Pattern of Tuberculosis, Trend and Outcome of Patients Registered at DOTS Centre of a Tertiary Care Hospital

Tuberculosis (TB) is one of the major public health and socio-economic issues in the 21st century globally. Assessment of TB treatment outcomes, and monitoring and evaluation of its risk factors in Directly Observed Treatment Short Course (DOTS) are among the major indicators of the performance of a national TB control program. Hence, this institution-based retrospective study was conducted to determine the treatment outcome of TB patients and investigate factors associated with unsuccessful outcome at Dilla University Referral Hospital, southern Ethiopia. Five years (2008 to 2013) TB record of TB clinic of the hospital was reviewed. A total 1537 registered TB patients with complete information were included. Of these, 942 (61.3%) were male, 1015 (66%) were from rural areas, 544 (35.4%) were smear positive pulmonary TB (PTB+), 816 (53.1%) were smear negative pulmonary TB (PTB-) and 177(11.5%) were extra pulmonary TB (EPTB) patients. Records of the 1537 TB patients showed that 181 (11.8%) were cured, 1129(73.5%) completed treatment, 171 (11.1%) defaulted, 52 (3.4%) died and 4 (0.3%) had treatment failure. The overall mean treatment success rate of the TB patients was 85.2%. The treatment success rate of the TB patients increased from 80.5% in September 2008-August 2009 to 84.8% in September 2012–May 2013. Tuberculosis type, age, residence and year of treatment were significantly associated with unsuccessful treatment outcome. The risk of unsuccessful outcome was significantly higher among TB patients from rural areas (AOR = 1.63, 95% CI: 1.21–2.20) compared to their urban counterparts. Unsuccessful treatment outcome was also observed in PTB- patients (AOR = 1.77, 95% CI: 1.26–2.50) and EPTB (AOR = 2.07, 95% CI: 1.28–3.37) compared to the PTB+ patients. In conclusion, it appears that DOTS have improved treatment success in the hospital during five years. Regular follow-up of patients with poor treatment outcome and provision of health information on TB treatment to patients from rural area is recommended.

This study is a descriptive method of research which is concerned with the relationship of the DOTS client and clinical related factor to the level of effectiveness of the DOTS program. The clinical related factor provides knowledge as to the set-up of the DOTS facility. The researchers used the correlational survey design of research since the purpose of this research study is to correlate the DOTS client and clinical related factor as to the effectiveness of the Directly Observed Treatment Short course (DOTS) for tuberculosis in terms of program administration, information dissemination, diagnostic services and medical supplies, and medical follow up. The researchers used the NTPTB register of each Rural Health Unit for the list of clients who are registered under the Directly Observed Treatment Short course strategy for the fiscal year 2010 as the respondents of this study. There were eighty-two (82) DOTS client identified and diagnosed of having tuberculosis. In the analysis and interpretation of the data, frequency count, mean and percentage are employed particularly in the interpretation of the profile of the respondents and clinical related factor. Coefficient of Correlation and T-test (test of the relationship) is used in determining the influence of the profile of the client and clinical related factor to the effectiveness of the DOTS program. The findings of the study reveal that there is a significant relationship between the profile of the clients, clinical related factors and the level of effectiveness of the Directly Observed Treatment short course program of the RHU. Keywords - Descriptive Correlation, Directly Observed Treatment Short course, Clinical Related Factors, Level of Effectiveness, Zambales, Philippines

After the initial gains in Tuberculosis case detection and cure rates, progress became stunted by persisting constraints and challenges in the implementation of the Directly Observed Treatment Short course strategy. This prompted the Stop Tuberculosis partners in 2006 to adopt innovative approaches including the Public-Private Mix, to improve access to and quality of care. This paper assesses the level of Public-Private Mix in Tuberculosis control in Jos, Plateau State. This was a facility-based, cross sectional study where data from all consenting private health care facilities owned by medically trained personnel and private medical practitioners in Jos North and Jos South Local Government Areas was collected using structured questionnaires. Eight (47.1%) of all 17 facilities assessed gave anti Tuberculosis drugs on clinical suspicion of Tuberculosis, 5(29.4%) required Acid Fast Bacillus result and 3(17.6%) referred elsewhere for the Tuberculosis management. Only 6 facilities (35.3%) were microscopy, treatment centres, or both. Ten (58.8%) of the facilities had the Directly Observed Treatment Short course guidelines, but these could be sighted in only 5 (29.4%), while six (35.3%) had Tuberculosis record and referral forms. In 13 (76.5%) of the facilities, no local government Tuberculosis and Leprosy supervisors had ever visited them. Only 30 (57.7%) medical practitioners had access to the Directly Observed Treatment Short course. Thirty two (61.5%) respondents treated Tuberculosis according to the Directly Observed Treatment Short course strategy, but 19 (36.5%) still used the conventional method. Only 22(42.3%) practitioners had ever received any training on the Directly Observed Treatment Short course strategy. The level of Public-Private Mix in Tuberculosis control in Jos is low.

