Burden of tuberculosis among students in two Ethiopian universities

Aims/Purpose: TB outbreaks emerge occasionally in long-term care facilities, including various educational establishments. This study was designed to determine the five years overall prevalence and trend of tuberculosis and associated factors among students at Adama Science and Technology University and Addis Ababa University 6 kilo campus.Methods: A five years retrospective study was conducted on students' medical records from TB Directly Observed Treatment Short Course (DOTS) clinics. The overall prevalence and the trend of smear positive, smear negative and extra pulmonary TB cases were determined. Odds ratio with 95 percent C.I was calculated using the Logistic Regression model. Furthermore, an in-depth assessment of AFB sputum smear examination practices of the lab staffs were conducted using the WHO's standard checklist.Results: A total of 112 and 263 TB cases were recorded in Addis Ababa University (AAU), 6 kilo campus and Adama Science and Technology University (ASTU), respectively. There was a statistically significant difference in prevalence of TB among students in ASTU compared to that in AAU, 6 kilo campus [AOR: 2.881, 95% CI (1.76-4.71)]. An in-depth interview with the respective University Clinic lab chiefs indicated that the University labs were not linked with the national tuberculosis program and hence quality of sputum smear microscopy examination practices in both study Universities were found to be poor. Conclusions: The numbers of tuberculosis cases observed in this study were high. Governmental and Nongovernmental agencies involved in TB control must consider higher education institutions as focal points for prevention and elimination of tuberculosis in Ethiopia

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

Background: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector; despite the high overall incidence rates. Aim: We conducted a survey to determine the extent of private-sector capacity; participation; practices and adherence to national guidelines in the control of TB. Setting: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. Methods: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis; management and prevention activities. Results: Out of 157 facilities surveyed; 40.5% were from the Copperbelt; 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme; the majority (62.7%) of these facilities did not show evidence of notifications. Conclusion: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment; Short Course (DOTS)

Assessment of Community Pharmacists' Willingness to become Tuberculosis DOTS Services Providers in Lagos State

"Background: Hospital based Directly Observed Therapy Short course (DOTS) for the treatment of tuberculosis though effective has constraints to its effectiveness e.g. restricted timings of TB clinics; long distance to travel by tuberculosis patients to TB DOTS clinics; etc. Community pharmacy based TB DOTS services under thesupervision of community pharmacists can address these constraints. Objectives: To assess community pharmacists' willingness to become Tuberculosis Directly Observed TherapyShort course (TB DOTS) service providers in Lagos state; Nigeria. Methods: A 25 item self completion questionnaire was administered to 120 community pharmacists spreadacross three; Association of Community Pharmacists zones of Ikotun; Iyana-Ipaja; as well as Festac zones in Lagos state; Nigeria respectively. These community pharmacists' zones were formed in Lagos state to ensure theease of administration and prevention of the operation of illegal premises in Lagos state and the twelve zones inLagos state are duly recognized by both the Pharmaceutical Society of Nigeria and the State Chapter of the Association of Community Pharmacists. Data was collected on a scale that ranged from 8 to 40 with an assumedneutral point of 24 and statistically analysed. Results: Community pharmacists in Lagos state Nigeria were willing to be TB DOTS services providers as shownby a mean score of 30.53+ 6.71 in 77 of the respondents. On the 5-point rating scale; ""5"" represented thehighest mean score while ""1"" represented the lowest mean score. On the 8 item scale; the lowest mean score is 8and the highest mean score is 40 with a neutral point of 24. The percentage performance was the number of respondents that scored above the critical or neutral point on the rating scale. Statistically not significant association was observed between having heard of TB DOTS services and their willingness (X2 =0.66; P=0.3485;P0.05). Association between training in the provision of TB DOTS services and the willingness observed was2statistically also not significant (X =2.08; P=0.2525; P0.05).So also for the association between number of yearsof community pharmacy practice and their willingness to be TB DOTS service providers (X2=1.18; p=0.371;P0.05). Conclusion: Community pharmacists in Lagos state Nigeria are willing to be TB DOTS services providers. Howevertheir willingness to be TB DOTS services providers is not associated with the level of training that they have hadon TB DOTS services provisions; neither is it associated with their level of awareness about TB DOTS services.Their years of community pharmacy practice experience also had no influence on their willingness to be TB DOTSservices providers."

