Summary
Introduction Healthcare workers (HCWs) in high-burden settings carry an occupational tuberculosis (TB) risk exceeding that of the general population. Most Indian data cover only doctors, nurses, and trainees, report raw case counts rather than category-specific rates, and rarely examine burden, knowledge, and health-related quality of life (HRQoL) together. We quantified all three across the full occupational spectrum of a hospital serving as the district TB center for Raigad district, Maharashtra, the Indian state with the highest burden of multidrug-resistant TB (MDR-TB). Methods This was a cross-sectional, questionnaire-based study of 250 HCWs across 10 occupational categories at a tertiary care teaching hospital in Raigad district, Maharashtra, India, over two months in 2024. Three instruments were administered: an investigator-designed TB screening questionnaire, an investigator-designed TB awareness questionnaire, and the RAND 36-Item Short Form Health Survey (SF-36). The primary outcome was the point prevalence of current active TB; secondary outcomes were TB within the preceding five years, TB awareness, and SF-36 domain scores. Proportions carry Wilson score 95% confidence intervals (CIs), categorical comparisons used Fisher exact tests with unadjusted odds ratios (ORs), and SF-36 scores were compared using the Mann-Whitney U test. Results Nine of 250 HCWs had current active TB (point prevalence 3.6%, 95% CI 1.9-6.7), and seven (2.8%, 95% CI 1.4-5.7) reported TB within the preceding five years; one HCW met both definitions, giving 15 distinct affected individuals (6.0%, 95% CI 3.7-9.7). Current active TB was approximately 11 times the pulmonary TB prevalence of 316 per 100,000 reported by the National TB Prevalence Survey of India. Three of the 15 (20.0%) had MDR-TB. Expressed as category-specific rates, burden was concentrated in ancillary staff: housekeeping (4/23 (17.4%)) against doctors (6/147 (4.1%)). Non-clinical and support staff carried a fourfold excess relative to clinical staff (6/42, 14.3% versus 9/208, 4.3%; OR 3.69, 95% CI 1.24-10.99, p = 0.024), as did male sex (10/90, 11.1% versus 5/160, 3.1%; OR 3.88, 95% CI 1.28-11.72, p = 0.023). Good TB awareness was recorded in 181/250 (72.4%, 95% CI 66.6-77.6) but followed a steep occupational gradient, from 96.3% of physiotherapy staff and 87.8% of doctors down to 14.3% of security personnel and 8.7% of housekeeping staff (doctors versus all non-physician staff, 87.8% versus 50.5%, p < 0.001). Among participants with complete SF-36 responses, TB-affected HCWs scored lower than unaffected colleagues across every domain, significantly so in seven of eight: overall score 52.6 (standard deviation (SD) 29.8) versus 76.7 (SD 15.5), p = 0.009, with the largest deficits in role limitation due to physical health (-32.0 points), general health (-28.9), and physical functioning (-26.3). Conclusions TB burden among HCWs at this center was an order of magnitude above the national population estimate and was concentrated in ancillary staff rather than physicians, precisely the group with the poorest TB knowledge. Affected HCWs showed substantial quality-of-life impairment relative to unaffected colleagues. TB infection control should extend administrative, environmental, and respiratory-protection measures, and mandatory training in local languages, to housekeeping, security, technical, and clerical staff.
