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UBC Theses and Dissertations

Evaluation on the effectiveness of directly observed treatment short course among newly diagnosed tuberculosis patients at the chest service, department of health, Hong Kong, 1996 Noertjojo, Kukuh


Setting: The Chest Service, Department of Health, Hong Kong, 1996. Problem: The notification rate of tuberculosis in Hong Kong has failed to decline since 1990 and has remained persistently high since then. The notification rate of 1996 was 103/100,000 population, ten times those of the industrialized countries. Objectives of the study: 1. To study the trend of tuberculosis in the past four decades 2. To determine the outcome of the tuberculosis treatment program in a random sample of patients Study design: Retrospective cohort study among newly diagnosed tuberculosis cases in 1996. Results: 1. Tuberculosis notification rate has been increasing from 103/100,000 population in 1996 to 115/100,000 in 1998 (10 times those in the developed countries) 2. Age and sex differences were prominent in the distribution of tuberculosis patients in 1996 3. There were high-risk groups, namely patients with diabetes mellitus, silicosis, and alcoholism 4. The treatment completion rate at 6 and 12 months among sputum smear positive tuberculosis patients were significantly lower than the rate of 85% (p < 0.05) targeted by the IUATLD and the WHO for developing countries 5. Relatively high treatment default rate (8.4% of all cases) at 12 months 6. The prevalence of resistance to any four first line tuberculosis drugs was higher than other industrialized countries 7. Despite the adoption of the multiple drug treatment for 6 months since 1989, about half of tuberculosis patients received treatment for longer than 6 months 8. Only 34.4% of tuberculosis patients had fully supervised treatment Recommendations: 1. Ensuring that every patient receives treatment through DOT in order to increase treatment completion rate 2. Reducing the number of defaulters by expanding incentives and enablers programs given to the patients 3. Focusing resources to reduce tuberculosis incidence among the elderly by conducting a pilot screening program for tuberculosis among residents in old age homes 4. Improving the adherent to treatment by enforcing the policy of 6 months chemotherapy 5. Increasing the awareness among health care professionals about the high prevalence of tuberculosis especially among the elderly 6. Development of an evaluation database on all patients being treated for tuberculosis

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