title: Treatment referral system for tuberculosis patients in Dhaka, Bangladesh.
abstract: OBJECTIVE
  To evaluate the referral system in an urban DOTS-based programme in Dhaka, Bangladesh, including the peri-urban area, and to identify opportunities to strengthen the system.
  
  
  METHODS
  This was a retrospective cohort study in which diagnosed tuberculosis (TB) patients and health providers from DOTS centres were interviewed. Research tools included pre-tested structured questionnaires and the TB patients' referral records.
  
  
  RESULTS
  Of 4974 TB patients who were referred to the different treatment centres, only 1756 (35%) of the counterfoils of the referral slips were returned. Of 250 patients randomly selected for interview, 165 reported to a DOTS centre, 69 did not and 16 could not be traced. Variations in educational qualification, residence and the identification of DOTS centres after counselling were statistically significant (P < 0.05). Lower monthly income (RR = 7.84, RR = 5.03), distance from the centre (RR = 36.21) and those receiving treatment from pharmacies (RR = 3) or non-governmental organisations (RR = 28.48) have more risk of irregular treatment.
  
  
  CONCLUSIONS
  A high proportion of referred patients were registered and initiated treatment, but many did not report to the referral treatment centre. Proper counselling and taking into account the patients' preferences during referral are essential to address access barriers to treatment adherence and improved treatment outcome.
authors.affiliation: Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Islam
authors.affiliation: Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hirayama
authors.affiliation: Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Islam
authors.affiliation: Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Ishikawa
authors.affiliation: Tuberculosis Control Programme, BRAC, BRAC Centre, Dhaka, Bangladesh.
authors.forename: K
authors.initials: K
authors.lastname: Afsana
keywords: DOTS centre; counselling; diagnostic centre; referral linkage