Treatment supporters and their impact on treatment outcomes in routine tuberculosis program conditions in Rawalpindi district, Pakistan

Tuberculosis [TB] is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility based and treatment supporter-based; by these two ways patients' compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients' treatment outcomes. The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities. The majority of patients [89.6%] were provided with treatment supporters. Of 404 [89.6%] cases with treatment supporters, in 203 [50.2%] the supporters were lady health workers, in 46 [11.4%] were community health workers and health facility workers, and in 155 [38.4%] were family members and community volunteers. A total of 384 [85.1%] were categorized as "treatment success", 31 [6.9%], as "transferred out", 17 [3.8%], as "expired", 16 [3.5%] as "defaulted" and three [0.7%] as "treatment failure". The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively. We found a significantly higher treatment success rate [93.1%] in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%

first and second line anti TB drug resistance pattern in Lahore

For the control of tuberculosis at national level, DOTS strategy [Directly observed therapy short course] is being implemented by National TB Control Program in collaboration with WHO. This programme if managed properly can cure nearly all-new TB patients. To determine the in vitro susceptibility pattern of second line drugs in multi drug resistant tuberculosis and inform tuberculosis control authorities and clinicians for appropriate management. A total of 1180 Mycobacterium tuberculosis positive patients receiving anti tuberculosis drugs and suspected of having drug resistance were referred to this Center for drug susceptibility testing. Sputa of all these patients were subjected to culture against first line of anti TB drugs. Those resistant to both INH and RIF were subjected to 2nd line of drug susceptibility testing. Out of 1180 suspected MDR-TB cases, 201[17%] showed resistance against both INH and RIF thus, confirming MDR-TB. Using the definition of extreme drug resistant TB [XDR-TB] i.e. MDR TB plus resistance to any one of floroquinolone and one of three injectables i.e. amikicin, kanynamicin and capreomycin, 4[2%] cases were XDR-TB. The frequency of XDR-TB was 2%. For MDR TB cases second line of anti tuberculosis drugs are still very effective

Screening of tuberculosis in Kharal Abbasian Azad Kashmir

To detect active tuberculosis in two areas of district Bagh, which were worst hit during October 8, 2005 earthquake leaving millions of people homeless and exposed to harsh weather and infections. This cross sectional study was done at Huda Bari camp and village Bani Pasari of district Bagh, Azad Kashmir from 17-24 November 2006. All cases above the age of 12 years complaining of fever, cough and weight loss for more than six weeks were screened for tuberculosis on 2 consecutive days by sputum microscopy for acid fast bacilli. Out of 247 suspected cases screened, 12[4.8%] cases of tuberculosis were picked by positive sputum microscopy for acid fast bacilli in the sputum. Of 12 cases 5 were on anti-tuberculous treatment before earthquake but had discontinued the treatment following this disaster, and developed symptoms in due course of time. Rest 7 cases were new, and were picked during screening. The reporting and recording system for tuberculosis in Azad Kashmir was very efficient and most paramedics had already located almost all known tuberculosis patients who were displaced due to earthquake and had motivated them to continue with the treatment for tuberculosis. Of 247 suspected cases of tuberculosis 12 cases [5%] had active tuberculosis. Timely relocation and treatment of already known cases and identification of the new cases had been a major step in averting another disaster following earthquake