Auditing the new decentralised oral treatment regimens in Malawi
OBJECTIVES: A country-wide audit of the oral regimens to determine: 1) TB ward bed occupancy rates, 2) patient DOT options, 3) patients' knowledge of treatment and 4) treatment outcomes compared to those obtained with previous treatment regimens.
DESIGN: Retrospective data collection using registers and treatment cards. Prospective interviews with patients. Inspections of TB wards.
RESULTS: There were 1513 TB beds occupied by 807 (53%) TB patients. Over 50% of 4793 patients registered with different types of TB chose guardian-based DOT. For 266 patients with pulmonary TB the correct knowledge about total duration of treatment (45%), all three DOT options (62%) and the months for giving follow-up sputum (16%), was poor. There were differences in treatment outcomes between TB patients on oral compared with previous regimens. With oral regimens, rates of unknown outcome were high.
CONCLUSION: Oral treatment regimens are associated with reduced bed occupancy rates on TB wards. However, rates of unknown outcome are increased, and TB control is therefore weakened.
Document Type: Regular Paper
Affiliations: 1: World Health Organization Country Office, Lilongwe, Malawi; and Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 2: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 3: Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan 4: Liverpool School of Tropical Medicine, Liverpool, United Kingdom 5: London School of Hygiene and Tropical Medicine, London, United Kingdom
Publication date: 2004-09-01
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