SUCCESSFUL MANAGEMENT OF A NATIONAL TUBERCULOSIS PROGRAM UNDER CONDITIONS OF WAR

OBJECTIVE: To compare treatment results before and after introduction of short course tuberculosis chemotherapy and to identify factors affe cting the results. DESIGN/SETTING: An eight-month chemotherapy regimen for smear-positive pulmonary tuberculosis was introduced in Nicaragua in 1984 with external financial assistance. We performed a retrospect ive record review to compare treatment results before and after introd uction of short-course chemotherapy. Information on support services a nd programme administration, availability of hospital beds for tubercu losis patients, access to health services and the economic and war sit uation in the two periods was assessed. RESULTS: The overall success r atio improved by 39% between the two periods reviewed, in spite of evi dence of a deteriorating economy and escalation in civil war. A succes s ratio of 71% was achieved and we estimate that between 80 and 90% of registered cases stopped transmitting tuberculosis. The best results were obtained in the treatment of previously untreated patients with e ight-month chemotherapy and in retreatment of relapses. The worst resu lts were obtained in retreatment of defaulters. Analysis of the findin gs by region suggests that short-course chemotherapy was important, bu t not enough by itself to guarantee success. Factors likely to have in fluenced treatment results are: commitment by health authorities in gu aranteeing personnel and hospital beds, training of personnel, and sup ervision of service delivery. Possibilities for further improvement ar e discussed. CONCLUSIONS: Good results were achieved in tuberculosis c ontrol with the introduction of short-course chemotherapy in spite of poverty and war. Government commitment and simultaneous improvement in supportive services and programme management is important when introd ucing short-course chemotherapy in low income countries.