Pattern and Magnitude of Treatment Delay among TB Patients in Five States in Southern Nigeria

Prompt diagnosis and early treatment of Tuberculosis (TB) cases is an important strategy in TB prevention and control. Thus; passive case finding of TB suspects; sputum examination for diagnosis; and prompt treatment using Directly Observed Treatment Short Course (DOTS) are key elements in the national guideline for TB control programme. The aim of this study is to determine the time interval between diagnosis of smear-positive TB cases and the commencement of treatment in DOTS facilities in southern Nigeria. The study was carried out in 20 healthcare facilities supported by TB Control Assistance Program (TB-CAP) involved in TB management in southern Nigeria; which comprised tertiary; secondary; and primary healthcare facilities including public and private facilities. Data were collected through review of clients' and facility records covering July-September 2009. Data collected were sociodemographic characteristics; sputum-smear result; date of diagnosis; and date of commencement of treatment. Data were analyzed using SPSS version 15.0 software. Of the total 2;507 TB suspects examined for Acid-Fast Bacillus (AFB); 323 were diagnosed to be Sputum-Smear-Positive (SS+ve); However; 269 new smear positive cases were commenced on treatment within the period; thus 54 (17.0) of the new SS+ve cases defaulted initially. One hundred and two (38) of them commenced TB treatment within 3 days of smear examination for diagnosis; while 59 (22) commenced 4-6 days after diagnosis. The study revealed significant delay in commencement of TB treatment for most new smear positive TB cases in southern Nigeria and underlines the need to further explore factors responsible for delay in commencement of TB treatment following diagnosis

Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug­ and extreme drug-resistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with 'low cure' and 'high MDR' rates. Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens. Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities. Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50 (56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%). Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance

Comparison of Pulmonary TB DOTS Clinic Medication before and after the Introduction of Daily DOTS Treatment and Attitudes of Treatment Defaulters in the Western Division of the Gambia

Background: Over a third of the world's population is infected with the tuberculin bacteria. In 1993 WHO launched the DOTS-strategy to enhance treatment compliance. Despite Gambia's adaption in 1985 it falls below WHO target of 85cure rate. The defaulter rate was 14in 2001; which reached 16in the urban areas of the Western Division in 2003. Objectives: This study aimed to compare TB treatment and outcomes before and after the introduction of daily directly observed therapy (DOTS) medication and the perceptions/attitudes of defaulters in the Western Division of the Gambia. Methods: The study employed a mixed study design; a quantitative cross sectional study that reviewed the clinic records of pulmonary TB patients before and after the introduction of daily TB-DOTS medication and an in-depth interview of defaulters on the daily medication. The study was conducted at the Brikama TB-clinic in Gambia; located at the main hospital of Brikama serving all satellite villages. It registers on average 110/100 000 new smear-positive pulmonary TB-cases per annum. The quantitative arm compared clinic-based records of TB-DOTS medication before and after the introduction of daily medication. The qualitative arm explored the perceptions of daily medication defaulters. Results: There was no statistically significant difference between the treatment outcomes of the two medication policies. However patients were less likely to have had three sputum tests reviewed in the daily medication period (22v 72Odds Ratio 6.2 (p 0.001). However; they reported that daily medication with its fixed-dose combination was more convenient. Conclusion: Patients' full compliance with daily medication was hindered by socio-economic factors. The daily medication with its increased workload undermines the proper implementation of fundamental DOTS-elements; particularly follow up and sputum review

Five year review of treatment outcome of directly observed therapy (DOT) for re-treatment pulmonary tuberculosis patients in UCH, Ibadan, Nigeria

