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TUBERCULOSIS CONTROL IN IZMIR METROPOLIS: RESULTS IN 2004 AND PROBLEMS. Dr. Onur Fevzi ERER, Dr. Önen CEYHAN, Dr. Ahmet Murat ORAL, Dr. Mehmet ÖZKAN. All people giving some help to tuberculosis control. - PowerPoint PPT Presentation
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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