Association of socio-demographic profile with types of tuberculosis among patients attending a rural DOTS centre in central Kerala, South India

Background:Re-evaluation of the epidemiological profile of tuberculosis (TB) patients can help to eliminate the number of cases. This study was aimed to analyse the association of socio-demographic profile with type of TB among patients attending a rural DOTS centrein central Kerala.Methods: A cross sectional study was conducted among TB patients at a rural DOTS clinic in central Kerala during January 2020-June 2021. Various socio-demographic parameters such as age, gender and socio-economic status and comorbidities of patients with pulmonary and extrapulmonary TB were retrieved from the DOTS register. The data was analyzed.Results: A total of 241 patients (134 males and 107 females) were enrolled. In general, age group 41-60 years showed maximum incidence (p=0.0283). Lower middle (32.7%) and middle class (36.5%) strata constituted the majority of burden (p=0.9091). The distribution of cases was not associated to occupation (p=0.06). Extrapulmonary form (55%) was found to be predominant with very poor awareness (p=0.06). A significant delay of at least 1-3 months in recognizing the symptoms and thus the clinical diagnosis particularly in extrapulmonary cases was found. Diabetes mellitus was the most frequent comorbidity in TB patients.Conclusions: The prevalence was most common in age group 41-60 years without any association to occupation. Since the diabetes mellitus is the most frequent comorbidity in TB patients, early screening will make an effective management. Society oriented awareness programme about the extrapulmonary TB is inevitable

Outcomes of tuberculosis treatment in a tertiary health facility in north-central Nigeria

Background: Tuberculosis (TB) remains a major public health concern despite being a curable and preventable disease. The treatment of TB using a cocktail of drugs over a period of six months under the directly observed treatment short-course strategy has led to a reduction in cases but is plagued by some challenges that leads to unsuccessful or poor outcomes, which can ultimately result in spread of infections, development of drug resistance and increase in morbidity and mortality. The objectives of this study are to determine outcomes of TB treatment in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria and the factors that may be associated with the outcomes. Methodology: This was a retrospective study using the medical records of patients who were registered for TB treatment over a five-year period between 2016 to 2020. Data from TB registers including demographic and relevant clinical information, and treatment outcomes, were extracted into a structured data extraction format, and analysed with SPSS version 21.0 software package. Univariate and bivariate analyses were conducted, and Chi square test was used to determine association between TB outcomes and independent variables at 95% confidence interval and p<0.05 was considered as the significant value. Results: Records of 1,313 patients were studied, 744 (56.7%) were males while 569 (43.3%) were females. The age range of the patients was ≤ 1 year - 96 years, with a mean age of 30±16.7 years. Most were pulmonary TB cases (88.8%, n=1,166), newly diagnosed (95.5%, n=1254), and human immunodeficiency virus (HIV) negative at the time of TB diagnosis (63.7%, n=837). Eight hundred and seven (61.5%) patients had successful treatment, and 34% (n=446) had unsuccessful outcomes made of 'loss to follow-up' 25.8% (n=339), deaths 7.8% (n=102) and treatment failure 0.4% (n=5), while 2.3% (n=30) were transferred out and 2.3% (n=30) removed from TB register. Treatment success rate was significantly higher in patients with pulmonary TB (p=0.0024), residents in Lafia LGA (p=0.0005), those treated in 2016 (p=0.0006) and bacteriologically confirmed cases (p<0.0001), while death rate was significantly lower among patients who were HIV-negative at the time of TB diagnosis (p<0.0001). Conclusion: TB treatment success rate in this study fell short of the WHO average rate. High rates of 'loss to followup' and deaths in this study is a wake-up call to all stakeholders in the facility and the State to put in place measures to reduce poor outcomes of TB treatment.

El VOT: una opción atractiva en la administración del tratamiento de la tuberculosis / Video Observed Treatment, an attractive option for the administration of tuberculosis therapy

Resumen El VOT (video observed treatment) es la autoadministración de la terapia certificada mediante registro de imágenes en video y podría constituir para algunos pacientes una alternativa complementaria al DOT (directly observed treatment) en la administración del tratamiento ambulatorio de la Tuberculosis en Centros de Salud Primarios. Existen evidencias internacionales en que la estrategia VOT mejora la adherencia al tratamiento, empodera a los pacientes, reduce los costos para pacientes y el sistema de salud y ahorra el tiempo dedicado por los pacientes al traslado a centros de terapia. La disponibilidad masiva de teléfonos portátiles con capacidad de trasmitir videos en la población de Chile podría permitir realizar una investigación piloto de VOT.