Tuberculosis (TB) is a major health problem in Nigeria. The country is currently fourth among the 22 high-burden countries (HBCs) of the world; with an incident of all new cases of 311/100;000 population per year out of which 137/100;000 population are smear positive and prevalence of 616/100;000 population. To highlight the burden of re-treatment smear positive pulmonary TB with and without HIV infection and determine how Directly Observed Therapy (DOT) using the retreatment regimen has affected the treatment outcome in the management of these patients. A Fiveyear retrospective study from April 2003 to March 2008 to evaluate the treatment outcome data of retreatment pulmonary TB who were also screened and confirmed for HIV at the outpatient clinic of the University College Hospital Ibadan; Nigeria. The effect of HIV status and treatment outcome was assessed so also the prevalence of HIV among recurrent PTB patients. The total number of cases assessed was 127. Majority of the patients were between the ages of 20 to 49(73.2). Forty-two of the PTB patients were HIV positive (33.1). The treatment outcome was as follows: Cured 81(63.8); Treatment completed 13(10.2); Died 22(17.3); Defaulted four (3.1) and transferred out seven (5.5) More patients were cured and had treatment completion among the HIV negative patients compared with HIV positive patients (p0.0001) The mortality was higher in those with HIV positive than negative patients (p 0.0001). Re-treatment pulmonary TB is frequent at this referral centre. A contribution to re-treatment prevention entails more rigorous management of new TB cases; particularly at lower levels of care. This effort will reduce the emergence of multi-drug resistant (MDR-TB) tuberculosis

Effectiveness of home-based directly observed treatment for tuberculosis in Kweneng West subdistrict, Botswana

Background: Tuberculosis (TB) and HIV are major public health problems in Botswana. In the face of growing TB notification rates, a low cure rate, human resource constraints and poor accessibility to health facilities, Botswana Ministry of Health decided to offer home-based directly observed treatment (DOT) using community volunteers. Objectives: The aim of this study was to assess the outcomes of home-based directly observed treatment (HB-DOT) versus facility-based, directly observed treatment (FB-DOT) in the Kweneng West subdistrict in Botswana and to explore the acceptability of HB-DOT among TB patients, community volunteers and health workers. Method: A quantitative, observational study using routinely collected TB data from 405 TB patients was conducted and combined with 20 qualitative in-depth interviews. Results: The overall cure rate for smear-positive pulmonary TB patients was 78.5. Treatment outcomes were not statistically different between FB-DOT and HB-DOT. Contact tracing was significantly better in FB-DOT patients. Interviews revealed advantages and disadvantages for both FB and HB options and that flexibility in the choice or mix of options was important. A number of suggestions were made by the interviewees to improve the HB-DOT programme. Conclusion: HB-DOT is at least as good as FB-DOT in terms of the treatment outcomes, but attention must be given to contact tracing. HB-DOT offers some patients the flexibility they need to adhere to TB treatment and community volunteers may be strengthened by ongoing training and support from health workers, financial incentives and provision of basic equipment

A basis for the clinical management of complicated MDR-TB cases

Successful multidrug-resistant tuberculosis (MDR-TB) treatment and programme performance is possible even in complex circumstances. Governments are subject to strong pressure from donors concerning both DOTS (directly observed treatment; short course) expansion initiatives and especially MDR management.1Nevertheless; anyone assuming an MDR programme can be launched just with money and drugs is probably labouring under a grave misapprehension. A sound understanding of the clinical management of both susceptible and resistant TB is one of the basic fundamentals. The substandard use of second-line drugs is not only measured in low cure rates but in drug resistance mplification in the community; and hence potentially circulating extensively drug-resistant (XDR) TB strains. From a clinical point of view; MDR management is lengthy and complicated; involving the entire range of problems attendant upon chronic disease plus the high toxicity profile of second-line drugs. In addition; in developing countries with high HIV/TB co-infection levels; the complexity in terms of clinical and drug management issues increases. Poverty and lack of access to care and treatment can reduce adherence and further complicate the recovery process. This paper provides a brief summary of the best practice in MDR-TB patients including the most frequent side-effects and practical advice on managing TB/HIV co-infection based upon the most recent evidence