Directly observed treatment short course (DOTS) and self-administered therapy (SAT) are the treatment options available for tuberculosis (TB). Studies conducted worldwide have shown difference in treatment outcome with these two treatment modalities. The study was undertaken to compare treatment outcome of DOTS and SAT in patients of pulmonary TB taking SAT from a tertiary care hospital and DOTS from the DOTS centre of a government hospital. It was a retrospective comparative study. The case record files of patients with pulmonary TB diagnosed from March 2011 to February 2012 were analysed as per the proforma. The sample size of patients was 150 (75 each from DOTS and SAT). The treatment outcome in DOTS group was cured 70.7%, treatment completed 1.3%, failure 5.3%, deaths 10.7%, defaulters 8% and transferred out 4% whereas in SAT group, cure was seen in 68% and 4% completed the treatment, 1.3% had treatment failure, and 26.7% were lost to follow up which included deaths, defaulters and those patients who switched over to other hospitals. The treatment success rate was similar (72%) in both groups. There was no statistically significant difference observed in the average weight gain at the end of treatment between the two groups. A total of 11 adverse drug reactions (4 DOTS, 7 SAT) were recorded in the study. The study shows no statistically significant difference between success rate in patients taking DOTS and SAT.

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. Conclusions: The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and radiographic abnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth. KEY WORDS: Childhood pulmonary tuberculosis, Doctors, Ranking, Diagnostic features, Directly observed treatment short course (DOTS).

Tuberculosis (TB) is one of the leading causes of morbidity and mortality in Pakistan. Assessment of TB treatment outcomes, monitoring and evaluation of its risk factors in Directly Observed Treatment Short Course (DOTS) are among the major indicators of the performance of a national TB control program. Even though Pakistan ranks 5th among the 22 high-TB burden countries, there are no available data in this regard. Institution-based retrospective study was conducted to determine the treatment outcome of TB patients and investigate associated risk factors at District Head Quarter Hospital Shangla, Khyber-Pakhtunkhwa, Pakistan. Two-year record (January 2011 to December 2012) of TB clinic of the hospital was reviewed. A total of 493 patients' complete information was reviewed in the study period. Of these, 42.19% were smear-positive pulmonary TB (PTB), 35.09% were smear-negative PTB, and 22.72% were extra-PTB (EPTB). The overall prevalence of smear-positive PTB was 42.19% (95% confidence interval [CI]: 37.9-46.2). Records of the treatment outcome showed that 192 (38.94%) were cured, 276 (55.98%) completed treatment, 13 (2.6%) defaulted, 9 (1.8%) died, 1 (0.2%) treatment failure, and 1 (0.2%) had transferred to other facilities. The overall mean treatment success rate of the TB patients was 94.93%. TB age and TB form or baseline smear were significantly associated with unsuccessful treatment outcome. The risk of unsuccessful outcome was significantly lower among TB patients age Conclusion: The treatment success rate was high and match the World Health Organization criteria. To sustain the effective implementation of DOTS in the area, effective management, and diagnosis should be given for EPTB.

Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia

Η φυματίωση τα τελευταία χρόνια αποτελεί ένα επιδεινούμενο πρόβλημα δημόσιας υγείας ανά την υφήλιο, με επίπτωση παγκοσμίως για το 2007 139/100.000 πληθυσμό, ενώ για την Ευρώπη 54/100.000 και για την Ελλάδα 5,9/100.000 πληθυσμό. Στην παρούσα μελέτη έγιναν αρχικά δύο επιδημιολογικές έρευνες που αφορούσαν: α) την επιδημιολογία της φυματίωσης στη Δυτική Ελλάδα και την αξιολόγηση της πληρότητας των υποχρεωτικών δηλώσεων (2000-2003) καθώς και β) την εκτίμηση του δείκτη διαμόλυνσης σε μαθητικό πληθυσμό του Νομού Ηλείας (1994-2000). Σκοπός μας ήταν να περιγραφεί και να αναλυθεί η επιδημιολογία της φυματίωσης στη Δυτική Ελλάδα (Νομοί Ηλείας, Αχαΐας, Αιτωλοακαρνανίας) καθώς και να αξιολογηθεί η εξέλιξη του δείκτη διαμόλυνσης της φυματίωσης στο νομό Ηλείας, στα πλαίσια πρόληψης της νόσου. Εν συνεχεία, μελετήθηκε η εφαρμογή της Άμεσα Επιτηρούμενης Θεραπείας (DOTS) σε 13 νεοδιαγνωσθέντες ασθενείς με φυματίωση (2006-2009), συγκριτικά με την έκβαση 41 πρώην διαγνωσθέντων ασθενών (μάρτυρες) χωρίς ΑΕΘ, όλοι κάτοικοι του Νομού Ηλείας, με απώτερο σκοπό την αξιολόγηση της αποτελεσματικότητας της εφαρμογής του DOTS, συγκριτικά με την έως τώρα συντηρητική αντιμετώπιση των ασθενών με ΤΒ. Για την ολοκλήρωση της μελέτης υπήρξε συνεργασία του Πνευμονολογικού Ιατρείου του Γ.Ν. Πύργου με τον ειδικά εκπαιδευμένο Γενικό/Οικογενειακό Ιατρό, ο οποίος πραγματοποιούσε τις κατ΄ οίκον επισκέψεις στις οικογένειες ασθενών και μαρτύρων. Αναφορικά με την έρευνά μας στη Δυτική Ελλάδα, η μέση ετήσια επίπτωση βρέθηκε να είναι 5,4 ανά 100.000 άτομα ενώ τα επίσημα στοιχεία από το ΚΕΕΛΠΝΟ παρουσιάζουν μόνο 3,8 κρούσματα ανά 100.000 πληθυσμό. Στην μελέτη μυκοβακτηριδιακής διαμόλυνσης για τον μαθητικό πληθυσμό του νομού Ηλείας, συγκρίνοντας τις δύο τριετίες 1994-1996 και 1998-2000, ο Μ.Ο. εξάπλωσης του ΔΜΔ για τους μαθητές του Δημοτικού μειώθηκε από 0,7% σε 0,16%, ενώ στους μαθητές του Γυμνασίου παρατηρήθηκε μια μικρή πτώση, από 2,51% σε 2,41%. Με βάση τις διεθνείς οδηγίες, η θεραπευτική αντιφυματική αγωγή αποτελείται από INH, RIF, PZA και EMB για 2 μήνες και για τους επόμενους 4 μήνες χορηγούνται μόνο INH και RIF. Κατόπιν αξιολόγησης των αποτελεσμάτων της προοπτικής μας μελέτης υπό το πρόγραμμα DOTS, προκύπτει ότι τα ποσοστά επιτυχούς θεραπείας ήταν 84,6% (προσεγγίζοντας το κατώτερο 85% που έχει θέσει ο WHO). Αξίζει να σημειωθεί, ότι ένας ασθενής (7,7%) απεβίωσε και ένας (7,7%) εξαφανίστηκε, λόγω αλλαγής πόλης στην οποία εργαζόταν. Αντίθετα, για τους μάρτυρες μόνο το 75,6% επιβεβαιώνουν αποτελεσματικότητα της θεραπείας. Σχετικά με τη νοσηρότητα των μελών, από τους 30 συγγενείς – μέλη των ασθενών, οι 4 (13,3%) χρειάστηκαν χημειοπροφύλαξη, ενώ από τους 111 συγγενείς – μέλη των μαρτύρων, οι 14 (12,6%) χρειάστηκαν χημειοπροφύλαξη και οι 7 (6,3%) νόσησαν και έλαβαν θεραπεία. Συμπερασματικά, η σωστή αντιμετώπιση του προβλήματος δεν έγκειται μόνο στην έγκαιρη διάγνωση και θεραπεία, αλλά και στην αξιόπιστη καταγραφή των κρουσμάτων που θα μας ευαισθητοποιήσουν στο να αντιληφθούμε την πραγματικά ανησυχητική διάσταση του προβλήματος και να χρησιμοποιήσουμε αποτελεσματικότερους τρόπους πρόληψης και αντιμετώπισης. Η άμεσα επιτηρούμενη θεραπεία, στοχεύει όχι μόνο στη σωστή παρακολούθηση και ίαση των ασθενών με φυματίωση, αλλά και στην εκπαίδευση των μελών των οικογενειών τους σε θέματα πρόληψης και βελτίωσης των επιβαρυντικών παραγόντων διαβίωσης, μειώνοντας σημαντικά τη νοσηρότητα του πληθυσμού.