VOT (Video Observed Treatment) is a video certificated self-administration of therapy and could be complementary to DOT (Directly Observed Treatment) for the administration of ambulatory tuberculosis treatment at Primary Health Centers. Reviewed international experience and evidence indicates that VOT improves treatment adherence, empowers patients, reduces health system costs and saves patient's transfer time to Therapy Centers. Given the high penetration of smartphones with videocall software in the Chilean population, the pre-requisites are provided to consider a VOT pilot research in Chile.

Adverse drug reactions in patients taking anti tuberculosis therapy from directly observed treatment short course centre at Mandya Institute of Medical Sciences, Mandya: a cross sectional study

Background: Ending the tuberculosis (TB) epidemic by 2030 is among the health targets of the sustainable development goals. Side effects to anti-TB drugs are common and may lead to reduced compliance to treatment. These adverse effects must be recognized early to reduce associated morbidity and mortality. Objective of this study was to determine the adverse drug reactions (ADR) to anti-tubercular therapy among patients visiting directly observed treatment, short-course (DOTS) centre MIMS, Mandya.Methods: A cross sectional study was conducted at DOTS Centre MIMS, Mandya. TB patients registered at DOTS Centre during the year 2018 were selected for the study. Verbal informed consent was taken from the TB patients and interviewed using pretested semi-structured questionnaire. Data analysis was done using descriptive statistics and chi square test.Results: Among the study population (n=90), 67 (74.4%) experienced ADR among which 47.7% took treatment for ADR and the remaining 52.3% patients were given reassurance. In this study, gastrointestinal manifestations (42.3%) were the most common adverse drug reaction (ADR). Of the TB patients who experienced ADR, 9.0% of them had interrupted ATT, however they completed full course of ATT.Conclusions: A considerable number of TB patients taking ATT experience ADRs and some of them may have to interrupt treatment. However, they need to be counselled or supervised with caution to complete their course of treatment to reduce the chances of treatment default and also reduce the occurrence of drug resistance.

Transmission and prevalence of drug-resistant tuberculosis in a Brazilian setting under a directly observed therapy short-course strategy

Abstract INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community.

Analysis of Risk Factors Affecting Sputum Conversion at the End of Intensive Phase Under DOTS for Treatment of Pulmonary Tuberculosis

Introduction: Microbiologically confirmed pulmonarytuberculosis patients under Revised National TuberculosisControl Programme (RNTCP) are treated with a 6-monthshort-course chemotherapy (SCC) regimen irrespectiveof co-morbid conditions. The aim of present study was todetermine the time taken for SSC conversion with standardcurrent treatment with anti-tubercular drugs and analysis ofrisk factors if any delaying it. We undertook this prospectivestudy to compare sputum conversion rates (smear) at the endof intensive phase (IP) of Category regimen.Material and methods: was a prospective study which wasconducted for a period of eleven months from August 2018 toJune 2019 at Department of Respiratory Medicine, K.N ChestHospital, S.N Medical College, Jodhpur Rajasthan India.Patients visiting Department of Respiratory medicine and whowere diagnosed as pulmonary tuberculosis by sputum smearexamination were included in study.Result: Sputum smear-positive patients are infectious to closecontacts as well as to community as they continue to expelbacilli for a variable period of time after initiation of DOTSregimen. Most patients undergo sputum conversion by theend of 3rd month. Patients who have predominant cavitatorydisease in radiology, high smear grading before treatment, aprior history of DS/DR tuberculosis are more likely to havedelayed sputum smear conversion.Conclusion: There need to mandate DST at the starting ofDOTS in line with latest RNTCP guidelines to prevent thedevelopment of MDR strains and failures. Also there is astrong need to constitute strong infection control measures tillpatients are labelled as noninfectious.