A Study of Quarterly Trend of Infectious Tuberculosis and Evaluation of Tuberculosis Control Program in Post Conflict Sierra Leone; 2002-2005

This study aimed to measure the impact of directly observed treatment short-course (DOTS) coverage on notification of infectious tuberculosis (TB) and treatment cure rate in the post conflict period of 2002 to 2005 in Sierra Leone. The study was a population based retrospective study on implementation of DOTS expansion by the National Leprosy TB Control Program (NLTCP). Data recorded in district TB registers and TB annual reports were analysed for trend of infectious TB registered quarterly; treatment cure rates and number DOTS centres opened per annum. A trend analysis of proportion of infectious TB (sputum smear positive) to all TB cases reported to the central program each quarter during the periods 2002 to 2005 was plotted. However; this did not appear to show any discernable pattern but the following observations were made. In 2003 the lowest proportion of infectious TB cases was reported. Furthermore; there appeared to be a decline in proportion of infectious TB cases reported in the third quarter of each year; corresponding to the peak of the rainy season. An evaluation of DOTS expansion based on Donabedian.s triad showed that 76of the target set for 2005 was achieved; that is 53 of the targeted 70 DOTS centres were opened by the end of 2005. A correlation-regression analysis gave a correlation coefficient (R) of 0.22 which suggests a weak relationship between treatment cure rate and district population DOTS coverage. The implementation of DOTS expansion by the NLTCP considerably improved DOTS coverage and treatment cure rates in the immediate post conflict period of 2002 to 2005. However; there was a weak association between district DOTS coverage and treatment cure rates; and its impact on trend of infectious TB notification was limited during this period

Bronchopulmonary tuberculosis-laboratory diagnosis and dots strategy outcome in a rural community: a retrospective study

Pulmonary tuberculosis is still a global public health threat. Despite all efforts at its containment; the scourge is still menacing especially in the rural communities and among HIV infected patients. This retrospective study was carried out to determine the case detection rate of pulmonary tuberculosis in a rural community hospital in Nigeria from 2001-2006. A total of 1219 suspected patients were tested for pulmonary tuberculosis by sputum smear stained by Ziehl-Neelsen technique. Out of this number; 350 (28.7) were positive for Acid-Fast Bacilli including 198 males and 152 females. Also 235 of the sputum-smear positive patients were tested for the human immunodeficiency virus (HIV) antibodies by Immunocomb 11 HIV 1 et 2 Bispot and confirmed by Immunocomb 11 HIV 1 et 2 Combfirm and HIV-1 Western Blot kit. Sixty three (26.8) of the sputum-smear positive patients were co-infected with HIV. Two hundred and seventy (77.1) of the AFB positive patients were treated under the Directly Observed Therapy-Short course; 201 of them (74.4) completed the treatment; 39 (14.4) defaulted; 30 (11.1) died before the completion of the treatment; 195 of the patients were declared cured and 6 were declared failed. Case detection rates could be improved upon by providing culture facilities at the DOTS centers. Also efforts should be made to ensure that all positive cases are followed to a logical conclusion and that anti-retroviral drugs are provided for patients co-infected with HIV to reduce the mortality rate of pulmonary tuberculosis

What are the Reasons for Patients not Adhering to their Anti-TB Treatment in a South African District Hospital?

