Assessment of Dot Implementation in Tigray, Northern Ethiopia
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Date
2009-07
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Addis Ababa University
Abstract
Mycobacterium tuberculosis infects one third of the world's population. Ethiopia ranks seventh
in the world & third in Africa with TB prevalence. TB is the leading cause of morbidity, the third
cause of hospital admission and the second cause of hospital death in Ethiopia. TB patients take
drugs for very long period of time. Hence, adherence is a major problem. To resolve this issue,
the World Health Organization recommends the strategy of Directly Observed Therapy-Short
Course (DOTS) which includes Directly Observed Treatment (DOT) to ensure a better patient
adherence. The observer may be a health worker or a trained and supervised community member.
Studies elsewhere show varying results on the effectiveness of Community Based DOT
(CBDOT) compared to Health Facility Based DOT (HBDOT) option. In Ethiopia, although
attempts have been made to assess quality of DOT implementation, comparative effectiveness of
CBDOT versus HBDOT programs has not yet been assessed.
This study was conducted to assess effectiveness of DOT implementation in CBDOT and
HBDOT program areas in Tigray region. The study also aimed to compare implementation
practice between the two DOT options and identify the factors affecting DOT implementation.
The study was a comparative cross sectional study conducted between October and December,
2008. Both quantitative and qualitative methods were used for data collection. The quantitative
methods used were retrospective review of Unit TB Registers avai lable in the health faci lities,
prospective observation of DOT observers' practice, exit interview of TB patients and selfadministered
questionnaire for health profess ionals. The qualitative method used was Focus
Group Discussions (FGD) for both groups.
A total of 378 patients, 118 from Hintalo Wajirat (CBDOT) and 266 from Enderta (HBDOT)
Woredas, registered from September 2005 to February 2008 treatment outcomes were reviewed
retrospectively from Unit TB Registers. Effectiveness was measured by success rate. Treatment
was successful for 101 (88.6%) and 181 (87.4%) new TB patients in CBDOT and HBDOT
program areas, respectively. For new sputum smear positive pulmonary TB cases treatment was
successful for 19 (90.5%) patients in CBDOT and 28 (84.8%) patients in HBDOT options.
CBDOT option was as effective as HBDOT in treating TB patients and can achieve good
treatment outcomes. CBDOT option also reduced transfer out of TB patients.This study found out that DOT implementation as indicated by observation of DOT provider
practice was comparable for CBDOT and HBDOT program areas. This indicated that CBDOT
observers can practice DOT like HBDOT providers. Hence, CBDOT can complement HBDOT
and could be a viable alternative in areas where people live faraway from health facilities.
The study also identified access, acceptability of DOT option and DOT providers, awareness of
patients and providers, support to the patient, incentive to CBDOT providers, health
improvement, documentation and supervision as factors that could affect DOT implementation.
Voluntary Community Health Workers are available in each and every village and are willing to
render service to their villagers. National/regional policy should be adopted to equip them with
proper training and provide supportive supervision so that they tremendously increase both
access and quality of DOT. Mechanisms should be devised to ensure that health workers develop
supportive attitude and facilitate wide scale deployment of voluntary Community Health Workers.
Key words: TB, DOT, CBDOT, HBDOT, Effectiveness, Treatment success and Tigray
Description
Keywords
TB, DOT, CBDOT, HBDOT, Effectiveness, Treatment success