TB DOTS STRATEGY IN DISTRICT RAWALPINDI: RESULTS AND LESSONS

Samia Iram, Shafqut Ali, Shahbaz Ali Khan, Munir A Abbasi, Syed Abbas Anwar, Fozia Fatima

Abstract


Background: Tuberculosis (TB) is one of the most ancient diseases of mankind. Despite newer
modalities for diagnosis and treatment, unfortunately, people are still suffering, and TB is among the
top 10 killer infectious diseases in the world. TB is a devastating disease due to its rapid transmission
and high rate of mortality causing around 1.8 million deaths annually. This study was conducted to
evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the target
population. Methods: Two Tehsils of District Rawalpindi were selected for the study. All patients
under TB treatment attending Basic Health Units (BHUs) and Rural Health Centres (RHCs) were
included in the study. The patients with extra pulmonary TB and children under five years of age were
excluded from the study. All patients were contacted individually and asked about the DOTS program
activity using a preformed questionnaire that mainly contained questions regarding knowledge of the
patients about their disease and the role of health facility in treating and following the disease. Results:
Out of the 224 patients who were included in the study, 87 (38.8%) were male, and 137 (61.2%) were
female. Majority (48.8%) of the patients was in age group of 21–40 years and 62.5% patients had
positive family history of TB. Among the patients, 51.8% were illiterate, 31.7% had studied till primary
level, and only 16.5% had the educational qualification of Matric or above. In our study 69.2% of
patients themselves or through their relatives reported to the health facilities to get treatment, while the
rest were picked by community health workers, 62.9% were diagnosed by the public hospitals, 23.2%
were diagnosed by general practitioners and 12.9% by the federal public hospitals. In our study 69.6%
of the patients were not observed at all or were observed by the family members. Conclusion: TB is
mainly a disease of the poor and illiterate people. Despite many achievements a bulk of patients are not
picked by the community health providers nor are they properly observed. We need to improve the
current working of the DOTS personnel. General practitioners are playing a big role in diagnosing the
disease, so they need to be integrated in the DOTS to effectively diagnose and control TB.
Keywords: Tuberculosis, DOTS, Practitioners, Health Care Providers, Primary Health Care, Pakistan

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References


Gadhave NA, Lade KS, Singh MC, Sawant SD. Tuberculosis: A

dreaded or curable disease –A Review. J Pharma Re

;4:2107–19.

Malmborg R, Mann G, Squire SB. A systematic assessment of

the concept and practice of public-private mix for tuberculosis

care and control. Int J Equity Health 2011;10(1):49.

Ananthakrishnan R, Muniyandi M, Jeyaraj A, Palani G,

Sathiyasekaran B. Expenditure Pattern for TB Treatment among

Patients Registered in an Urban Government DOTS Program in

Chennai City, South India. Tuberculosis Research and Treatment

; 2012.

National Tuberculosis control Programme, Pakistan. Available

at: http://www.ntp.gov.pk/about.htm

Abegunde DO, Stanciole AE. The economic impact of chronic

diseases: how do households respond to shocks? Evidence from

Russia. Social Sci Med 2008;66(11):2296–307.

Hopewell PC. Tuberculosis control: how the world has changed

since 1990. [Editorial]. Bull World Health Organ

;80(6):427.

DeRiemer K, García-García L, Bobadilla-del-Valle M, PalaciosMartínez M, Martínez-Gamboa A, Small PM, et al. Does DOTS

work in populations with drug-resistant tuberculosis? Lancet

;365:1239–45.

Fatima R, Ejaz Q, Enarson D, Bissell K. Comprehensiveness of

primary services in the care of infectious tuberculosis patients in

Rawalpindi, Pakistan. Public Health Action 2011;1(1):13–5.

Styblo K, Bumgarner J. Tuberculosis can be controlled with

existing technologies: evidence. The Hague: Tuberculosis

Surveillance Research Unit; 1991.p. 60–72.

Ahmadzai H, Kakar F, Rashidi M, Suarez P, Ameli O, Hartman

A. Scaling up TB DOTS in a fragile state: post-conflict

Afghanistan. Int J Tuberc Lung Dis 2008;12(2):180–5.

Kapoor SK, Raman AV, Sachdeva KS, Satyanarayana S. How

Did the TB Patients Reach DOTS Services in Delhi? A Study of

Patient Treatment Seeking Behavior. PloS one 2012;7(8):e42458.

Ullah ANZ, Huque R, Husain A, Akter S, Islam A, Newell JN.

Effectiveness of involving the private medical sector in the

National TB Control Programme in Bangladesh: evidence from

mixed methods. BMJ Open 2012;2(6):e001534.

Ullah ANZ, Newell JN, Ahmed JU, Hyder M, Islam A.

Government–NGO collaboration: the case of tuberculosis control

in Bangladesh. Health Policy Plan 2006;21(2):143–55.

Yimer SA, Holm-Hansen C, Bjune G. Assessment of knowledge

and practice of private practitioners regarding tuberculosis

control in Ethiopia. J Infect Dev Ctries 2012;6(1):13–9.


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