INTER-COUNTRY MEETING OF NATIONAL TUBERCULOSIS PROGRAMME MANAGERS IN THE EASTERN MEDITERRANEAN REGION
INTER-COUNTRY MEETING OF NATIONAL TUBERCULOSIS PROGRAMME MANAGERS IN THE EASTERN MEDITERRANEAN REGION 26-29 APRIL 2004 Lahore-Pakistan Dr.Dhafer S. Hashim NTP Manager MOH-Iraq
Introduction I raq is one of the countries in WHO Eastern Mediterranean Region (WHO-EMRO) with the highest tuberculosis (TB) burden. The estimated incidence of TB is about 130 new cases / 100.000 population / year [WHO / MOH 2003], with about 30.000 new cases per year among which 12600 new smear positive pulmonary Tuberculosis (PTB).
Control of TB is a top priority for Iraqi Ministry of Health (MOH) and a most challenging task. the Directed Observed Therapy – Short Course (DOTS) has been adopted in 1998 (Except the 3 North Governorates – Dahuk, Erbil, Sulaymanyah which had started the implementation since 2001 and only partially).
In the first half of 2003, due to the war and the subsequent widespread looting and intentional damage to governmental facilities, DOTS has been disrupted throughout the country as well as other core public health services.
There is an urgent need to restore and strengthen the NTP at all levels (central, intermediate and peripheral).
National TB programme (NTP) Structure: The main components of NTP are: 1. MOH / Higher National anti- TB committee. 2. Directorate of Public Health & Primary Health Care. 3. Respiratory and chest disease institute. 4. Respiratory and chest disease clinics in the governorates. 5. District TB coordinator (DTC). 6. Primary health care centers (PHCC).
Aim of NTP: 1- Detection 70% of the expected new smear positive PTB cases. 2- Cure more than 85% of new smear positive PTB cases.
Estimated cases: According to WHO statistical data, there is about 60 new smear Positive PTB / 100.000 population each year i.e. 12600 total cases. Case detection rate (CDR): Only 17/100.000 new smear positive PTB cases was recorded in 2003 ( case detection rate was 28% ). This indicates poor CDR (global target 70% ) with about 9000 hidden cases and about 5000 cases of smear positive PTB should be detected to achieve the global target. This poor CDR could be due to the following reasons: a-poor social awareness. b-shortage of lab facilities including the culture. c-poor communications and transport difficulties. d-poor doctor awareness. e-passive case detection. f-absence of the decentralization in diagnostic activity within DOTS programme.
DOTS Target area Case Detection and Cure Rate in 2003 IRAQ
Types of tuberculosis: A total of 11656 new Tuberculosis cases recorded all over to the country (with the exclusion of north governorates). Among the above number there is 7304 (62%) PTB ( 3577 smear Positive and 3727 smear Negative PTB), 3454 (30%) extra pulmonary Tuberculosis.Among smear positive cases there are 898(20%) Relapse.
Around (70%) of TB cases are among. reproductive age group (15-54) years. TB Cases according age group in2003
Male to Female ratio was around 2:1. TB Cases and Sex
Most of extra pulmonary cases (49%) are of pleural and that of lymph nodes (17%). Extra pulmonary TB IN 2003
Treatment outcome: The evaluation was done for new smear positive pulmonary tuberculosis Cases recorded in 2002 with a total of 3895 . Cure rate :Was 86% among total 3895 cases. Treatment Completed : 5%. . Treatment failure : Was only 1.7% among the above total cases. Death: 3%. Interrupted Treatment : 2.7%.. Transfer Out: 1.6%. Treatment Success : 91%.
<ul><li>Obstacles : </li></ul><ul><li>Poor communication. </li></ul><ul><li>Shortage of Laboratory materials. </li></ul><ul><li>Lack of supervision in field work. </li></ul><ul><li>Absence of training for NTP staff. </li></ul><ul><li>Absence quality assurance system regarding both work performance and Laboratory activities. </li></ul>
<ul><li>PLANS: </li></ul><ul><li> </li></ul><ul><li>Strengthen the TB laboratory services. </li></ul><ul><li>Strengthen the DOTS network and activities and implement decentralization of diagnostic activities. </li></ul><ul><li>Strengthen the surveillance system. </li></ul><ul><li>Train and re-motivate medical and paramedical staff. </li></ul><ul><li>Strengthen collaboration with health care providers other </li></ul><ul><li>than the MOH. </li></ul><ul><li>Develop operational research. </li></ul><ul><li>Rehabilitate National TB Hospital. </li></ul><ul><li>Integrate DOTS in Medical School. </li></ul><ul><li>Establish Drug Resistant Surveillance & DOTS plus programme. </li></ul>
Where Is Iraqi NTP Now? 1- Drugs:supported by WHO. 2- Supply and re - equip all TB Laboratories (central, intermediate and peripheral levels) all around the country with essential materials in terms of reagents, kits and consumables enough for six months by Aide Medicale Internationale (AMI) - French NGO. Waiting for …… 3-Reestablishment of supervised SCC on 1 st Oct 2003 instead of ambulatory Domiciliary Treatment. 4-CPA had prepared a big budgetary proposal plan to support NTP. Waiting for ……
Urgent Recommendations: Asking For WHO to support through Jumpstart programme 1- Implement an efficient communication network. 2- Strengthen Supervision Activity & Ensure quality assurance system. 3-Ensure adequate training Of NTP Staff. 4-Strengthen the TB laboratory services .