Introduction :TB is a major health problem in South Africa; with increasing numbers of patients notified; inadequate successful treatment rates and an emerging problem with resistant strains. This study was conducted at a District Hospital in KwaZulu-Natal where the successful treatment rate was as low as 23. The aim of this study was to identify key factors at the hospital that may affect adherence to TB treatment and to recommend interventions that could improve adherence. Methods:The study design was a case control study using prospectively collected data. Information was collected over an 8-month period; when the patients started their anti-TB treatment; according to the known factors that influence TB adherence. The patients were then followed up to determine those who did not adhere to their treatment; and those who successfully completed treatment. The two groups involved; therefore; were the controls (those who did adhere) and the cases (those who did not adhere). The data previously collected were then compared for significant associations with the controls and cases. Results :Data were obtained from 159 TB patients; 105 (66) were adherent and 54 (34) non-adherent. The following variables showed a significant association (p 0.05) with non-adherence: higher level of education; distance from the hospital; time taken to travel; the method of transport; satisfaction with the hospital; food security; income; the smoking of tobacco and/or marijuana; the patients' perspective and beliefs; HIV testing and status; functional status; social support; the relationship with the TB nurse; depression score; and self-rating of confidence. A stepwise logistic regression was performed; and only two variables remained significantly associated: travel time (OR7.9; 95CI 1.4-44.1) and the relationship with the TB nurse (OR2.6; 95CI 1.3-5.1). Conclusions: The most important recommendation is to improve the relationship between patients and TB nurses through training in communication skills. A more holistic assessment of patients would help identify issues such as depression; and a more patient-centred approach would help to understand and address patient's concerns; beliefs and expectations. It may also be important to ensure that management and administrative systems support a more patient-centred approach. It may be important to encourage the recruitment of family physicians who are trained in communication skills and a patient-centred approach; to work in the rural areas; where they can mentor and teach other colleagues and staff. More needs to be done in terms of helping patients to access facilities through transport; or in making services more available at the community level through DOTS (Directly Observed Treatment) supporters and adequate home-based carer support

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated

Multidrug-resistant tuberculosis at the National Hospital, Abuja, Nigeria

Five hundred (500) cases of pulmonary tuberculosis (TB) were seen at the Chest Clinic of the National Hospital; Abuja; Nigeria over a 2-year period (2004-2005). The diagnosis and management of multidrug-resistant (MDR) TB were studied as part of DOTS-Plus: Directly Observed Treatment Short-course (DOTS) programmes that add components for MDR-TB diagnosis; management; and treatment. The cases of pulmonary TB that showed mycobacterium resistance to rifampicin and isoniazid (MDR-TB) using the Lowenstein Jensen (solid medium) slope at the National Hospital and later using BACTEC 460 available at Zankli Medical Center at Abuja; were treated with the standard WHO recommended regimen for MDR-TB and the outcomes were studied. Twenty cases (4) of MDRTB were recorded; all 20 were also HIV-positive. One (8) died and 19 (95) were apparently cured at the end of therapy. This is the first report of MDR-TB and DOTS-Plus in Nigeria. There is an urgent need to study the MDR-TB pattern in Nigeria as extensive resistant TB (XDR-TB) has now been reported which is even worse prognostically than MDR-TB

Perceptions of Tuberculosis and Treatment Seeking Behaviour in Ilala and Kinondoni Municipalities in Tanzania

This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB); and treatment seeking behaviour; among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. The mean age of the respondents was 33.2 years (range= 11-72 years). Forty-six (66.7) of the patients had primary school education. Fifty-nine (84.1) patients had good knowledge on the transmission of TB. Majority (75) of the respondents were of the opinion that the incidence of TB was on the increase and this was mainly associated with HIV/AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68) visited public health facilities for treatment as their ?rst action. Overall; 83.8(57/68) respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Only 18.8(13/69) had to spend an average of US$ 0.2-0.3 as travel costs to the healthcare facility. Most of the respondents (57.8) said they were well attended by service providers. Half (21/42) and 59.3(16/27) of the males and females; respectively; mentioned good patient-service provider relationship as an important reason for satisfaction of the service (?2 =0.57; df=1; P0.005). Twenty-nine (42) of respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. In conclusion; there is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care

