Mobilization of Cured Patients to Improve TB Control Programme in Sarlahi District of Nepal

Abstract

Background: Tuberculosis is a growing problem in Nepal and Case Detection Rate is largely limited by pre-existing social and cultural determinants of patient's behavior in tuberculosis. Population predominantly rural, prevailing superstitions, the social stigma attached to the tuberculosis and low community participation limited the betterment of treatment and control of tuberculosis. The present study on revealing the role of cured patients in increasing Case Finding Rate and Cure Rate in local condition will be valuable feedback for finding the effectiveness of Directly Observed Treatment Short Course on tuberculosis control. Methods: Twelve of Directly Observed Treatment Short Course centers/Sub centers were randomly selected for intervention and other twelve of Directly Observed Treatment Short Course centers/Sub centers were selected for control sites. Ten household of the each of Directly Observed Treatment Short Course center were interviewed to know the knowledge on TB and of Directly Observed Treatment Short Course and their perception disease. Data was collected using interviews, focused group discussions, In-depth interviews as well as reviewing the records from the Directly Observed Treatment Short Course Centers. Data Collection took place from in Oct. 2006 and in April 2007. Results: Mobilization of the cured patients was effective in increasing Case finding Rate, Cure Rate and Sputum Conversion Rate and in decreasing Defaulter Rate in comparison with control sites. Most of the respondents were illiterate (40.4 %) and 34.2% were involved in agriculture. Ninety three percent of the respondents had heard Tuberculosis. Nearly 3/4th of them (72.3 %) thought Tuberculosis is curable and 92 % thought appropriate place for treatment was government health institutions. Seventy two percent knew its preventive measures. More than half of the respondents (58 %) had heard of Directly Observed Treatment Short Course and all knew that of Directly Observed Treatment Short Course can completely cure disease. Almost all cases had been diagnosed by Sputum test and X-ray and most of them were diagnosed in private clinics. Nearly 39 percent knew the treatment course schedule and almost all (97.3 %) knew that medicines were available free of cost in government health institutions. Conclusions: Mobilization of cured patients seems to be effective to control Tuberculosis in Sarlahi district. Many people were visiting private clinics as laboratory services seem to be less satisfactory in government health institutions. Keywords: control program; cured patients; directly observed treatment short course; tuberculosis.