EVALUATION AND PLANNING IN NATIONAL TUBERCULOSIS-CONTROL PROGRAMS - THE USEFULNESS OF THE STANDARDIZED-PATIENT TREATMENT CARD

Through systematic evaluation of information contained in tuberculosis patients treatment cards, we present an example of a rapid operations evaluation method for identifying issues important to a national tube rculosis programme (NTP), Analysis of all 279 treatment cards of patie nts scheduled to attend one specific clinic day was made ((Kinondoni d istrict in Dar es Salaam, Tanzania). Two hundred and twenty five patie nts (81%) were diagnosed as having pulmonary tuberculosis. Males accou nted for 61% of cases. Ninety two per cent were cases without prior hi story of treatment. Of all patients, those under 15 years and those ag ed 25 to 54 years were more likely to be sputum smear-negative compare d with other age groups. A chest radiograph was obtained as recommende d to support the diagnosis in only 61 (38%) of 160 cases diagnosed as sputum smear-negative pulmonary tuberculosis. Initial drug dosing base d on weight (mg/kg) revealed frequent dosing errors of isoniazid (97%) and pyrazinamide (65%), almost exclusively overdosing, in sputum smea r-positive patients. Systematic examination of patient treatment cards provided usefull information and raises issues important to NTP plann ing and operations. Weaknesses in the execution of the national progra mme in Dar es Salaam were identified: the under-utilisation of chest r adiography to diagnose sputum smear-negative tuberculosis and overdosi ng of certain drugs.