Evaluation of tuberculosis control programme in Khartoum State for the year 2006

Abstract

Background: Tuberculosis (TB) is among the top ten causes of global mortality. Sudan is among the countries with high TB prevalence; with an estimated incidence of 90/100,000 smear-positive cases. In 1993, the Khartoum State tuberculosis control programme was established. Since its establishment, however, the programme has never been adequately assessed. Aim: To evaluate and describe the tuberculosis control programme in Khartoum State, Sudan in 2006; to find out if the programme achieved its global targeted goals; and to identify the challenges and needs for performing a good standard tuberculosis control programme. Methods: A descriptive cross-sectional and retrospective study design was used. The study population was tuberculosis control departments at the levels of the state (n = 1), localities (n = 7), health areas (n = 19) and health facilities (n = 42). Records review and group interviews were used to collect the required data. Results: The study found that the TB control programme in Khartoum State achieved a 77.2% case detection rate of the smear-postive cases, and 73.5% treatment success rate, and a case fatality rate of 2.2%, treatment failure rate of 2.2%, and default rate of 14.1%. There was no system to detect the prevalence of MDR-TB (multi-drug resistant TB) or HIV (human immunodeficiency virus) among the TB cases. The programme was not well implemented at locality or health area levels. Conversely, drugs and laboratory supply systems were functioning well. Conclusions: The tuberculosis control programme in Khartoum State is centralized, not updated, and does not achieve the targeted goals.

Keywords

Tuberculosis evaluation case detection smear-positive DOTS control

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References

World Health Organization. The world health report about health systems improving performance, Geneva 2000. Available at: http://www.edscuola.it/archivio/handicap/whr_03.pdf (accessed 8 February 2007).

Murray CJ , Lopez AD Mortality by cause for eight regions of the world: global burden of disease study. Lancet 1997; 349:1269-76.

The global fund to fight AIDS, tuberculosis and malaria. HIV/ AIDS, tuberculosis, and malaria: the status and impact of the three diseases 2005. Available at: http://www.theglobalfund.org/en/files/about/replenishment/disease_report_en.pdf (accessed 8 February 2007).

World Health Organization. Global tuberculosis control. Geneva: Unpublished document; 2001. Available at: http://www.migrantclinician.org/_resources/GlobalTBControl.pdf (accessed 8 February 2007).

Crofton J. Reforms to the health sector must retain vertical programmes like those for tuberculosis. BMJ 2000;320:1726.

De Cock KM , Soro B. , Coulibaly IM , Lucas SB Tuberculosis and HIV infection in sub-Saharan Africa. JAMA 1992;268:1581-7.

WHO. Tuberculosis control: progress and long-term planning 2006. Available at: http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_R19-en.pdf (accessed 8 February 2007).

Preventive medicine department ministry of health Khartoum state, Sudan. Yearly integrated analysis report for year 2005. February, 2006.

WHO. A report on country profile for world health day 2001, 2001. Available at: http://www.emro.who.int/MNH/WHD/CountryProfile-SUD.htm (accessed 10 February 2007).

10.

El Sony AI , Baraka O. , Enarson DA , Bjune G. Tuberculosis control in Sudan against seemingly insurmountable odds. Int J Tuberculosis and Lung Dis 2000;4:657-64.

11.

WHO. Compendium of indicators for monitoring and evaluating national tuberculosis programmes 2004. Available at: http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.344_intro.pdf (accessed 10 February 2007).

12.

CDC. Framework for programme evaluation in public health 1999;48(11). Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm (accessed 23 March 2007).

13.

Yassin MA , Datiko DG , Shargie EB Ten-year experiences of the tuberculosis control programme in the Southern region of Ethiopia. Int J Tuberculosis and Lung Dis 2006;10(10):1166-71.

14.

WHO. EMRO Region. Challenges in tuberculosis control programme in Eastern Mediterranean Region. World health day 2007. Available at: http://www.emro.who.int/stb/tbday07-kit-tb-challenges.htm (accessed 10 August 2007).

15.

Osman A. The stigma of pulmonary tuberculosis on patients in Khartoum state 2006. (Ministry of health Khartoum state research documents ).

16.

World Lung Foundation Democratic Republic of the Congo. Courtesy of the stop TB partnership 2004. Available at: http://www.worldlungfoundation.org/map_congo.html (accessed 13 September 2007).

17.

WHO. Tuberculosis impact indicators 2006. Available at: http://www.afro.who.int/tb/impactindicators.html (accessed 8 September 2007).

18.

Lawrence K. , Altman A. Tuberculosis patient in rural Tugela Ferry, South Africa. New York Times, 20 March 2007 .

19.

Shailesh P. , Ankita C. , Asha P. , Chaganbhai P. Clinical aspects of tuberculosis with directly observed treatment in Mehsana district India . Internet J Health 2007;2.

20.

Kamanga J. Factors contributing to reported high defaulter rates among patients on TB treatment. International AIDS Conference 1998;12:41. Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/102227665.html (accessed 5 October 2007).

21.

Taidhi Y. , Kapere S. , Serunkuma R. , Sonko M. , Magezi D. Factors contributing to reported high defaulter rates among patients on TB treatments. International AIDS Conference. 2002 . Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/102259613.html (accessed 5 October 2007).

22.

Silvio W. Behavioral barriers in tuberculosis control: a literature review. Washington DC: The Change Project/ Academy for Educational Development; 2004. Available at: http://www.communicationforsocialchange.org/maziarticles.php?id=296 (accessed December 2007).

23.

CDC. Self-study modules on tuberculosis, module 9: patient adherence to tuberculosis treatment reading material 2007. Available at: http://www.2.cdc.gov/phtn/tbmodules/modules6-9/m9/9-toc.htm (accessed 5 October 2007).