TB DOTS STRATEGY IN DISTRICT RAWALPINDI: RESULTS AND LESSONS
AbstractBackground: Tuberculosis (TB) is one of the most ancient diseases of mankind. Despite newermodalities for diagnosis and treatment, unfortunately, people are still suffering, and TB is among thetop 10 killer infectious diseases in the world. TB is a devastating disease due to its rapid transmissionand high rate of mortality causing around 1.8 million deaths annually. This study was conducted toevaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the targetpopulation. Methods: Two Tehsils of District Rawalpindi were selected for the study. All patientsunder TB treatment attending Basic Health Units (BHUs) and Rural Health Centres (RHCs) wereincluded in the study. The patients with extra pulmonary TB and children under five years of age wereexcluded from the study. All patients were contacted individually and asked about the DOTS programactivity using a preformed questionnaire that mainly contained questions regarding knowledge of thepatients 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%) werefemale. Majority (48.8%) of the patients was in age group of 21–40 years and 62.5% patients hadpositive family history of TB. Among the patients, 51.8% were illiterate, 31.7% had studied till primarylevel, and only 16.5% had the educational qualification of Matric or above. In our study 69.2% ofpatients themselves or through their relatives reported to the health facilities to get treatment, while therest 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 ismainly a disease of the poor and illiterate people. Despite many achievements a bulk of patients are notpicked by the community health providers nor are they properly observed. We need to improve thecurrent working of the DOTS personnel. General practitioners are playing a big role in diagnosing thedisease, 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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