Decentralisation of directly observed treatment in a large African city: evaluation of the experience of Djibouti.
METHODS
Decentralisation of directly observed treatment (DOT) for tuberculosis patients in three public centres in Djibouti city from April 2000.


OBJECTIVE
To evaluate decentralisation based on the success rate by site of treatment and according to certain critical variables.


METHODS
Comparative evaluation of the success rate of smear-positive patients followed in all treatment centres from 1 May 2000 to 31 March 2001.


RESULTS
The success rate was 58% for the main centre, Centre Paul Faure, and 81% for all the peripheral centres together (P < 10.6). It was 80% for the three new centres and 85% for the established centres (P > 0.05). Age under 20 years, female sex and treatment centre were factors linked to success. After stratification, sex was shown to be the confounding variable. Multivariate analysis shows that non-Djibouti nationality is related to treatment success (P = 0.02). In the groups of established and new centres, there is an inverse linear relationship between success rate and workload, with greater capacity in the established centres.


CONCLUSIONS
Urban decentralisation of DOT increases the chances of treatment success among smear-positive patients. Another centre for supervised treatment needs to be created in one of the public health centres in Djibouti city.
Bernatas
J J
JJ
National Tuberculosis Programme, Ministry of Health, Djibouti, Djibouti. bernatas@mauritel.mr
Ali
I M
IM
Ismaël
H A
HA
Matan
A B
AB
Aboubakar
I H
IH
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy / Q000379:methods*; D015730:Djibouti; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents