Salimuddin Aziz, Syed Ejaz Alam.
Implementation of directly observed treatment short course at a Trust Hospital in Karachi.
Pak J Med Res Jan ;48(3):68-70.

Background: In Pakistan directly observed treatment short course has its own limitation, as we discovered daily attendance was not acceptable to the patients as it entailed loss of working hours and extra expense of daily travel and reluctance of young unmarried girls to attend daily because of social stigma and hence weekly attendance and free drugs were introduced with a responsible member of the family, i.e. mother in case of young unmarried girls and wives to see that the husband take his daily drugs this had better compliance and we have been able to achieve cure rate. In view of the heavy burden of tuberculosis in Pakistan directly observed treatment short course strategy was adopted throughout Pakistan. Objectives: To audit the results of directly observed treatment short course implemented in a clinic where some modification were made because of compelling circumstances. Subjects and Methods: Chiniot General hospital, Karachi is a trust hospital where all types of patients are treated and admitted at a subsidized cost. Tuberculosis clinic in collaboration with directly observed treatment short course was established with an understanding that patients would be seen free. All patients attending the tuberculosis clinic during the last three years ending 31st December 2004 and diagnosed as tuberculosis pulmonary/extra pulmonary were registered and provided free drugs for 8 months. Diagnosis of tuberculosis was made mainly by direct smear microscopy for acid fast bacilli, chest X-ray and mantoux test. Extra pulmonary diagnosis was made by fine needle aspiration, biopsies and cultures were done when required. Results: A total of 692 patients with all form of tuberculosis who attended the free clinic were analyzed. There were 237 males and 455 females (M:F ratio 1:2). Disease was pulmonary in 487(79%) cases and extra pulmonary in 205(29.6%) cases. Majority of extra pulmonary cases had pleural effusion, adenitis, followed by abdominal and bones tuberculosis. Weekly free drugs were provided for the full course of 8 months. Seventy-five percent (519) cases completed the full course of anti-tuberculosis drugs and were discharged as being cured. Joint pains were the chief complaints expressed by the patients during therapy while drug toxicity was uncommon. Thirteen cases developed drug induced hepatitis, 4 had multiple drug resistance and referred to Ojha Institute Karachi for further therapy. Three patients died during treatment. Conclusions: Tuberculosis is a treatable disease and 75% cases achieved cure but there was a high default rate. Reasons for this default need to be explored and addressed.

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