Background: Directly observed treatment short course (DOTS), a combination therapy, drugs are administered for six to eight months in patients diagnosed with tuberculosis, increases the risk of adverse drug reactions. The objective of this study was to study the adverse drug reaction profile of new sputum smear positive (NSP) patients of pulmonary tuberculosis (PTB) treated under DOTS. A prospective observational study was carried out in Dr. RPGMC Kangra at Tanda, Himachal Pradesh, India over a period of six months. Methods: The study included 130 newly diagnosed TB patients on anti‑TB treatment under DOTS. A symptom based approach was followed for monitoring ADRs. The severity was assessed by Modified Hartwig scale and causality by WHO-UMC probability scale. Data was expressed as percentages for discrete variables using Microsoft excel. Results: Out of the total 130, 84 patients experienced ADRs with an overall incidence of 64.6%. 45 (34.6%) patients showed single ADR whereas 39 (30%) patients had two or more ADRs. Gastritis alone was present in 36 (27.8%) patients followed by itching 2 (1.5%), hypersensitivity 2 (1.5%), arthralgia 2 (1.5%), generalized weakness 2 (1.5%) and jaundice in 1 (0.8%) patients. Vomiting was present in 29 (22.2%) patients, neuropathy in 4 (3.1%) patients, arthralgia in 2(1.5%) patients, hypersensitivity, jaundice, itching and generalized weakness in 1 (0.8%) patient each. 21 (16.2%) patients experienced mild , 56 (43.1%) had moderate and only 7 (5.4%) had severe ADRs. All the ADRs were possible in nature. Conclusions: The incidence of ADRs was 64.6% and GI irritation was found to be most common ADR reported by 57.6% patients.

Objective: To find the impact of Tuberculosis disease upon quality of life of patients who undergo Directly Observed Treatment Short Course (DOTS). Methodology: A descriptive design is carried out at Respiratory and Chest Diseases out Patients' Clinic, of Nov 20th, 2012 to July 11th, 2013, in order to find out the impact of tuberculosis disease upon quality of life of patients who undergo Directly Observed Treatment Short Course (DOTS). A non-probability (Purposive) sample of (60) Tuberculosis patients. The data collection process has been performed in February 13th, 2012 to the April 6th, 2012. The data were described analyzed through the use of descriptive statistics such as (frequencies, percentage, mean of score and comparative significant) and inferential statistics such as (Chi-square, and T-test). Results: The results of the study showed that Tuberculosis negatively influence upon patients quality of life domains. Conclusion: The study concludes that the maximum effect of presented by the social domain, followed by the psychological, level of independency, then the physical domain. While the minimum impact, presented by spiritual domain, followed by the environmental domain. Recommendation: The study recommended that necessary to do a health educational programs to increase health awareness among peoples who attendants the outpatient clinics and special health centers for tuberculosis disease, as well as the use of mass media by the health authorities.

ObjectiveThe objective of this study is to assess effectiveness of directly observed treatment short course (DOTS) in treatment of tuberculosis (TB) patients in all public health facilities of Debre Tabor town, Ethiopia from January 2016 to December 2017.ResultAmong 354 TB patients, 53.1% were males. Furthermore 22.6%, 40.4%, and 37% were smear positive pulmonary, smear negative pulmonary and extra pulmonary TB respectively. Study also revealed that TB–human immunodeficiency virus (HIV) co-infection and overall TB treatment success rate were 18.1% and 90.7% respectively. Regular weigh follow-up, sputum follow-up and HIV status were significantly associated with treatment success with P-value < 0.001, < 0.001 and 0.334 respectively. But TB treatment success weren’t associated with sex (P = 8.62), health facility type (P = 0.749) and TB type (P = 0.778). The study also showed that the overall TB treatment success rate was in line with World Health Organization (WHO) target on treatment success rate. Furthermore the study indicated higher TB–HIV co-infection and variations in conducting regular weight and sputum follow-up among HFs.

