Evaluation of DOTS Strategy in Tuberculosis Treatment in Kirkuk Governorate

More than 2 billion people, equal to one third of the world’s population, are infected with tuberculosis (TB) bacilli, the microbes that cause TB. One in 10 people infected with TB bacilli will become sick with active TB in their lifetime. To assess treatment outcome and to evaluate the compliance of our patients registered for anti-TB treatment at Kirkuk Center of Tuberculosis Treatment. A one year prospective cohort study of tuberculosis patients (n=100) registered for antiTB treatment at Kirkuk center of tuberculosis treatment according to the World Health Organization guidelines. Among study participants, 100 patients (100%) were sputum smear positive, the 100 study participant (100%) were tested for HIV. There was no TB-HIV co-infection .Among the 100 study participants, 90(90%) had successful treatment outcome (90 cured). The overall death, default, were 3(3%), 7 (7%) respectively. There was no treatment failure. Active pulmonary tuberculosis was predominant at age group (21-30) year, 31(31%) patients. Also there was a significant association between the residence and tuberculosis, 77 (77%) patients were living in urban area. Treatment outcome of the patients who registered in Direct Observation Treatment, Short course therapy (DOTS) was successful.


Introduction
More than 2 billion people, equal to one third of the world's population, are infected with tuberculosis (TB) bacilli, the microbes that cause TB. One in 10 people infected with TB bacilli will become sick with active TB in their lifetime [1].Infection begins when aerosolized droplets containing viable organisms are inhaled by a person susceptible of the disease. On 24 March 1882, the German doctor Robert Koch communicated to the Berlin Society of Physiology that he had discovered the microorganism responsible for the deadly pulmonary tuberculosis, named Tuberkelvirus in his seminal publication made 2 weeks later [2]. Iraq is considered to be a middle burden country with TB, and occupies rank 108 globally and 7 in Eastern Mediterranean region among countries with TB burden size. According to WHO report, the estimated incidence of TB in Iraq is 45/100000 population (i.e. estimated total new TB cases is around 15000 per year), while the prevalence is74/100000 and the mortality is 3/100000 [3]. In response to this catastrophe, the World Health Organization (WHO) global tuberculosis program in 1993 declared tuberculosis a global emergency and began promoting a management strategy called directly observed therapy short course (DOTS). By 2005, 187 countries had started implementing DOTS with 4.9 million cases of tuberculosis being treated using DOTS in that year alone [8]. DOTS has 5 key components as identified by WHO: -Government commitment to sustained tuberculosis control activities.
-Case detection by sputum smear microscopy among symptomatic patients.
-Standardized treatment regimen of 6 to 8 months for at least all confirmed sputum smear positive cases, with DOTS for at least the initial 2 months.
-A regular, uninterrupted supply of all essential anti-tuberculosis drugs.
-A standardized recording and reporting system that allows assessment of treatment.

Patients and Method:
The study was carried on patients attending the outpatient clinic in Kirkuk General     treatment. [6]. Conolly -M et all [7] mentioned that tuberculosis is the leading cause of death in women worldwide because of socioeconomic and cultural factors leading to barriers in accessing health care because of the stigma associated tuberculosis. In this study 3 patients died and all of them were female and this agree with the study above. Janssen et al [ 8] study showed tuberculosis incidence is higher in the age group 65y old in developed countries. In this study tuberculosis incidence is higher in patients under 65y old and this may be due to the impact of the stressful life in a wars-torn country on the body immunity. Pio-A et al [9] study showed that the prevalence of HIV/AIDS infection was negligible in Bangladesh, China, Nepal, and Peru .In this study the prevalence of HIV/AIDS is not founded. Bhatti -N et al [10] study showed that the socioeconomic factors are predominantly responsible for the increase of incidence of tuberculosis in England and Wales and the national rise of tuberculosis affects only the poorest areas and there was a strong association with overcrowding that is why Tuberculosis is more common in urban area like we found in our study as (77%) of the patients were from urban area (taking into the consideration that TB is an airborne disease). Also in our study (84%) of patients are from low and medium socioeconomic class and in family size more than 8 members. Espinal -MA et al [11] shows that there is persistently low prevalence of multiple drug resistant tuberculosis in Chile and

Conclusion:
DOTS can produce cure rate up to (90%) even in the poorest countries, it does not require neither hospitalization nor isolation. It can prevent development of drug resistance which is fatal and up to 100 times costs more. Case detection by direct sputum smear microscopic examination is accurate, simple and reliable and DOTS recording and monitoring system follows each patient through the entire course of treatment to ensure cure.