A Comparative Study on Community Based DOTS service and Health Institution Based DOTS service among TB Patients

Abstract

Tuberculosis (TB) is the most problematic and highly prevalent communicable disease affecting about one-third of the world’s population and debilitating pulmonary (PTB) infection today. In spite of all these efforts by the government of Nepal, many people still die every year and transferring the disease to the healthy person. The new approach for the effective treatment of tuberculosis has been introduced i.e. Community Based Directly Observed Treatment Short Course (CB-DOTS) which provides training to community health workers to increase awareness, detection, and treatment of TB and bring services directly to the homes of those at risk for infection and those who are infected. The aim of this study was to compare availability, accessibility, compliance and satisfaction between CB-DOTS service and health institution based DOTS (HI-DOTS) service among TB patients. A cross sectional study was carried out in Kaski and Tanahun district in 2014. Census was conducted for the TB patients who are registered during 6 months in the community based DOTS with same number and same time period, that had been enrolled in DOTS from health institution were chosen. The collected data was entered in EPI-DATA and analyzed by using the software SPSS-16. In HI-DOTS the average traveling time to get TB drugs is ≤ 30 minutes for 56.8 percent respondents and in CB-DOTS majority of the respondents; 90.9 percent have to travel ≤ 30 minutes. In HI-DOTS majority; 84.1 percent were dissatisfied and only 15.9 percent were satisfied. Just opposite to this, majority (81.8%) of respondents utilizing CB-DOTS service were satisfied and only 18.2 percent were dissatisfied. There is highly significant association between the patient's satisfaction and two different DOTS services (p<0.001). CB-DOTS service approach shows its better effectiveness in availability, accessibility, compliance and patient's satisfaction aspects. CB-DOTS is a viable option and can complement and strengthen the existing HI-DOTS, especially in developing countries like Nepal where the health system is overwhelmed with increasing number of TB patients and high TB related deaths.

Key words: Community Based Directly Observed Treatment Short Course, Availability, Accessibility, Satisfaction