Sputum smear conversion rate of adult pulmonary tuberculosis patients under directly observed treatment shortcourse in Rajarajeswari Medical College and Hospital, Bangalore

Background: Tuberculosis is among the most important causes of death from a single infectious agent and a major public health problem causing an enormous burden of disease and economic impact especially in the developing countries. Pulmonary tuberculosis is the most common form of tuberculosis causing >85% of all tuberculosis cases. The smear conversion rate is an operational indicator for the directly observed treatment short course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India.Methods: A longitudinal study was conducted in DMC, RRMCH, in the first two quarters of the year 2013 i.e., from January 1st to June 31st of the year 2013. All 130 adult category I (new) sputum smear positive cases that attended DMC, and registered under RNTCP constituted the sample for the study. Data was collected by interview method by using pre-tested, semi-structured questionnaire. Data was analyzed using SPSS version 20.0.Results: Majority of the study subjects was >50 years, Hindus, illiterates, belonged to nuclear family from rural area belonged to upper lower socio-economic class. The overall sputum smear conversion rate is 92.4%. Lower sputum smear conversion rate was observed in the following risk factors like the male gender, smoking, diabetes, initial high pre-treatment smear grading and poor drug compliance.Conclusions: The overall sputum conversion rate at the end of two months of intensive phase under (DOTS) chemotherapy in 118 sputum smear positive (cat I) new pulmonary tuberculosis patients in Designated Microscopy and Treatment Centre (DMC) Rajarajeswari Medical College and Hospital was 92.4%.

Incidence of adverse drug reactions in patients taking anti-tuberculosis treatment

Background: High incidence of infection has caused a large number of morbidity and mortality which is partly due to serious adverse reactions induced by Anti-Tuberculosis (Anti-TB) drugs. In present prospective study an attempt is made to estimate the incidence and risk factor for ADRs among patients treated for tuberculosis.Methods: All the new patients starting their treatment with selected six DOT center were enrolled in study. All patient's complete clinical history was recorded. They were followed regularly for occurrence of ADR till end of their treatment.Results: Total of 108 patients (67 male and 41 female) had taken and completed their treatment during the study period (March 2007 - April 2008) and were observed for occurrence of ADR during their treatment period. Out of total108, 28 patients (25.9%) experienced one of the ADR, out of 28 patients, 12 (42.85%) patients developed GIT intolerance, and hepatitis was seen in 8 (28.57%) patients, while 4 (14.48%) patients developed skin reactions. Only 3 (7.14%) patient developed dizziness and loss of balance, which was relieved by reduction of dose of streptomycin.Conclusions: With close monitoring and on time action, RNTCP DOTs regimens can be safely and successfully administrated.

Effectiveness of daily directly observed treatment, short-course regimen among patients registered for treatment at an urban primary health center in Bengaluru

Tuberculosis (TB) is a major public health problem in India with high morbidity and mortality. As per the World Health Organization guidelines, the Revised National Tuberculosis Control Program introduced daily directly observed treatment, short-course (DOTS) regimen with a fixed-dose combination with weight bands. This study was undertaken to compare the effectiveness of daily DOTS regimen with intermittent regimen and to assess the proportion of adverse drug reactions in both groups. Materials and Methods: A descriptive study was conducted at a peripheral health institute under one of the TB Units in South Bengaluru. Participants registered for treatment during the third and fourth quarter of 2017 were selected using continuous sampling. Data were collected by case record analysis, structured interviews, and telephonic follow-up. Results: The study included 81 participants, with the mean age of 40 ± 16.1 years. Majority of the study participants 55 (67.9%) were male, and majority (38 [46.9%]) belonged to the upper-lower class. Forty-two (51.8%) of the study participants were on intermittent regimen, and 39 (48.1%) were on daily DOTS regimen. There was 100% sputum conversion at the end of treatment under both treatment regimens. A total of 36 (85.7%) participants under intermittent regimen and nine (23%) under daily regimen developed one or the other adverse drug reactions. The treatment success for participants under intermittent regimen was 38 (90.47%) and that for daily regimen was 35 (89.74%). However, there was no statistically significant difference between the two groups. Conclusion: Both daily and intermittent DOTS regimens are equally effective in TB treatment, but adverse drug reactions were more common with the intermittent regimen.

