Expansion of directly observed treatment, short-course in urban and public-private mix areas of Bangladesh

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Abstract: Success with tuberculosis (TB) control was relatively poor in urban centers and some of the difficult to reach areas (eg, workplaces and prisons) in Bangladesh prior to 2004. This may be due to the complexities that exist within urban health care systems and the unique health care-seeking behaviors of urban citizens. A variety of health care institutions and providers are providing health services in urban areas. To increase the case detection of TB suspects, a number of initiatives were undertaken by the National Tuberculosis Control Program. The total geographic area was divided among different nongovernmental organizations to implement TB care services. Medical academic institutions and hospitals, industrial workplaces, and prisons were involved to provide DOTS (directly observed treatment, short-course, as an internationally recommended strategy for TB control) services. As a result, an increased number of TB cases were identified and reported in the urban and public-private mix areas. The TB case detection rate in the six city corporation areas increased from 60% in 2005 to 74% in June 2007, with an 87% sputum conversion rate in 2006 and an 84.5% treatment success rate in 2005. However, decreased treatment success rates were observed in hospital settings and in prisons, which might be due to ineffective referrals provided upon discharge. It is crucial to engage all care providers to increase DOTS coverage and to control TB in urban and special settings. Keywords: public health, tuberculosis, developing country, program, expansion, DOTS, public-private mix

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