Background: Directly observed treatment short course (DOTS) is a cornerstone of Revised National Tuberculosis Control Program of India. Adverse drug reactions (ADRs) induced by this therapy is common and it causes significant morbidity and mortality. Hence, the present study was undertaken to determine the incidence and pattern of ADRs and to assess causality and severity. Methods: We conducted prospective, observational study at DOTS center of tertiary care hospital, Pune. 150 pulmonary tuberculosis patients undergoing DOTS therapy were enrolled. They were monitored weekly in an intensive phase and monthly in the continuation phase. The suspected ADRs were recorded and assessed for causality and severity by standard algorithms. Results: Incidence of ADRs due to DOTS was 19.33% &amp; total 35 ADRs had occurred in our study. Gastrointestinal intolerance, arthralgia &amp; itching with or without rashes were most common ADRs (incidence rates: 12.67%, 2.67% and 2.67%, respectively). On evaluation of causality by Naranjo algorithm, majority of ADRs 91.43% were “possible.” As per WHO- Uppsala Monitoring Center scale, majority of ADRs 91.43% were “possible.” As per Modified Hartwig and Siegel scale, majority of ADRs were “moderate” (48.57%) but 8.57% were “severe.” Female gender was found to be a significant risk factor for developing ADRs (odds ratio: 3.08, 95% confidence interval: 1.33-7.12. 3.33%). ADRs &amp; hepatotoxicity was major reason for defaulting from DOTS (60%). Conclusion: ADRs induced by DOTS are common and there is need of incorporating pharmacovigilance system for this vital public health program. Counseling of patients for timely prevention, detection, and management of ADRs will help in minimizing the further occurrence of ADRs.

Background: Tuberculosis was the first infectious disease declared by the WHO as a global health emergency. Men are more commonly affected than women. The case notifications were higher in males than in females most countries. The objective of the study was to assess socio-demographic determinants of tuberculosis patients attending directly observed treatment short course (DOTS) centre in Urban Ghaziabad.Methods: This was an observational cross-sectional study. The study was carried out in selected DOTS centres of district Ghaziabad. 850 study subjects age group more than 15 years were included. Multistage sampling was done. Numbers and percentage were used. SPSS version 13 was used for statistical analysis.Results: Majority 41.17% of tuberculosis (TB) patients belonged to 15-25 years age group. 30.58% patients were in 26-35 years age group followed by 23.52% in 36-45 years age group and least 4.70% were in &gt;45 years age group. Majority 54.1% of TB patients were females that compared to 45.9% were males. Among tuberculosis patients majority 58.82% were married as compared to 40% were unmarried and least 1.18% were widow. 75.29% tuberculosis patients were Hindus as compared to 22.35 were Muslims and least 2.35% were Sikh/Christian. Among tuberculosis patients majority 44.71% were from nuclear family. 31.76% had joint family and least 23.53% had 3rd generation family.Conclusions: It was concluded that socio-demographic determinants were low. It was recommended to raise socioeconomic standard of population, give health education to improve personal habit and stop TB transmission.

Background: Defaulting from Directly Observed Treatment Short Course (DOTS) is a big challenge to the effective control of TB. There are no published data on defaulting from DOTS in Benin City which necessitated this study to determine the rate of defaulting and identify factors that significantly contribute to defaulting in Benin City, Nigeria. Methods: This was a case control study from August to December 2011 of 1253 TB patients placed on DOTS in Benin City. The two DOTS centres used for the study were situated in University of Benin Teaching Hospital (UBTH) and Egor local government secretariat, both in Egor local government area (LGA) in Benin City. Out of 1253 patients registered on DOTS in the two study centres, 722 patients comprising of 172 defaulters and 550 non- defaulters were selected for the study using the inclusion and exclusion criteria. Logistic regression analysis was performed to determine association between independent variables and defaulting. Results: The default rate was 23.8%. Defaulting was significantly associated with: male sex (OR 3.05; 95%CI 1.60 - 5.80), being married (OR 3.06; 95%CI 1.34 - 6.99), a history of travel (OR 6.87; 95%CI 3.19 - 14.80) and concomitant drug use with TB drugs (OR 1.95; 95%CI 1.02 - 3.73). Conclusion: The default rate from DOTS in Benin City and the factors significantly associated with defaulting have given us some information initially unavailable about defaulting from DOTS in Benin City. TB control programmes taking these factors into consideration need to be done to promote compliance to treatment.

Tuberculosis related stigma attached to the adherence of Directly Observed Treatment Short Course (DOTS) in West Bengal, India