Practice of family and non-family based directly obseved treatment for tuberculosis in Pakistan: A retrospective cohort study

Background: Tuberculosis (TB) is ranked the eighth leading cause of death in low and middle income countries. The implementation of Directly Observed Treatment Short-course (DOTS) suggested by World Health Organization (WHO) can result in significant reduction in TB incidence. Our study is an attempt to determine sputum smear conversion rates in 2-month’s follow-up of smear positive TB patients. It also investigates patterns of drug administration for tuberculosis patients and determines whether these patterns affect treatment success rates or not.Methods: Retrospective data of TB patients aged >15 years was collected from all Health Facility Centres (HFC) in Vehari, Pakistan from 2002 to 2006. We adopted two strategies that is, family based DOTS (FBDOTS) and non-family based DOTS (NFBDOTS) for 53-months period. Moreover, NFBDOTS has been redistributed among 3 health care givers (sub DOTS). Outcome assessment was done through laboratory examination of sputum.Results: Successful treatment rates have been observed between FBDOTS and NFBDOTS (p=0.07). Significant difference has also been observed for cured patients between FBDOTS and NFBDOTS (p<0.001) and for gender analysis as well (p=0.000). Among sub DOTS, LHW-DOTS was neither significant with CHW-DOTS (p=0.7) nor with CV-DOTS (p=0.8). Conversion rates which was taken from smear positive to smear negative after 2-months intensive phase in NFBDOTS are little higher (p=0.08).Conclusion: The results suggest that tested strategies are more or less equally effective. Family members can supervise TB treatment in a way as health workers.