DOTS strategy and community participation: an experience in the Ecuadorian Andes.

SETTING: The Chine community in Angamarca parish, Cotopaxi Province, in the Ecuadorian Andes. OBJECTIVE: To relate the DOTS strategy to the world view of the indigenous community in the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) patients. DESIGN: Cross-sectional study involving all inhabitants of Chine. RESULTS: Aspects of the community's world view were considered in the community-based application of DOTS. A cure rate of 100% was attained, with 0% defaulting from treatment. CONCLUSION: The results obtained indicate that involving the world view of the community in the management of tuberculosis has several advantages.

Pulmonary tuberculosis in an indigenous community in the mountains of Ecuador.

SETTING: An aboriginal community of 653 persons. OBJECTIVE: To determine the prevalence of pulmonary tuberculosis (PTB) and to analyse related factors. DESIGN: The total population was surveyed; those with chronic productive cough were asked to provide sputum specimens. PTB was diagnosed by bacilloscopy (acid-fast bacilli [AFB]). An analysis of socio-economic factors and clinical history associated with chronic cough or positive smear for PTB was carried out using multiple correspondence analysis and logistic regression models. RESULTS: Two hundred and two patients were identified with chronic cough and 173 with chronic productive cough. Chronic cough was associated with having a history of PTB (adjusted OR=4.89, 95%CI 2.6-9.4) and with work-related migratory movements (adjusted OR=2.05, 95%CI 1.3-3.3). Of 92 coughers with sputum samples analysed, 44 (47.8%) were PTB-positive, giving a prevalence of 6.7% in the whole population. In the groups aged 15-34 and >or=45 years, women had higher positivity rates than men, whereas in the group aged 35-44 years rates were higher in men. Twenty-seven per cent of families had one to four smear-positive members. CONCLUSION: The Tuberculosis Control Programme in the area studied needs to be strengthened, taking into account the ethnic context, work-related migration and the socio-economic and geographic context.