Tuberculosis control in Sudan against seemingly insurmountable odds.
METHODS
Sudan, Africa's largest and one of its poorest countries, in which civil disturbance, resource limitation and communications difficulties are substantial impediments to delivery of health services.


OBJECTIVE
To 1) illustrate the burden of tuberculosis; 2) review measures taken to control the disease; 3) outline the introduction of the DOTS strategy; and 4) demonstrate the trend in the output of the DOTS strategy.


METHODS
Published information on general health, tuberculosis and health structure provide the setting. Routine reports illustrate the trend in case notification in Sudan, and outcome of treatment by period of enrollment on treatment (cohort).


RESULTS
Since 1992, sputum smear microscopy centres have been established in existing health facilities (179 of a total 290 targeted centres). By the end of the second quarter of 1998, 82,860 cases of tuberculosis had been reported, of whom 52% were sputum smear-positive cases. Of these, 89% had no history of previous treatment for as much as one month. The treatment outcomes for 11,000 new smear-positive cases were reported by the end of the second quarter of 1997; the proportion of notified cases for whom treatment results were available increased from 16% in 1994 to 63% in 1996. Of these, 72% were successfully treated, increasing from 62% in 1994 to 73% in 1996.


CONCLUSIONS
Despite seemingly overwhelming odds, the DOTS strategy has been successfully commenced and is in the process of expansion throughout the country, with monitoring of the quality of diagnostic examinations and improvements in treatment outcome. Further improvement is necessary, but appears feasible.
El Sony
A I
AI
Sudan National Tuberculosis Programme, University of Khartoum. aelsony@hotmail.com
Baraka
O
O
Enarson
D A
DA
Bjune
G
G
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000995:Antitubercular Agents / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods*; D003906:Developing Countries; D018563:Disease Notification / Q000379:methods; D006801:Humans; D011314:Preventive Health Services; D013183:Sputum / Q000382:microbiology; D013397:Sudan; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control*
D000995:Antitubercular Agents