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An assessment of the impact of a DOTS programme in North Western Province, Sri Lanka

Date: Poster sessions
Source: Forum 11
Authors: Sunil Bernard De Alwis, Provincial Director of Health Services, North Western Province, Sri Lanka


The objective of this study was to assess the impact of the directly-observed treatment short course (DOTS) programme of the District Respiratory Disease Control Programme of Kurunegala and Puttlam districts, in North Western Province, Sri Lanka.

The study was based on an analysis of patient and service related factors influencing the outcome of tuberculosis (TB) treatment in pre-DOTS, transition and DOTS periods (1998­2000, 2001, 2002­2003). A survey of health personnel and DOTS providers was conducted in the province to identify their perceptions of the TB control programme.

The treatment outcomes for 1191 pre-DOTS patients, 506 patients in the transition period and 1600 patients in the DOTS period were compared. In addition, a sample survey was conducted among 337 patients from the pre-DOTS period and 342 patients from the DOTS period. In addition, 218 health personnel were also surveyed in the study.

There was a significant improvement in the treatment success rate and a significant reduction in defaulting and treatment failure in the DOTS period. Treatment outcome was found to be significantly related to the age and level of education of the patient.

There was a reduction in distance to the treatment centre and transport cost for a single journey in the DOTS period. In a logistic regression analysis significant predictors for positive treatment outcome were, cost per single journey (P<0.001) and the marital status of the patient (P-0.004). The majority of defaulters and other patients wanted to have health personnel visiting their homes to provide anti-TB drugs.

The majority of health personnel were of the opinion that DOTS is a better strategy in comparison to previous regimens, and that it should be strengthened further by various means. To make this programme more successful, the practical difficulties experienced by patients and service providers need to be addressed by relevant health authorities.

In an overall assessment, DOTS is a better approach than previous strategies. Nevertheless, it was observed that there should be some flexibility over daily travel to the treatment centre by patients. The necessity of community mobilization and identification of the most appropriate DOTS provider was also emphasized. The regular training of health personnel in TB management, and in programme management, is essential for effective programme implementation. The advantages of good supply logistics and improvement in infrastructure/facilities were also highlighted. Better coordination with other similar programmes and integration of the TB control programme with the existing public health care network will improve performance.