Capacity of Healthcare Facilities in the Implementation of Direct Observed Treatment Strategy for Tuberculosis in Arumeru and Karatu Districts; Tanzania

Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS; in Arumeru and Karatu districts; Tanzania. Information sought included the capacity to offer TB service and availability of quali?ed staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed; 86 (77.5) in Arumeru and 25 (22.5) in Karatu. Only 23.4(26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38) of them were government owned. Thirty eight (44.7) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0) of health facilities which do not provide any TB services had qualifed clinical offcers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004; 187 (60.7) had treatment outcome available; 124 (66.3) were cured and 55 (29.4) completed treatment. In Karatu 638 cases were noti?ed in 2004; 305 (47.8) had treatment outcome available; 68 (22.3) cured and 165 (54.1) completed treatment. In conclusion; the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20and 30for clinical and laboratory components of DOTS; respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community-based DOTS in Tanzania

Outcome of Directly Observed Therapy Short Course (DOTS) Regimen in a Rural Communicty of the Nigerian Niger Delta

Background: The objective of this retrospective study was to evaluate the outcome of directly observed therapy short course (DOTS) application in a Nigerian rural community.Methods: A retrospective study of all the records of DOTS at the centre from January 2001 to December 2005 was compiled and features such as: age; gender; drugs used; and outcome of treatment (defaulted; cured; died; or developed multidrug resistant-TB) were considered. Also the different personnel and infrastructure at the centre for the programme were also assessed. Results were analysed using Epi Info 6 statistical software; and P values 0.05 were considered significant. Results: Two hundred and seventy four (274) cases of pulmonary TB were registered at the centre during the study period; consisting of 100(36.5) females and 174(63.5) males with a statistically significant gender difference (P0.001). The age range with the highest number of pulmonary tuberculosis cases was 31-40 years (24.8; n=68); and the age range with the lowest number was 71 years and above (1.1; n=3). Treatment outcome showed that 84.7(n=232) completed treatment with cure; 2.5(n=7) developed multidrug resistance at completion of treatment; 5.5(n=15) defaulted; 3.3(n=9) died in the course of treatment; and treatment in 11 people was still ongoing. Conclusion: The outcome of DOTS in the present study was impressive; and the programme should be extended to other rural communities; however; more efforts should be made towards the tracing of defaulters

Facteurs associes a l'abandon du traitement antituberculeux a Kinshasa. Strategie DOTS

Une enquete avec echantillonnage probabiliste a ete conduite entre juillet et septembre 2006; en utilisant les donnees relatives au suivi therapeutique de la tuberculose durant la periode de janvier 2002 a decembre 2004 dans 3 de 6 districts sanitaires et 7 de 35 zones de sante a Kinshasa. D'une part; 155 tuberculeux ayant abandonne le traitement et 155 temoins selectionnes parmi les patients ayant termine leur traitement ; et d'autre part 12 infirmiers issus des zones de sante ayant un taux d'abandon de traitement 5et 13 infirmiers issus des zones de sante presentant un taux d'abandon de traitement 5ont ete selectionnes et soumis a un questionnaire ad hoc pour rechercher les determinants associes a l'abandon du traitement. Cinq determinants associes a l'abandon du traitement anti-tuberculeux selon la strategie DOTS ont ete retenus dans le modele de regression logistique : le statut de celibataire OR 3.173 (1.232-11.037); l'age inferieur a 40 ans OR : 1.930(1.215-4.054); la meconnaissance de l'etiologie de la maladie 0R : 20.210 (2.358-29.060); une mauvaise accessibilite geographique 0R : 4.500 (1.289-15.573) et une mauvaise source d'information sur la maladie 0R : 4.451 (1.740-11.338). Ces resultats suggerent que la prise en compte et l'amelioration des conditions socio-economiques et demographiques et surtout le choix des canaux d'informa- tion pour la population ciblant les groupes a haut risque d'abandon de traitement reduiraient considerablement l'incidence de la tuberculose