Factors influencing compliance to directly observed treatment, short course therapy and effectiveness of awareness program on knowledge and compliance

Background: Tuberculosis (TB) is one of the most infectious diseases if not treated properly it may lead to mortality. The directly observed treatment, short course (DOTS) therapy is the choice of the treatment of TB. Objectives: The objectives of the study were (1) to determine the factors influencing compliance of persons with TB to DOTS, (2) to evaluate the effectiveness of an awareness program on knowledge and compliance to DOTS among persons with TB, (3) to find the association between pre-test level of knowledge with selected sociodemographic variables, and (4) to find the association between pre-test level of compliance to DOTS with selected sociodemographic variables. Materials and Methods: An evaluative approach with one group pre-test and post-test design was used as a research design in the study. 50 participants were selected as a sample using purposive sampling technique. The data were collected using structured knowledge questionnaire and compliance checklist through interview schedule Results: The study result showed that the mean post-test knowledge score (17.32 ± 1.58) was higher than the mean pre-test knowledge score (10.80 ± 2.05) and “t” value is 27.22 at P < 0.05. Similarly, the mean post-test compliance score (8.92 + 0.72) was higher than the mean pre-test compliance score (6.00 ± 1.05) and “t” value is 9.369 at P < 0.05. The sociodemographic variable such as age and educational status was significantly associated with pre-test knowledge score (χ² = 5.993, P < 0.05, and χ² = 11.49, P < 0.05), respectively, and gender was significantly associated with pre-test compliance score (χ² = 4.482, P < 0.05). The main reason for noncompliance to DOTS therapy was difficult to take multiple drugs for a long period and data showed that family support (29.55%) was highly influencing to comply with DOTS therapy. Conclusion: The awareness program was highly effective in increasing knowledge among TB person and compliance to DOTS therapy. Therefore, the knowledge and compliance of the TB person to DOTS therapy can be further improved by providing on-going awareness programs.

Depression among tuberculosis patients attending a DOTS centre in a rural area of Delhi: A cross-sectional study

Background: Studies have shown that the prevalence of psychiatric disorders, particularly depression, is high among tuberculosis (TB) patients, and may adversely affect treatment compliance. A person suffering from TB can develop depression in due course of time owing to a number of factors, namely the long duration of treatment for TB, stigmatization faced by the patient due to the disease and lack of family support to name a few. Objectives: The present study aimed to determine the prevalence of depression and its correlates among TB patients enrolled at a Directly Observed Treatment Short-course (DOTS) center in a rural area of Delhi. Methods: The study was a DOTS center-based, cross-sectional study, among 106 patients of pulmonary and extrapulmonary TB, above 18 years of age. An interviewer-administered questionnaire in Hindi was used to collect basic sociodemographic data and the Patient Health Questionnaire (PHQ)-9 was used for detecting depression. Those with a score of 10 or more were considered to be suffering from depression. Data analysis was done using SPSS licensed version 20. Chi-square was used to test for association between qualitative variables, and a P < 0.05 was considered statistically significant. Results: A total of 106 patients participated in the study, of which 61 (57.5%) were males. The median age was 30 years (inter-quartile range 24� years). Depression was found to be present in 25 (23.6%) participants. A higher proportion of patients with depression were unemployed currently, and also belonged to middle or lower class (P < 0.05). Depression was not found to be associated with religion, gender, marital status, HIV status, presence of diabetes, DOTS category nor with the phase of treatment. Conclusion: Depression among TB patients is common, affecting almost one in four TB patients. Physicians and DOTS providers should have a high index of suspicion for depression when assessing TB patients.

Outputs and Outcome of the Pharmacy Directly-Observed Treatment Short-Course (DOTS) Initiative in the Philippines

@#<p><strong>OBJECTIVE:</strong> This was an evaluation of the effectiveness of the technical assistance package for the Pharmacy DOTS Initiative (PDI) in the Philippines.</p><p><strong>METHODOLOGY:</strong> Five pre-identified implementation sites were included in the evaluation. A survey was conducted to ascertain pharmacies currently implementing PDI and the number of TB presumptive cases referred by these pharmacies. Data abstraction was performed to determine the change in the number of TB cases seen by local TB programs after its implementation.</p><p><strong>RESULTS:</strong> Findings revealed that the proportion of pharmacies actively referring presumptive TB patients is not significantly lower than 60% (p=0.1892). Furthermore, results showed that the average monthly referrals were not statistically lower than 20 clients per month (p=0.9159). Nevertheless, interrupted time series analysis found no statistically significant immediate effects (p=0.516) and long-term effects (p=0.3673) on the total number of new TB cases identified after the PDI was implemented in the year 2014.</p><p><strong>CONCLUSION:</strong> The PDI was able to achieve outputs related to pharmacy engagement and referral of TB presumptive clients. However, the PDI was unsuccessful in increasing the actual number of TB presumptive cases seen by local TB programs in its implementation sites.</p>

