Successful management of a national tuberculosis programme under conditions of war.
OBJECTIVE
To compare treatment results before and after introduction of short course tuberculosis chemotherapy and to identify factors affecting the results.


METHODS
An eight-month chemotherapy regimen for smear-positive pulmonary tuberculosis was introduced in Nicaragua in 1984 with external financial assistance. We performed a retrospective record review to compare treatment results before and after introduction of short-course chemotherapy. Information on support services and programme administration, availability of hospital beds for tuberculosis patients, access to health services and the economic and war situation in the two periods was assessed.


RESULTS
The overall success ratio improved by 39% between the two periods reviewed, in spite of evidence of a deteriorating economy and escalation in civil war. A success 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 eight-month chemotherapy and in retreatment of relapses. The worst results were obtained in retreatment of defaulters. Analysis of the findings by region suggests that short-course chemotherapy was important, but not enough by itself to guarantee success. Factors likely to have influenced treatment results are: commitment by health authorities in guaranteeing personnel and hospital beds, training of personnel, and supervision of service delivery. Possibilities for further improvement are discussed.


CONCLUSIONS
Good results were achieved in tuberculosis control 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 introducing short-course chemotherapy in low income countries.
Heldal
E
E
Norwegian National Health Association/National Health Screening Service, Oslo, Norway. eiheldal@online.no
Cruz
J R
JR
Arnadottir
T
T
Tardencilla
A
A
Enarson
D A
DA
D000995:Antitubercular Agents / Q000627:therapeutic use*; D003906:Developing Countries; D004334:Drug Administration Schedule; D006078:Government Programs / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009527:Nicaragua; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*; D014857:Warfare
D000995:Antitubercular Agents