Three decades History of Tuberculosis Control in Kerbala/Iraq
DOI:
https://doi.org/10.22317/imj.v4i2.817Keywords:
Tuberculosis, Directly Observed Therapy, Health Evaluation, Program EvaluationAbstract
Objective: To assess tuberculosis control between 1988 and 2017 and evaluate the outcomes of treatment among the October patients put on DOTS in Karbala governorate since the initiation of DOTS strategy in 2000. Material and methods: Data on tuberculosis incidence between 1988 and 2017 were assessed. In addition, all quarterly reports were collected in addition to the annual reports to estimate the outcome indices of DOTS in the governorate. Evaluation indices included the incidence and death rates; case detection rate for smear positive and total tuberculosis patients; cure rate; treatment success rate; default rates; treatment failure rates; drug resistance rates; contact tracing during the study period between 2005 and 2014. These indices were compared to the available national indices in the whole country. The indices of treatment success and failure rates were compared to the available previous reported rates in the governorate and in Iraq. Analysis used SPSS-20 and Excel data sheet. Discussion with experts working for decades in TB control programs revealed some defect in determining these indices. Results: Between 1988 and 2017 there was a total of 8665 TB patients, while between 2005 and 2017 the total was 4055: 2592 pulmonary TB patients (62%) and 1541 extra-pulmonary tuberculosis patients (38%). Gender distribution showed male predilection (60.3%) and a mean age of patients was 41.88±19.74 year and one half of the patients were above 44 year of age, but the most frequent age group was 25-34 year. Positive smear Case Detection rates were below the WHO planned goals ranging from 11.5% and 29.1%. The total reported deaths during the study period were 78 deaths. Defaulters were 97 patients at a rate of 2.39, while treatment failure cases amounted to 33 patients (a rate of 0.81%). Drug sensitivity test was introduced to country in 2010 and was done only in Baghdad till the introduction of Genexpert MTB/RIF test in January 2014 and a total of 72 patients were MDR cases. Case detection rate among contacts was 0.31%. Conclusions: The success in DOTS in Karbala is similar to the results in the whole country and in most developing countries and approaching the WHO set goals, while the case detection rates were behind. However, some defect areas need further support to prevent failure and aid continuous tuberculosis control and stop TB.References
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37. Mohammed SH, Ahmed MM, Al-Mousawi AM, Azeez A. Seasonal behavior and forecasting trends of tuberculosis incidence in Holy Kerbala, Iraq. International journal of mycobacteriology. 2018;7(4):361.
38. Al Mousawi A. Evaluation of Directly Observed Short Course Treatment (DOTS) Program in Kerbala province in Iraq between 2005 and 2017. Iraq Medical Journal. 2018;2(4).
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40. Al Mousawi A, Alwash H. Tuberculosis program health care workers knowledge about tuberculosis in Kerbala governorate in 2017. Iraqi Journal of Public Health. 2017;1(3).
41. Mohanad Mohsin A, Hattem A-L, Amer WFA-J. Tuberculosis in Babylon Governorate– Iraq (Three years before & Three years after 2003). Kerbala Jorunal of Medicine مجلة كربلاء الطبية. 2010;3 no.1(6):766-71.
42. Nidhal AH. Epidemiological Study of tuberculosis in Maysan governorate during the period (2001-2008)year. Journal of Misan Researches. 2011;8(15):37-57.
43. Arora V, Gupta R. Directly observed treatment for tuberculosis. The Indian Journal of Pediatrics. 2003;70(11):885-9.
44. Engelbrecht M, Janse van Rensburg A, Kigozi G, van Rensburg HD. Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa. BMC infectious diseases. 2016;16(1):633.
45. Muhsen FA-R, Mohamed KG, Alhatami AO. Assessment treatment outcomes of DOTS programme among tuberculosis patients in Al-Najaf governorate/Iraq. Assessment. 2015;2(2):58-64.
46. Annual Report, Iraqi Ministry of Health. Baghdad: Ministry of Health, Iraq, 2014.
2. Global Tuberculosis Report 2016. Switzerland: World Health Organization, 2016 WHO/HTM/TB/2016.13.
3. Organization WH. Compendium of indicators for monitoring and evaluating national tuberculosis programs. 2004.
4. Global Tuberculosis Report 2017. Switzerland: World Health Organization, 2017 WHO/HTM/TB/2016.13.
5. Elmadhoun WM, Noor SK, Bushara SO, Ahmed EO, Mustafa H, Sulaiman AA, et al. Epidemiology of tuberculosis and evaluation of treatment outcomes in the national tuberculosis control programme, River Nile state, Sudan, 2011–2013. East Mediterr Health J. 2016;22(2):95-102.
