Lung India (Jan 2007)
To study the effectiveness of DOTS at J N Medical College Aligarh
Abstract
Background: Tuberculosis remains the major cause of morbidity and mortality in India and affects largely the most productive members of the society. The major concern is increasing number of MDR TB cases due to inadequate and improper treatment of primary and post primary TB cases. However Directly observed ther-apy, short course (DOTS) is emerging as standard of care for the majority of TB patients and results from various parts of country are encouraging. Objective: To study the effectiveness of directly observed therapy and to compare it with self administered therapy in patients with tuberculosis. Design: Prospective randomized uncontrolled study The study was conducted on the patients attending the OPD or indoor patients at J N Medical College and hospital A M U Aligarh from October2004 to June 2006. Patients included pulmonary and extra-pulmonary TB cases diagnosed on the ba-sis of sputum smear, culture, chest radiograph, cytological and histopathological examination. Patients were assigned into two groups to receive either treatment under DOTS or self administered treatment. We compared the treatment outcomes in these patients between the two groups. Results: Patients treated by directly observed therapy DOT (n=495) had a similar cure rate compared with patients treated by self- administered therapy (n=450) (81% vs 81.6%, p > 0.05). The overall default rate was significantly more in the self administered group when compared to DOT (7.5% vs 5.3%, p < 0.05), but this was mainly due to high default rate among category II patients while the default rate among category I & III patients was comparable in the two groups. In our study mortality rate was found to be significantly high in the DOT group compared to SAT group (4% vs. 1.8%, p< 0.01).This was also attributed largely by the category II patients with mortality rate 13.4% among the DOT compared to 6.2% in The SAT group (p< 0.01). Mortality rates in the category I & III patients were comparable in the two groups. Rates of treatment failure, relapse and acquired drug resistance were similar between the two groups. Conclusion: Patients treated by DOT have excellent cure rates with lesser default rates. Thus we conclude that treatment plans that emphasize directly observed therapy from the start of treatment, have greatest success in improving tubercu-losis treatment outcomes, thereby preventing the transmission of disease in com-munity.
