Assessment of the implementation of tuberculosis (TB) communty based directly observed treatemtn, (CB-DOTS), in Tororo District, Uganda
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INTRODUCTION AND BACKGROUND: Tuberculosis (TB) affects 20 million people the world over. Uganda is among the 22 high burden countries (HBC) and is ranked 16th in the global TB control. Community based directly observed treatment short course (CB-DOTS) was introduced in uganda in 2000 and in Tororo in 2003 as an effective approach to treating thus controlling TB, The targets for CB-DOTS set to be achieved, globally and nationally by the end of 2005 have not been met in Tororo district. Therefore the constraits and challenges to CB-DOTS program implementation in Tororo District need identification and so as to make recommendations for effective program implementation. OBJECTIVES: This study’s main objective was to assess the implementation of (CB-DOTS) in Tororo district so as to recommend improvements in program implementation through better and informed decision making. METHODS: A descriptive cross-sectional study was conducted in Tororo district during the months of January and febraury 2006. Both qualitative and quantitative data were collected. Trained research assistants used a facility checklist, questionnaires, Focud group discussion (FGD), Key informant (KI) interviews and a community survey to collect data. Quantitative data was analyzed using Epi- Info version 3.2.2 and presented as frequency tables, proportions and where necessary cross tabulations to test for associations. Qualitative data was coded and analyzed using the master sheet method and presented in text form. RESULTS: The majority of the treatment abnd Diagnostic units (TDU) were HC III were found to have inadequate numbers of laboratory trained personnel and were poorly equipped. Sputum smear positive patients that had repeat sputum smears in 2004-5 were 26.4%. Two out of three health sub-districts (HSD) lacked plans and budgets for implementation of CB-DOTS. In 2004-5 only 33.6% (77/216) of the patients on tuberculosis treatment had trained community volunteers. More than 50% of the health units had experienced anti-TB drug stock out. Supervision, monitoring and reporting at all levels was inadequate and irregular. However, the community in Tororo district has fairly satisfactory knowledge about TB. Knowledge about TB was statistically associated with their level of education, (Primary education, OR 2.43, 95% CI 1.06-5.57. Post primary education, OR 6.33, 95% CI 1.33-41.18). CONCLUSIONS: Inadequate numbers of laboratory health workers and equipment in the rural based HC 111 reduced access to laboratory TB diagnosis. This undermines case detection and cure rates. Irregular drug supply, poor community mobilization, inadequate monitoring and supervision, inadequate fund towards the program all compromised implememtation of CB-DOTS in Tororo district. About a third (33%) of the patients on treatment had community volunteers to observe treatment. RECOMMENDATIONS: The Director of District Health Services (DDHS) should organize continous in-service training of all health workers and consider training of those available at HC 111 as microscopists. The DDHS should facilitate and motivate sub county health workers (SCHWs) to identify a community volunteer for every patient to ensure CB-DOTS implementation. The DDHS should establish effective support supervision of CB-DOTS activities in the district so as to improve the quality of records and reporting. The DDHS should ensure regular supply of anti-tuberculosis drugs by imparting skills for better inventory control and management of ordering which takes into account lead time, re-ordering levels and minimum drug levels.