6. Almissari AM, Rashid BA, Rhaman OA. Assessment of Directly Observed Therapy Short Course (DOTs) Program Therapy in Treatment of Tuberculosis in Al-Sader City 2003-2005. Nursing National Iraqi Specility Journal. 2013;26(3):1-8.
7. Wartan SW. DOTs implementation in Iraq: 5 year evaluation & expected outcome in 2010. The Medical Journal of Basrah University. 2005;23(2):54-61.
8. Mohammed SH, Ahmed MM, Al Mousawi AM. Evaluation of Case detection rates of Pulmonary Tuberculosis before and after adoption of GeneXpert MTB/RIF. 2018. 2018;59(2):1019-25.
9. Mohammed S, Ahmed M, Karem K. Incidence of Multi-Drug Resistant Escherichia Coli Isolates from Blood and Urine in Kerbala, Iraqا. Journal of Kerbala University. 2014;12(4).
10. Arwa Tahrir R, Ahmed Asmer M. The Pattern of Drug Resistance in Iraqi Pulmonary Tuberculosis Patients Referred to the Specialized Center for Chest and Respiratory Disease. Iraqi postgraduate Medical Journal. 2014;13(2):181-6.
11. Ramadhan AT, Salihi, Layth, Abdulrazaq, Mohammad Yahya, Al-Sikafi, Hayder, H. Ali Characteristics of Multidrug esistance Tuberculosis Cases in Baghdad. Iraqi postgraduate Medical Journal. 2015;14(1):65-70.
12. Global tuberculosis report 2014. World Health Organization, 2014 9241564652.
13. Yakubu Sani I, Giwa A, Momodu H, Muazu J, Mohammed G. Directly Observed Treatment Short-Course for Tuberculosis: A Three-Year Survey of the Treatment Outcome in a Teaching Hospital in Northeastern Nigeria. International Research Journal of Pharmacy. 2012;3(7):243-5.
14. Srikanta K, Zulfia K, Mohammad Athar A, Ali Jafar A. Role of sociodemographic factors in tuberculosis treatment outcome: A prospective study in Aligarh, Uttar Pradesh. Annals of Tropical Medicine and Public Health. 2015;8(3):55-9.
15. Adegoke OA, Orokotan OA. Evaluation of directly observed treatment short courses at a secondary health institution in Ibadan, Oyo State, Southwestern Nigeria. Asian Pacific journal of tropical medicine. 2013;6(12):952-9.
16. Adejumo OA, Daniel OJ, Otesanya AF, Salisu-Olatunj SO, Abdur-Razzaq HA. Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria. Nigerian medical journal : journal of the Nigeria Medical Association. 2017;58(1):44-9.
17. Atekem KA, Tanih NF, Ndip RN, Ndip LM. Evaluation of the tuberculosis control program in South West Cameroon: Factors affecting treatment outcomes. Int J Mycobacteriol. 2018;7(2):137-42.
18. Gebrezgabiher G, Romha G, Ejeta E, Asebe G, Zemene E, Ameni G. Treatment Outcome of Tuberculosis Patients under Directly Observed Treatment Short Course and Factors Affecting Outcome in Southern Ethiopia: A Five-Year Retrospective Study. PloS one. 2016;11(2):e0150560.
19. Irajian GR, Nassaji M, Ranjbar R, Beheshti A, Ghorbani R, Salmanzadeh-Ahrabi S, et al. Implementation of Directly Observed Short Course Therapy for Tuberculosis. Journal of Biological Sciences. 2008;8(1):217-20.
20. Kaur G, Goel N, Kumar D, Janmeja A, Swami H, Kalia M. Treatment outcomes of patients placed on treatment under directly observed therapy short-course (DOTS). Lung India. 2008;25(2):75-7.
21. Parida A, Bairy KL, Chogtu B, Magazine R, Vidyasagar S. Comparison of Directly Observed Treatment Short Course (DOTS) with Self-Administered Therapy in Pulmonary Tuberculosis in Udupi District of Southern India. Journal of Clinical and Diagnostic Research : JCDR. 2014;8(8):HC29-HC31.
22. Phanchai R. TB Treatment with DOT: RCT vs. Effective Program Management. Walailak Journal of Science and Technology. 2015;12(7):581-5.
23. Gabriel AP, Mercado CP. Evaluation of task shifting in community-based DOTS program as an effective control strategy for tuberculosis. The Scientific World Journal. 2011;11:2178-86.