Assessment of microbiological status after successful completion of intermittent revised national tuberculosis control programme directly observed treatment, short course regimen for microbiologically confirmed pulmonary tuberculosis cases: While new daily regimen going to be implemented in India

Purpose: The Revised National Tuberculosis Control Programme (RNTCP) is now introducing daily fixed-dose regimen instead of Directly Observed Treatment, Short Course (DOTS) regimen for treatment of drug-sensitive tuberculosis (TB) in India. It would be beneficial to understand the drawbacks, barriers and advantages of the existing system for better implementation of new policy. Our study was aimed to evaluate the current microbiological status of new microbiologically confirmed pulmonary TB patients who have successfully completed intermittent DOTS regimen within last 2 years and also to find the economic barriers faced by beneficiaries to avail DOTS treatment. Materials and Methods: We included patients who had completed CAT 1 DOTS regimen within the last 2 years. The patients were interviewed. Sputum sample was collected for microscopy and cartridge-based nucleic acid amplification test. Results: All patients were adhered to intermittent DOTS therapy, and sputum conversion rate was 83%. Minor gastrointestinal side effects were experienced by 60% of cases and 87% consumed drugs under supervision. On microbiological examination, 10% of the study population was found to be positive for TB and they all were rifampicin sensitive. Those who had completed treatment within 1 year with no clinical symptoms re-appeared after treatment. Conclusion: Till date, RNTCP does not follow up the patients for any period of time after successful completion of treatment. Through the present study, we could find relapse cases in 10% of the previously treated non-symptomatic patients. These unnoticed relapse cases have potential to spread TB and increase disease burden of country. Thus, we can conclude that RNTCP has to follow up the patients after successful treatment to determine whether they relapse. It is needed for the success of programme and control of the disease in the country.

Avaliação de impacto da estratégia TDO no controle da tuberculose em Pernambuco / Evaluation of the impact of the TDO strategy in the control of tuberculosis in Pernambuco

A tuberculose (TB) é uma das doenças infecciosas mais antigas no mundo, e até os dias atuais ainda permanece sendo um sério problema para a saúde pública global. O Tratamento Diretamente Observado (TDO) caracteriza-se como elemento chave, no fortalecimento da adesão ao tratamento da TB e na prevenção do aparecimento de cepas resistentes aos medicamentos, uma vez que ainda existem taxas de cura inferiores a meta preconizada e um número ainda elevado de abandono do tratamento. Em Pernambuco a estratégia TDO foi implantada inicialmente pela capital Recife a partir de 2005-2007 e segundo dados, no ano de 2013 chegou a uma cobertura de 63,5% em todo o estado. Para o presente estudo foram utilizados dados secundários retirados do Sistema de Informação de Agravos e Notificações (SINAN) no período 2005 a 2014. Os resultados apontam que a maioria dos pacientes são adultos jovens do sexo masculino, não brancos, alfabetizados, moradores de zona urbana e entre as doenças e agravos o mais presente foi o alcoolismo. A taxa de incidência da TB apresentou uma média em torno de 48,6%. Os casos de óbitos, no estado, apresentou uma média de 4,3. A forma pulmonar predomina diante das demais, com uma média de mais de 4000 (85%) casos ao ano no Estado. A média de cura e abandono ficou em torno de 71,3% e 9,9% respectivamente. A realização do TDO só veio a surtir efeito no estado a partir de 2007 (53,86%) seguindo até o ano de 2014 com 60,37%.Foi observado que nos últimos 10 anos de estudo (2005-2014) a probabilidade de cura, a partir da diferença de médias entre os grupos, foi de 26% a mais para o grupo dos tratados (TDO) do que para o grupo controle (não TDO). Esses resultados são corroborados por três diferentes critérios de Matching (pareamento) via Propensity Score (escore de propensão): o vizinho mais próximo, indicando que os indivíduos submetidos ao TDO têm em média 23% de chances a mais de cura, com base nos Estratos, este percentual é de 21% e o Kernel, apresentou 23% a mais de chances de cura.(AU)

