DOTS IN CAMBODIA

SETTING: Since the 1970s, Cambodia, a country of 10 million people in South East Asia, has experienced war, genocide and the virtual dismant ling of the health system. It has a severe tuberculosis (TB) problem, with a new tuberculosis case notification rate, all forms, of about 15 0 per 100 000 population and a tuberculosis programme, established in the early 1980s, achieving cure rates of only 40-50% in the last decad e. OBJECTIVE: To describe the implementation of a DOTS programme (dire ctly observed treatment with short course chemotherapy) under difficul t conditions and its rapid success on a nation-wide scale. DESIGN: The World Health Organisation's recommended strategy was implemented in a phased manner throughout the country from 1994. The resources for TB drugs and running costs came from 13 sources. The DOTS strategy was gr adually introduced after training and with regular supervision into 12 0 TB units inside general public hospitals at provincial and district level, after a mapping exercise; 75% of tuberculosis cases, all forms, are hospitalized during the entire initial phase and 85% of the total number of tuberculosis cases received free food from the World Food P rogramme. RESULTS: Two and a half years after the start of the new pro gramme, DOTS was implemented in 85% of all public hospitals. In 1996, case-detection rates had reached 127 smear-positive PTB (pulmonary tub erculosis) and 149 PTB all forms per 100 000 inhabitants; 90% of all t uberculosis patients received DOTS. From January 1994 to June 1995, 4 164 new cases started category 1 treatment (2ERHZ/6EH). Of these, 89% were cured or completed treatment, 5% defaulted, 3% died, 1% were trea tment failures and 2% transferred out. CONCLUSION: The DOTS strategy c an be successfully implemented in even very difficult conditions such as those found in Cambodia.