Abstract
BackgroundIn 2009 Lesotho had an estimated TB prevalence of 696 cases/100 000 population – the 4th highest in the world. This epidemic was characterised by high rates of death, treatment failure and unknown treatment outcomes. These adverse outcomes were attributable to a high rate of TB and/or HIV co-infection and weaknesses in the implementation of Lesotho's National Tuberculosis Programme (NTP). This study was conducted in St Joseph's Hospital, Roma (SJHR) to assess the implementation of the NTP.MethodRecords of 993 patients entered into the SJHR TB register between 2007 and 2008 were reviewed. Patients’ treatment details were extracted from the register, validated and analysed by STATA 10.0.ResultsOf 993 patients registered: 88% were new patients, 37% were diagnosed on sputum smear microscopy alone, 35% were diagnosed on sputum smear microscopy with chest X-ray, whilst 25% were diagnosed on chest X-ray alone. In addition: 33% were sputum smear positive, 45% were sputum smear negative, and 22% had extra-pulmonary TB. As to treatment outcome: 26% were cured, 51% completed treatment, and 51% converted from sputum smear positive to sputum smear negative over six months, whilst 16% died. Regarding HIV, 77% of patients were tested for HIV and 59% had TB and/or HIV co-infection. Of ten NTP targets only the defaulter and treatment failure rate targets were met.ConclusionWhilst only two out of ten NTP targets were met at SJHR in 2007–2008, improvements in TB case management were noted in 2008 which were probably due to the positive effects of audit on staff performance.
Highlights
Worldwide there were an estimated 9.2 million new cases of tuberculosis (TB) in 2006 of which 4.1 million were TB sputum smear-positive
In addition in 2006 the Global Plan to Stop Tuberculosis was launched with the aim of treating 50 million people for TB and enrolling 3 million patients who have both TB and HIV onto antiretroviral therapy (ARV) by 2015
The records of seven patients whose records were incomplete or who were started on treatment and transferred to another facility outside the SJHR catchment area were excluded from the study
Summary
Worldwide there were an estimated 9.2 million new cases of tuberculosis (TB) in 2006 of which 4.1 million were TB sputum smear-positive. The 6th goal, namely to combat HIV and/or AIDS, malaria and other diseases, included the target to reduce the incidence, prevalence and death rates associated with tuberculosis and to increase the proportion of tuberculosis cases detected and cured under Directly Observed Treatment Short Course (DOTS).[4]. This universal drive was augmented in 2000 by the Stop TB Partnership, which called for action from ministerial delegations from 20 countries with the highest burden of TB. This study was conducted in St Joseph’s Hospital, Roma (SJHR) to assess the implementation of the NTP
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