Tuberculosis (TB) is one of the oldest infectious diseases in the world, and to this day still remains a serious problem for global public health. The Directly Observed Treatment Short-Course (DOTS) is characterized as a key element in strengthening adherence to TB treatment and prevention of the emergence of resistant strains to drugs, since there are still healing rates below the recommended target and an even higher number abandonment of treatment. In Pernambuco the DOTS strategy was implemented initially by Recife capital from 2005-2007 and second data, in 2013 reached a 63.5% coverage throughout the state. For the present study were used secondary data taken from Diseases and Notifications Information System (SINAN) in the period 2005 to 2014. The results show that most patients are young, adult males, not white, literate, urban residents and among the diseases and disorders the most present was alcoholism. The TB incidence rate in PE averaged around 48.6%. The cases of deaths, in the state, showing that PE is an average of 4.3. The pulmonary form predominates on the others, with an average of more than 4000 (85%) cases per year in the state. The average healing and abandonment was around 71.3% and 9.9% respectively. The realization of the DOTS only came to take effect in the state from 2007 (53.86%) followed by the year 2014 with 60.37%. It was observed that in the last 10 years of study (2005-2014) the probability of cure from the mean of difference between the groups was 26% higher for the group of treated (DOTS) than for the control group ( not DOT). These results are supported by three different criteria Matching by Propensity Score: the nearest neighbor matching, indicating that individuals submitted to DOTS have averaged 23% chance more healing, based on Strata this percentage is 21% and Kernel, showed 23% more chances of cure.(AU)

A transferência da política do tratamento diretamente observado em diferentes níveis de gestão para o controle da tuberculose / Policy Transfer of the Directly Observed Treatment at Different Levels of Management for Tuberculosis Control

Trata-se de estudo qualitativo desenvolvido por meio de análise de discurso cujo objetivo foi analisar a discursividade dos gestores em diferentes níveis de gestão sobre transferência da política do tratamento diretamente observado (TDO) no controle da tuberculose. Para isto, esta análise parte do contexto de decisão macropolítico para o contexto micropolítico tendo como cenário local o município de Ribeirão Preto-SP, considerado prioritário para o controle da doença. Foram entrevistados quatro sujeitos-gestores envolvidos com a política do TDO nas instâncias estadual, regional, municipal e no nível intermediário entre a regional e o município, mediante aceite de termo de compromisso. Os dados foram coletados no período de agosto a dezembro de 2013, as entrevistas foram audiogravadas, transcritas, respeitando-a na sua íntegra. O corpus da pesquisa foi composto por recortes, formação discursiva e marcas linguísticas, quais foram selecionados dos discursos dos sujeitos. A análise ocorreu mediante a fundamentação teórico-metodológica da Análise de Discurso (AD) de matriz francesa, que se sustenta sobre três vertentes teóricas: o Materialismo Histórico, a Linguística e a Psicanálise. Este tipo de análise não visa uma análise exaustiva horizontal ou de toda extensão do objeto de pesquisa, por entender que este não se esgota e que um discurso institui-se sempre em relação aos outros. Busca-se apoiar na exaustividade vertical com o intuito de contemplar o objetivo do trabalho e da temática abordada. Os dados foram organizados sob o eixo da temática da transferência de políticas e da temática da TB os quais apontaram para diferentes efeitos de sentido durante a transferência da política do TDO como o silenciamento, apagamento, polifonia, polissemia e contradição durante o processo de transferência desta política nos diferentes níveis de gestão, que passou gradativamente pelo processo de transferência autoritária para a transferência voluntária da maior instancia política para a menor. Destaca-se que no município este processo ocorreu de forma incompleta visto que não houve a superação do paradigma da desconcentração das ações de TB para a Atenção Primária em Saúde (APS)

