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Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India

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SETTING: Tiruvallur District in Tamilnadu, South India, where the World Health Organization-recommended DOTS strategy was implemented as a tuberculosis (TB) control measure in 1999.

OBJECTIVE: To assess the epidemiological impact of the DOTS strategy on the prevalence of pulmonary tuberculosis (PTB).

DESIGN: Surveys of PTB were undertaken on representative population samples aged ≥15 years (n = 83 000–90 000), before and at 2.5 and 5 years after the implementation of the DOTS strategy. The prevalence of PTB (smear-positive/culture-positive) was estimated.

RESULTS: TB prevalence declined by about 50% in 5years, from 609 to 311 per 100 000 population for culture-positive TB and from 326 to 169/100 000 for smear-positive TB. The annual rate of decline was 12.6% (95%CI 11.2–14.0) for culture-positive TB and 12.3% (95%CI 8.6–15.8) for smear-positive TB. The decline was similar at all ages and for both sexes.

CONCLUSION: With an efficient case detection programme and the DOTS strategy, it is feasible to bring about a substantial reduction in the burden of TB in the community.

Keywords: DOTS; community survey; epidemiology; prevalence; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Tuberculosis Research Centre, Chennai, India 2: Institute for Research in Medical Statistics, Madras Chapter (ICMR), Chennai, India 3: Department of Health and Mental Hygiene, New York, New York, USA 4: Office of the World Health Organization Representative to India, New Delhi, India

Publication date: August 1, 2008

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