Evaluation of Tuberculosis Management and its Failures: A Health System Research in Khuzestan

Successful control of tuberculosis (TB) is achieved by a good management of TB control program based on Directly Observed Treatment Short course (DOTS). The aim of this study was to evaluate anti TB activities at the mid levels of TB management.Subjects and In a descriptive study which was conducted in Khuzestan province from Sept 2000 to Sept 2002 anti TB activities in Khuzestan Health Centre was studied. Managing indexes such as manpower, laboratory equipments, drug provisions, budget and anti TB activity indexes such as case finding rate, cure rate and treatment failure rate were analyzed. DOTS coverage was 61.7%. Duration of time between onset of symptoms and diagnosis of TB was more than 3 months in about 30% of patients. TB incidence rate was 21.3 per 100000 population and case finding rate was 41.6%. Cure rate, treatment failure and death rate due to TB were 94.2%, 3.1% and 2.6% respectively. 37.7% of primary health care worker (called Behvarzes) and 17% of general physicians were unaware of DOTS. Approved budget was 25% of required budget. Job satisfactory rate in Behvarzes and physicians was 80% and 20% respectively. Sixteen percent of the health centers suffered from at least one major anti TB drug. TB management, at the mid levels, suffers from weakness in personal education, drug provisions and financial supporting. More than half of the patients remain undiagnosed. The treatment failure rate and mortality rate was relatively high. Irregular treatment increases the risk of multi drug resistant TB.