This qualitative study was conducted using discourse analysis, the objective of which was analyzed the reports of different level managers regarding policy transfer of Directly Observed Treatment (DOT) in the control of tuberculosis. This analysis starts with the context of macro-political decisions in the micro-political context and the local setting was the city of Ribeirão Preto, SP, Brazil, considered a priority in the control of the disease. Four managers involved with the DOT policy at the state, regional, and city levels and another manager in the intermediate level between region and city were interviewed after signing consent forms. Data were collected from August to December 2013. The interviews were recorded, transcribed, respecting it in its entirety. The study's corpus was composed of excerpts, discursive formations and linguistics marks, which were selected from the participants' reports according to the guiding question. Analysis was based on the French theoretical-methodological framework of Discourse Analysis, which in turn is grounded on three theoretical aspects: the Historical Materialism, Linguistics and Psychoanalysis. An exhaustive horizontal analysis, or an analysis that encompasses the entire extent of the research's object, is not intended in this type of analysis because the topic is not exhausted and discourses are always instituted in relation to others. The objective is to be supported in vertical exhaustiveness to contemplate the objective of the study and the topic under study. Data were organized under policy transfer' and tuberculosis' thematic axis, which indicate different effects of meanings during DOT policy transfer, such as muting, blanking, polyphony, polysemy, and contradictions during this policy transfer process at the different levels of management, which gradually moved from an authoritative transfer to a voluntary transfer, from a higher political instance to a lower one. Nonetheless, this process was not completed in the city because the paradigm decentralizing TB actions from Primary Health Care (PHC) was not overcome

Perceived obstacles to optimal detection of tuberculosis cases among PHC workers in Osun and Oyo state, Southwest Nigeria.

Background: TB cases detected in Nigeria are still far below WHO target of 70% despite adoption of DOTS strategy since 1994 with subsequent expansion of treatment to primary health centers where diagnosis and treatment is done mainly by general health care workers. However, the extent of adherence to standard guideline by such cadre is unknown. Aims & Objective: This study aimed at assessing the knowledge on TB diagnosis and treatment by PHC workers in Osun and Oyo States. Material and Methods: A cross-sectional descriptive study was conducted among 280 general health care workers in 23 health care facilities selected using multistage sampling technique. Interviewed was done with a pre-tested selfadministered questionnaire in November, 2007. Results: Majority of the respondents (41%) are Community health extension workers i.e115 (41.1%) while 76 (27.1%) are nurses and 37 (13.2%) pharmacists. Knowledge on TB causation and mode of transmission was found to be relatively high as about 200 (71.4%) correctly describe TB as a microbial infection and about 216 (77.1%) knew airborne route as mode of transmission. When asked to define DOTS, 62.5% of the health workers gave a correct definition with only 109 (38.9%) abled to list the 4 main drugs given during intensive phase of treatment. In addition, about half of the respondents (52.5%) knew that treatment last for 8 months. Conclusion: The findings in this study several knowledge gaps on directly observed treatment short course therapy among healthcare providers. Multiple strategies are required to improve health care workers' knowledge and practice of Tuberculosis control.

Current Status of Tuberculosis in Korea / 대한내과학회지

Tuberculosis is still a serious communicable disease in Korea. The prevalence of tuberculosis had been rapidly decreased in past by the country widely expanded national control program, improvement of nutrition and development of medical services. However, decline of tuberculosis is recently stagnated because of increase of aged population and the prevalence of other chronic disease such as diabetes. The registry number of new tuberculosis patients was 36,305 and 2,365 cases were died of tuberculosis in 2010. Proportion of retreatment cases which is caused by the improper patient care is much higher than other countries. Public-private collaboration system to improve management of tuberculosis patients treating from the private sector has been recently implemented. However, directly observed treatment which is known as an international standard of patient care and adopted by the most of the countries have to be implemented to accelerate the decline of tuberculosis morbidity and improve patient care.

Implantação da estratégia DOTS no controle da Tuberculose na Paraíba: entre o compromisso político e o envolvimento das equipes do programa saúde da família (1999-2004) / Implementation of the DOTS strategy in the control of TB in Paraiba: between the political commitment and the involvement of the teams of the family health program (1999-2004)

Foi analisada a implantação da estratégia Tratamento Diretamente Observado de Curta Duração (DOTS) no controle da tuberculose, sob a ótica dos coordenadores do Programa de Controle da Tuberculose (PCT), nos seis municípios prioritários da Paraíba. Foram realizadas entrevistas semiestruturadas com sete coordenadores de PCT. Fortalezas do DOTS: cinco municípios alcançaram a taxa de cura de 90 por cento. Entre as debilidades identificou-se, na dimensão política, a descontinuidade do cargo de coordenador de PCT, o despreparo da equipe local, a precariedade da estrutura técnico-administrativa e a insuficiência da rede laboratorial; na dimensão operacional ainda é baixa a incorporação da busca de sintomáticos respiratórios pelas Equipes de Saúde da Família. Ocorreram mudanças de cunho epidemiológico, operacional e político. a implantação e garantia da sustentabilidade do DOTS no Estado dependem do modo da organização dos serviços de saúde e o compromisso político do gestor no apoio a estratégia.

