Evaluation of Direct observed treatment short-course DOTS) strategy in National Tuberculosis ControlProgramme-Sudan

Abstract

This study was conducted during the period February ٢٠٠٥-february ٢٠٠٦ In the National Tuberculosis Control Programme in Sudan. The objectives was study the effectiveness of DOTS strategy (outcome ) in Sudan (١٩٩٦-٢٠٠٣), to evaluate the follow up system in these strategy treatment results, to detect the case finding-detection rate and to identify problems facing the DOTS to achieve their objectives. In addition, the study was designed to compare between the different states in Sudan. The sample was Detected from all tuberculosis patients new smear-positive cases reported to the DOTS units in all states covered by DOTS strategy (٢٢ states out of ٢٦ states) from (١٩٩٦-٢٠٠٣). It was selected by cohort analysis of reports and records from case finding and treatment results. Various data analysis demonstrated those eight years after introduction of DOTS strategy in Sudan. It has been possible to achieve treatment success rate of ٨٠٪ for new smear-positive TB patients, except in year ٢٠٠٢(٨٥٪). These results are below the WHO recommended ٨٥٪, the case detection rate in the range (٥٨٪ in ١٩٩٦ to ٣٥٫٧٥ in ٢٠٠٣). This result is also below the WHO recommended ٧٠٪ also. The study reflected that there are some adverse factors such as social stigma, poverty, co-infection with HIV that may affect TB control. Also, there were few problems that faced the achievement of the DOTS strategy objectives such as low expansion of TB services, insufficient political commitment, turn over of staff, instability of population in some areas, illiteracy, unfavorable socioeconomic factors and wars. The comparison between ٢٢ states out of ٢٦ states reflected that there were factors interfering with TB control such as the centralization of DOTS services in some states, absence of political support, difficulties in transportation in most states of the study. ٩ The recommendations are concentrated on the need for more political commitment, reduction of defaulter rates to raise treatment success rate. In addition, expansion of the DOTS centers to cover all population, promotion of monitoring system and need for regular international evaluation and supervision of the programme.