Compliance with anti-tuberculosis chemotherapy in developing countries.

Abstract

A problem of definit ion Among others, one common characteristic of developing countries is a higher prevalence of tuberculosis than is found in technologically advanced countries, along with limited health service resources. In this context, anti-tuberculosis chemotherapy should be applied to the greatest possible number of patients, in order to cure them and thereby interrupt the chain of transmission of tuberculosis in the population. That is why doctors cannot prescribe just any of the various chemotherapy regimens presently known--they must prescribe only those regimens sanctioned by the national anti-tuberculosis programme, or risk producing anarchy in the health services, confusing health care personnel, and incurring expenses which are unacceptable for the population as a whole. Compliance with anti-tuberculosis chemotherapy in developing nations therefore calls for several 'actors', each with a special role to play: 1.--The patients, who receive and take the drugs. 2.--The doctors, who prescribe the drugs. 3.--The nurses and auxiliary health care personnel, who supervise the administration or supply of drugs and follow up patients who don't show up. 4.--The person in charge of the programme as a whole, who selects the appropriate chemotherapy regimens, organises drug supplies, and oversees the programme. 5.--The staff running the programme at the intermediate level, who organise the supervision and evaluation of the treatment given to the patients [1]. Thus, compliance with anti-tuberculosis chemotherapy in developing countries cannot be defined solely as conformity between treatment prescribed by the doctor and the treatment actually received by the patient [2], but also implies conformity between the treatment prescribed by the doctor and the treatment called for by the national antituberculosis programme.