Three decades History of Tuberculosis Control in Kerbala/Iraq

Abstract

Objective: To assess tuberculosis control between 1988 and 2017 and evaluate the outcomes of treatment among the October patients put on DOTS in Karbala governorate since the initiation of DOTS strategy in 2000.
 Material and methods: Data on tuberculosis incidence between 1988 and 2017 were assessed. In addition, all quarterly reports were collected in addition to the annual reports to estimate the outcome indices of DOTS in the governorate. Evaluation indices included the incidence and death rates; case detection rate for smear positive and total tuberculosis patients; cure rate; treatment success rate; default rates; treatment failure rates; drug resistance rates; contact tracing during the study period between 2005 and 2014. These indices were compared to the available national indices in the whole country. The indices of treatment success and failure rates were compared to the available previous reported rates in the governorate and in Iraq. Analysis used SPSS-20 and Excel data sheet.
 Discussion with experts working for decades in TB control programs revealed some defect in determining these indices.
 Results: Between 1988 and 2017 there was a total of 8665 TB patients, while between 2005 and 2017 the total was 4055: 2592 pulmonary TB patients (62%) and 1541 extra-pulmonary tuberculosis patients (38%). Gender distribution showed male predilection (60.3%) and a mean age of patients was 41.88±19.74 year and one half of the patients were above 44 year of age, but the most frequent age group was 25-34 year.
 Positive smear Case Detection rates were below the WHO planned goals ranging from 11.5% and 29.1%. The total reported deaths during the study period were 78 deaths. Defaulters were 97 patients at a rate of 2.39, while treatment failure cases amounted to 33 patients (a rate of 0.81%). Drug sensitivity test was introduced to country in 2010 and was done only in Baghdad till the introduction of Genexpert MTB/RIF test in January 2014 and a total of 72 patients were MDR cases. Case detection rate among contacts was 0.31%.
 Conclusions: The success in DOTS in Karbala is similar to the results in the whole country and in most developing countries and approaching the WHO set goals, while the case detection rates were behind. However, some defect areas need further support to prevent failure and aid continuous tuberculosis control and stop TB.