopy test may take 2 days and the result will then be sent back to the clinic the person visited.
If TB bacteria are detected in the sputum, the smear microscopy test result will be positive. If none are detected the test result will be negative. However, TB can be difficult to diagnose, and if the symptoms persist despite a negative result from this test and no other obvious causes, further tests may be performed. These include a chest x-ray and the attempt to culture TB bacteria from a sputum sample. The person being tested may be referred to a larger clinic where an x-ray machine is available. The culture tests can take from 6 to 8 weeks to get a result.
How does this affect my family’s schedule?
If you or your nanny suspect that she or someone else in your family may have TB, it is important to go for a test as soon as possible. If your nanny is having a TB test, you can discuss her taking sick leave during this period, which could be from 2 days up to a week in length depending on the clinic involved. While the person is waiting for their result, in case they do have TB, they should avoid children, especially those under five, practice good cough hygiene by covering their cough with their sleeve, and spend time outdoors in the sun and in well-ventilated areas.
If your nanny or any other adult in your family tests positive for TB, they will be put off work by the doctor for two weeks to limit the potential of spreading the infection. This is as a precaution to avoid spreading infection and to give the person time to recover from their symptoms and the side effects of the medication. However, once someone has been on effective treatment for 2 days, they are no longer infectious to others. Within these two weeks, the person should follow the guidelines mentioned above at home to avoid infecting anyone else.
How does TB affect children?
TB affects children differently to adults. It is very difficult, for example, for a child to transmit TB to another child, and an adult is almost always the source of infection. TB can also be difficult to diagnose in a child because they find it difficult to cough up sputum.
If your child is under five and has been in close contact with someone, whether this is your nanny or someone in the family, who is diagnosed as having TB, the child will probably be put onto isoniazid preventative therapy (IPT). IPT is a precaution taken to ensure that any latent TB that may have infected the child is eliminated.
Can TB be cured?
Yes. The good news is that unlike HIV, TB is curable. It is very important that anyone who has TB takes their TB medicine exactly as the doctor, nurse or counselor prescribes. A TB patient will be given several drugs to kill the TB germs. The patient’s sputum will be tested during the course of the treatment period to make sure that the medication is working. The TB germ dies very slowly and it will take at least six months for the drugs to kill all the TB germs. This, and the side-effects of the medication, can make it a challenge to finish treatment, but doing so is critical. A TB patient must not stop taking their medication when they feel better as this will mean that they will become sick again, and it will take even longer and they will have to take even more medication to cure them.
What to do if someone in your family or your nanny is diagnosed with TB?
Don’t panic. Because of the high prevalence of TB in South Africa, many of us have already been exposed to the TB germ many times. It is estimated that around 60% of adults in the Western Cape have a latent TB infection; in other words they cannot transmit TB and are not sick, but already carry the TB germ in their bodies. If you are an adult who has had close contact with someone with TB, but do not have a compromised immune system and are not displaying any symptoms of TB, you do not need to have a TB test.
Remember that anyone who is has been on effective TB treatment for 2 weeks is no longer infectious.
Try to find out as much as you can about TB so that you have something factual and concrete to work with. Learn the symptoms of TB so that you know when someone should go for a TB test. Consult your clinic, family doctor or TB/HIV Care Association on 021 425 0050 if you are unsure of anything.
How can you the employer help your nanny if she is diagnosed with TB?
Your nanny can come back to work after being on effective treatment for 2 weeks. She would no longer be infectious. Your nanny will need your support and understanding. Firing her because you are afraid that your children could get infected is irrational and illegal. Many nannies are the breadwinners of their own family and you could devastate a whole family by rash actions.
There is a possibility that you could act as a treatment supporter for your nanny, but this is ultimately something both of you must choose. Being a treatment supporter would mean that you would learn about TB and the medication she will be taking, and that you will remind your nanny to take her medication daily, and support her through any issues that arise.
In the first month of treatment, the person diagnosed may have to go to the clinic daily to get their medication. Thereafter they may have to go every two weeks, and finally monthly. Although people often start to feel better after the first few weeks, it is critical that the full course of treatment is completed or the disease will not be cured, and the TB germs will become more difficult to cure. It is also advisable for anyone diagnosed with TB to live a healthy lifestyle, to exercise and to eat healthy food.
It is important as an employer to be aware of how much time you may have to allocate for her to go and fetch or take her medication and how this may affect your family schedule so that you can plan effectively.
How should I deal with the fear of TB as a parent?
However as a parent myself, I understand the concern and fear when it comes to our offspring.
Knowledge and education are the first steps to dealing with the anxiety and stigmas attached to the TB disease. Stigma is normally a negative attitude that people have about something they are scared of, but do not know very much about.
Looking ahead in the face of TB in South Africa
While there are many new technological developments in the field of TB diagnostics, vaccines and drugs, these are unlikely to be widely available very soon. It is still best to prevent TB by covering our coughs, keeping small areas well-ventilated by opening windows, by being vigilant for the symptoms of TB, and by being supportive of those who are diagnosed with TB.
The information for the above article is obtained from the TB/HIV Care Association and USAID’s TB programme. The article is co -authored by Super Nannies and the TB/Care Association.