KARACHI, June 9: The recent government efforts in intensifying TB control activity have helped expand the DOTS coverage from six per cent to virtually 100 per cent during the five years, in all 131 districts of Pakistan. This follows the exercise the federal, provincial and district governments undertook in collaboration with WHO and local communities, as part of the Basic Development Needs (BDN) Programme in selected areas of all four provinces in 1996.

It would be pertinent to mention that poverty and tuberculosis follow each other like a shadow. Tuberculosis usually strikes persons in their most economically productive years and serves to perpetuate poverty in these individuals.

The BDN programme hence aims at achieving better quality of life with the ultimate goal of arranging good health. It is an integral approach for socio-economic development based on full community involvement, community organization, and self reliance, through self management and self financing by the people.

As the BDN programme also aims at poverty reduction by increasing literacy, improving health services, skills enhancement and provision of interest free loans for income generation, it offers a unique opportunity for improving the overall quality of life of TB patients and their families.

An intervention study was accordingly conducted in the Dadu district of Sindh to evaluate the role of community in enhancing case detection and treatment success rates of DOTS patients.

Community representatives of the BDN programme were required to ensure that there was no interruption in the treatment of TB patients and less default, so that virtually all registered patients were cured.

The study aimed at linking DOTS implementation with the BDN was carried out by Dr Mobina Agboatwala, Dr Syed Karam Shah, Dr Ghulam Nabi Kazi, Dr Noor Ahmed, Dr Ashiq Dombki, Dr Sohail Saeed and Asif Ahmed under the direct supervision of WHO Representative to Pakistan Dr Khalif Bile Mohammad in 2004.

The BDN team, which was already involved in community mobilization, was given training in DOTS implementation. Teachers, local councillors and CBO activists were also involved.

Ultimate findings showed that the case detection rate (CDR) and sputum conversion rates were significantly higher in Taluka Sehwan – a BDN area – as compared to Johi taluka where all other factors were similar, but the community was not organized.

According to the above mentioned study, the CDR target for smear positive or infectious cases for all countries of the region including Pakistan was 70 per cent against the desired treatment success rate of at least 85 per cent.

Figures indicate that while at the start of the study, the CDR was at around 37 per cent in the first quarter of 2004, it shot up to 60, 93 and 97 per cent in the second, third and fourth quarters of 2004 respectively.

The figure for the first quarter of 2005 ending on March 31, 2005 stands at 81 per cent.

It may be mentioned that in Sehwan, which has a population exceeding 214,000, the incidence of smear positive or infectious TB cases is estimated at around 171 per year at the rate of 80/100,000 population.

During 2004, a total of 124 or 72 per cent cases were detected, and although the target was reached, the figure would have been considerably less had it not been for proper mobilization of the local communities through the study and intensive monitoring.

The finding clearly indicates that had the study been initiated in the fourth quarter of 2003, the CDR in the first quarter of 2004 would have been significantly higher.

It may be mentioned that the overall CDR of Dadu and Jamshoro districts during 2004 was 43 per cent, which rose to 45 per cent in the first quarter of 2005.

The position of routine immunization and other critical health indicators was also far superior in Taluka Sehwan as compared to the talukas of Dadu and Jamshoro districts.

Overwhelmed by the health gains, the Sindh Department of Health and WHO have agreed to extend the BDN programme to all talukas of Dadu and Jamshoro districts. Rough cost estimates for the programme have already been prepared. — APP