After a long period of decline, tuberculosis (TB) incidence and mortality in the Tamale Metropolitan Area rose dramatically during the 1990s and peaked in the (2000s). During the same period, the proportion of patients with notified TB that were cured fell from 90% in 1990 to an estimated 72% in 2011. Despite the introduction and gradual uptake of the Direct Observatory Treatment Strategy (DOTS) over the past decade, and a decline in case notifications, treatment success rates have remained consistently low. The World Health Organization (WHO) attributes these high failure rates to drug resistance, high default and mortality rates among patients undergoing DOTS.
We conducted a retrospective cohort study of patients with newly detected smear- [and/or] culture-positive TB who were older than 17 years, notified under DOTS, and began TB treatment during the period 1 January 2009 to 31 December 2010. We excluded patients who were admitted to psychiatric hospitals, in prison, died within one month of treatment initiation or did not live within Tamale city limits. Individual programmatic risk factors and outcomes were assessed by reviewing patients’ charts and TB treatment records, through a TB database set up by the National TB Program.
We assessed risk factors for non-adherence, default and the development of multiple drug resistance during therapy.
In an earlier study, (Yahaya et al, 2009), we reported the cause of death among patients undergoing DOTS in the Tamale Teaching Hospital. During January2001 to December .In that study, we observed a 9.6% mortality rate. Mortality was caused, not only by TB but also by co-morbidity conditions; such as alcoholism and cardiovascular diseases. We found that both alcoholism and late presentation substantially contributed to mortality. Based on our findings, we proposed several specific interventions that may improve treatment outcomes and reduce the acquisition of drug resistance in patients undergoing TB therapy in this setting:
1. Intensive education and training of staffs is necessary, to improve compliance and adherence to direct observatory treatments (DOTS).
2. Mass education is obligatory, to attract TB patients to come to the hospital for screening and early intervention.
3. TB management in the hospital will have to be patients centered treatment.
4. Enabler’s package will have to be improved, to reduce defaulting and absconding.
5. All this will lead to reduction of multiple drug resistance, morbidity and mortality.
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