Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

John M Tumbo,Gboyega A Ogunbanjo

doi:10.4102/phcfm.v4i1.191

Abstract

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug– and extreme drugresistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with ‘low cure’ and ‘high MDR’ rates. Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens. Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities. Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50(56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%). Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance.

Highlights

Tuberculosis (TB) remains the top infectious cause of mortality in adults, with an estimated 1.7 million deaths globally in 2004 and 1.8 million in 2008
It is estimated that 73% of new active TB cases are associated with HIV infection.3 1n 1991, targets set for national TB control programmes at the World Health Organization (WHO)’s World Health Assembly aimed to detect at least 70% of all new sputum smear-positive cases arising per year and cure at http://www.phcfm.org doi:10.4102/phcfm.v3i1.191
More than half of the respondents (56.8%) reported having a directly observed treatment (DOT) supporter, and 54.5% who reported to be on DOT had been ‘consistently observed’ taking their TB treatment

Summary

Introduction

Tuberculosis (TB) remains the top infectious cause of mortality in adults, with an estimated 1.7 million deaths globally in 2004 and 1.8 million in 2008. Almost a third of the world’s population (more than 2 billion people) are infected with the TB bacilli, which cause TB, and one in every 10 infected people is estimated to become sick with active TB in their lifetime.[1] TB is a major public health problem in South Africa, with the country recently having been ranked fifth on the list of 22 high-burden TB countries in the world. According to the Global TB Report 2009 of the World Health Organization (WHO), South Africa had nearly 460 000 new cases in 2007, with an incidence rate of an estimated 948 cases per 100 000 population – a major increase from 338 cases per 100 000 population in 1998.2. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug– and extreme drugresistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with ‘low cure’ and ‘high MDR’ rates

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Discussion

Conclusion