24. Organization WH. Country cooperation strategy for WHO and Iraq: 2012-2017. 2013.
25. Marzook AA. Effect of war on treatment of pulmonary tuberculosis, and evaluation of Directly-observed therapy in Baghdad. Al-Kindy College Medical Journal. 2011;7(1):33-8.
26. Global tuberculosis report. World Health Organization, 1999 9241564652.
27. Ameen SS. Evaluation of treatment outcome of direcly observed short-course chemotherapy in Saddam city pilot project: Baghdad Unviverisity; 2000.
28. Al-Yasirry FAR, Habeeb, Q S. Evaluation of DOTs Programme in Najaf Governorate. 2004.
29. Muhsen FA, Mohamed, K G, Alhatami, A O. Assessment treatment outcomes of DOTS programme among tuberculosis patients in Al-Najaf governorate/Iraq. Muthanna Medical Journal. 2015;2(2):58-64.
30. Ahmed MM, Abdul-Lattif H, Al-Joboury A, W. Falah Tuberculosis in Babylon Governorate– Iraq (Three years before & Three years after 2003). Kerbala Jorunal of Medicine 2010;3 no.1(6):766-71.
31. Jabre SH. Emergence of relapse in supervised chemotherapy pulmonary tuberculosis in Diwanyah. Al-Qadisiah Medical Journal. 2008;4(5):41-50.
32. Yaseen YO. Role of the private health sector in detection of cases of tuberculosis in Missan Governorate. The Medical Journal of Basrah University. 2016;34(1):35-41.
33. Abdul-Al-hassan DA, Abood AK. The geographical pattern of pulmonary tuberculosis in the province of Basra. Journal of Basrah researches(The Humanities). 2006;30(2C):141-65.
34. Salih YI, Ibraheem, M S, Subhi, R. Epidemiological Characters of Tuberculosis in Salahaldeen Governorate during 2008. Medical Journal of Tikrit. 2011;17(1):99-111.
35. Hasan A-RS, Hasan A-RA, Al-Meshhadan iI. Treatment Outcomes of Inmates with Pulmonary Tuberculosis in Baquba Penitentiary: A Follow-Up Study. Iraqi Journal of Community Medicine. 2008;21(4):315-9.
36. Abdul Wahab ARAF. Tuberculosis in Falluja ( 1 year ) Epidemiological study ( 30/6/2007 – 1/7/2008). Al- Anbar Medical Journal. 2009;Vol.7(1):106-14.
37. Mohammed SH, Ahmed MM, Al-Mousawi AM, Azeez A. Seasonal behavior and forecasting trends of tuberculosis incidence in Holy Kerbala, Iraq. International journal of mycobacteriology. 2018;7(4):361.
38. Al Mousawi A. Evaluation of Directly Observed Short Course Treatment (DOTS) Program in Kerbala province in Iraq between 2005 and 2017. Iraq Medical Journal. 2018;2(4).
39. Mohammed SH, Ahmed MM, Al Mousawi AM. Evaluation of Case detection rates of Pulmonary Tuberculosis before and after adoption of GeneXpert MTB/RIF. Iraqi Journal of Science. 2018;59(2C):1019-25.
40. Al Mousawi A, Alwash H. Tuberculosis program health care workers knowledge about tuberculosis in Kerbala governorate in 2017. Iraqi Journal of Public Health. 2017;1(3).
41. Mohanad Mohsin A, Hattem A-L, Amer WFA-J. Tuberculosis in Babylon Governorate– Iraq (Three years before & Three years after 2003). Kerbala Jorunal of Medicine مجلة كربلاء الطبية. 2010;3 no.1(6):766-71.
42. Nidhal AH. Epidemiological Study of tuberculosis in Maysan governorate during the period (2001-2008)year. Journal of Misan Researches. 2011;8(15):37-57.
43. Arora V, Gupta R. Directly observed treatment for tuberculosis. The Indian Journal of Pediatrics. 2003;70(11):885-9.
44. Engelbrecht M, Janse van Rensburg A, Kigozi G, van Rensburg HD. Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa. BMC infectious diseases. 2016;16(1):633.
45. Muhsen FA-R, Mohamed KG, Alhatami AO. Assessment treatment outcomes of DOTS programme among tuberculosis patients in Al-Najaf governorate/Iraq. Assessment. 2015;2(2):58-64.
46. Annual Report, Iraqi Ministry of Health. Baghdad: Ministry of Health, Iraq, 2014.