Assessment of directly observed chemotherapy short-course on tuberculosis prevalence in calabar, cross river State, Nigeria

ABSTRACT

In 1993, the World Health Organization declared tuberculosis a global emergency and the Directly Observed Treatment Short-course [DOTS] was introduced as the eradication strategy. Tuberculosis is highly prevalent in the densely populated countries of sub-Saharan Africa [including Nigeria] and South-East Asia. This study on the Assessment of Directly Observed Treatment Short-course on Tuberculosis Prevalence in Calabar, Cross River State Nigeria aimed at comparing the treatment outcome of tuberculosis before the DOTS regime [1990-1993] and during the DOTS regime [1994-2000] in the Infectious Disease Hospital [IDH] and the University of Calabar Medical Centre, both in Calabar. Using a systematic sampling technique, five thousand seven hundred and six [5706] case files were selected from the two hospitals [706 before DOTS and 5000 after DOTS]. Total male cases was 3416, and females 2290, giving a ratio of 32. Information on sex, age, compliance, defaults, cure rate and death rate was extracted from the files and recorded on dummy tables. Analysis showed that [i] there was a significant difference in the gender prevalence of TB before and after DOTS regime [x[2] = 300.94; P < 0.05] [ii] The age group most infected ranged from 15-44 years, which constituted 74.59% of all registered patients [iii] That there was statistically significant difference in compliance before and after DOTS regime [P < 0.27] [iv] That the default rate was higher in the pre-DOTS than in the post-DOTS regime [P = 0.05] and that [v] there was a significant difference in mortality among TB patients before the DOTS regime [P = 0.032]. It was also shown that factors which adversely affected compliance included duration of treatment, poverty, cost of drugs, side effects of drugs, alternative therapy, lack of motivation of the patients, distance to health facility and lack of supervision by health workers. Factors that aided default were lack of knowledge by the patients and communication between health workers and the patients about the disease, the side effects of the drugs and duration of the treatment