The scope of this paper is to analyze the implementation of the Directly Observed Treatment Short-Course (DOTS) strategy in the control of tuberculosis, from the standpoint of the coordinators of the Tuberculosis Control Program (TCP) in six priority municipalities in the state of Paraíba, Brazil. Semi-structured interviews were conducted with seven TCP coordinators. Five municipalities proved to be DOTS success points achieving a 90 percent cure rate. Among the DOTS weak points in the political dimension, the following aspects were identified: lack of continuity of the TCP coordinator position; lack of preparedness of the local team; precarious technical-administration structure and insufficiency of the laboratory network. In the operational dimension, the search for respiratory symptoms by the Family Health Teams is still low. Changes of an epidemiological, operational and political nature have been incorporated, though the implementation and guarantee of the sustainability of DOTS in the State depends on the way the health services are organized and on the manager's political commitment to support the strategy.

Effect of Disease Related Variables on Treatment Outcome Under DOTS.

The study was undertaken to assess the effect of various disease related variables on treatment outcome of patients treated under Directly Observed Treatment Shortcourse (DOTS) chemotherapy. The objective of the study is to identify the factors which affect treatment outcome and are responsible for default. This Cross sectional study was carried out at three TUs (Tuberculosis Unit) of Agra city, Uttar Pradesh, India. Two DMCs (designated microscopy centers) were selected randomly from each TU. All the patients from the DOTS centers under these DMCs registered during January to December 2007 were included in the study until the sample size of 900 patients was complete. Treatment cards of these patients were obtained from their respective DMCs after their outcome had been recorded. Chi-square test was used for statistical analysis. 71.6% patients had favorable outcome while 15.1% defaulted. Defaulter were more among category-II (26.4%), pulmonary cases (18.2%) and retreatment cases (28.4% among treatment after default, 18.8% among failure and 42.9% among relapse cases), while 19.4% & 18.3% of patients among sputum positive & negative patients defaulted. Deaths were also more among pulmonary (8.0%), category II (12.3%) & treatment after default cases (11%). Favorable outcome was observed among 80.4% of new patients, 72.8% of category I patients and 85.7% of category III patients. 83.5% of patients with extra pulmonary disease had favorable outcome, while only 67.4% of pulmonary TB patients had favorable outcome. Present study concludes that default to treatment is more among category II patients, retreatment cases and patients with pulmonary disease.

Effect of Disease Related Variables on Treatment Outcome Under DOTS.

The study was undertaken to assess the effect of various disease related variables on treatment outcome of patients treated under Directly Observed Treatment Shortcourse (DOTS) chemotherapy. The objective of the study is to identify the factors which affect treatment outcome and are responsible for default. This Cross sectional study was carried out at three TUs (Tuberculosis Unit) of Agra city, Uttar Pradesh, India. Two DMCs (designated microscopy centers) were selected randomly from each TU. All the patients from the DOTS centers under these DMCs registered during January to December 2007 were included in the study until the sample size of 900 patients was complete. Treatment cards of these patients were obtained from their respective DMCs after their outcome had been recorded. Chi-square test was used for statistical analysis. 71.6% patients had favorable outcome while 15.1% defaulted. Defaulter were more among category-II (26.4%), pulmonary cases (18.2%) and retreatment cases (28.4% among treatment after default, 18.8% among failure and 42.9% among relapse cases), while 19.4% & 18.3% of patients among sputum positive & negative patients defaulted. Deaths were also more among pulmonary (8.0%), category II (12.3%) & treatment after default cases (11%). Favorable outcome was observed among 80.4% of new patients, 72.8% of category I patients and 85.7% of category III patients. 83.5% of patients with extra pulmonary disease had favorable outcome, while only 67.4% of pulmonary TB patients had favorable outcome. Present study concludes that default to treatment is more among category II patients, retreatment cases and patients with pulmonary disease.