tuberculosis control in izmir metropolis: results in 2004 and problems

TUBERCULOSIS CONTROL IN IZMIR METROPOLIS:

RESULTS IN 2004 AND PROBLEMS

Dr. Onur Fevzi ERER, Dr. Önen CEYHAN,

Dr. Ahmet Murat ORAL, Dr. Mehmet ÖZKANAll people giving some help to tuberculosis control

Total number of inhabitants: 3 566 000 13 TB Dispensary (TBD), 240 Primary Health Center (PHC) 1162 TB Patients

Metropolis inhabitants:2 565 000 8 TBD, 137 PHC 950 TB Patients

University Hosp..

6%

State Hosp6%

TBD15%

Chest Hosp.59%

Chest Hosp.

TBD

State Hosp

University Hosp..

Social İns. Hosp

Military Hosp

Childre's Hosp..

Private

Other

Proportions of TB patients where diagnosed

26 27

45

37

27 25 26

343940

3237

45414243

494546

42

0

10

20

30

40

50

60

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

insidans per 100 000

Türkiyeİzmir

TB incidence

New smear + TB

0,000%

0,005%

0,010%

0,015%

0,020%

0,025%

0,030%

0,035%

0,040%

0-4y 5-14y 15-24y 25-34y 35-44y 45-54y 55-64y 65+

age groups

inci

den

ce

male

female

total

233; 25%

717; 75%

Pulmonary

Extra pulmonary

TB patients in Metropolis ( n: 950)

All forms of TB patients treatment results (n: 950)

CURETREATMENT COMPLETED

DEFAULT FAİLURE DİED TRANSFER

Pulm. (n:717)

%46.7 %39.3 %5.2 %0.6 %4 %3.7

Extra-pulm.

(n: 233)- %90.5 %2.5 - %0.8 %6

Pulmonary TB treatment success: %86

147; 23%

20; 3%

466; 74%

Smear + Smear -

Smear ?

633; 88%

65; 9%11; 2%

8; 1%

New pulm.

Relapse

Default

Transfer

Pulmonary TB Patients ( n: 717)

New Pulmonary TB –treatment results

CURETREATMENT COMPLETED

DEFAULT FAİLURE DİED TRANSFER

Smear(+)

(n:466)%66.9 %20.6 %4.2 %0.6 %3.6 %3.8

Smear(-) (n:147)

- %89.1 %3.4 - %5.4 %2

Smear? (n:20)

- %60 %15 - %15 %10

New Pulm. (n:633)

%49.2 %37.7 %4.4 %0.4 %4.4 %3.6

New Pulmonary TB treatment success : %86.9

Old Pulmonary TB :treatment results

CURETREATMENT COMPLETED

DEFAULT FAİLURE DİED TRANSFER

Relapse (n:65)

%32.3 %46.1 %12.3 %3 %3 %3

Default (n:11)

%9 %63.6 %18 - - %9

Old pulm.

(n: 76)%28.9 %48.6 %13.1 %2.6 %2.6 %3.9

Old Pulmonary TB treatment success : %77.5

DOT applications in Izmir Metropolis

First, Eşrefpaşa TBD started DOT applications in 2003 DOT was became prevalent in metropolis by Izmir Provincial Health Department in 2004.DOT was applied some district TBD as Ödemiş District TBD in 2002 and Tire District TBD in 2005 It is aim that DOT will be begun in all district TBD at end of 2006.

First meeting was in İzmir Provincial Health Department at

6.10.2003

Participants:

Dr. Salih Zeki Güçlü Prof Dr. Eyüp Sabri Uçan Dr. Şefika Mutlu Dr. Murat Saltık Dr. Yusuf Aldoğan Dr. Neşe Bardakçı Dr. İpek Çoşkunol Dr. Vildan Gezer

Dr. Şükran Yensel Dr. Nuray Yücetin Dr. Alev Atasever Dr. Enver Yalnız Dr. Aydan Çakan Dr. Emel Tellioğlu Dr. Onur Fevzi Erer

DOT protocol

DOT applications in Izmir Metropolis

12 meetings were done until Jan 2004.

Education program : 3 days for TBD

physicians 2 days for TBD nurse ,

others 2 days for PHC

physicians , nurse. 380 health workers

were educated in 17 days.

8 TBD and 98 PHC put

into practise in March

2004.

195; 20,5%

755; 79,5%

DOT No DOT

151; 20%

310; 41%

294; 39%

TBDPHCOther

DOT applications in Izmir Metropolis

New smear (+) TB (n:466)

RESULTDOT

No DOT (n: 111)TBD (n:97)

PHC (n: 156)

OTHER (n:102)

CURE %72.1 %77.5 %51.9 %60.3

T.COMPLETED %19.5 %12.8 %31.3 %22.5

DEFAULT %1.0 %3.2 %5.8 %7.2

FAİLURE - - %1.9 %0.9

DİED %3.1 %3.2 %3.9 %4.5

TRANSFER %4.1 %3.2 %4.9 %4.5

•DOT – No DOT cure and treatment succes p> 0.05•DOT health workers – DOT other cure p = 0.0001

treatment succes p>0.05

•DOT health workers – No DOT cure p=0.004 treatment succes p=0.05

Conclusion

Cure rates and DOT application rates were not at desired levels (cure; old: %28.9 and new: %66.9)

High rates of defaults especially in the old cases ( %13.1)

DOT rate has to increase It has to re-evaluate that state of DOT applications by a

person other than health workers

Problems

Problems related with patients Problems related with PHC Problems related with TBD Problems related with hospitals Problems related with new health projects

All people giving some help to tuberculosis control

All doctors, All nurse

All health workers

THANK YOU