title: Ten years' experience of Directly Observed Treatment Short-course (DOTS) in Gambella Regional State, Ethiopia: An evaluation of tuberculosis control program.
abstract: BACKGROUND
  World Health Organization (WHO) declared tuberculosis (TB) as a global public health emergency and recommended DOTS as a standard strategy for controlling the disease. TB is one of the major causes of infectious diseases in the world, and 25% of all avoidable deaths in developing countries. About a third of the world's population is estimated to be infected with tubercle bacilli, and hence at risk of developing active disease. The objective of the study was, therefore, to evaluate the impact of DOTS strategy on smear-positive pulmonary tuberculosis case finding and their treatment outcomes in Gambella Regional State, Ethiopia.
  
  
  METHODS
  A retrospective health facility-based descriptive study was employed. Quarterly data were collected by using WHO structured reporting format for TB case finding and treatment outcome from all DOTS implementing health facilities in the region.
  
  
  RESULTS
  A total of 10,024 TB cases (all forms) were registered and reported between the periods from 2003 up to 2012. Out of these, 4100 (40.9%) were smear-positive pulmonary TB, 3164 (31.6%) were smear-negative pulmonary TB and 2760 (27.5%) had extra-pulmonary TB. An average case detection rate (CDR)1of 40.9% (SD=0.1) and treatment success rate (TSR)2of 55.7% (SD=0.28) for smear-positive pulmonary TB including other forms of TB were reported for the specified years period. Additionally, the average mean values of treatment defaulter and treatment failure rates were 4.2% and 0.3%, respectively.
  
  
  CONCLUSIONS
  The recommended TSR set by WHO was achieved as it was already been fulfilled more than 85% from 2009 up to 2011 in the region and the reported CDR was far below (40.9%) for smear-positive pulmonary TB including other forms of TB from the target. Therefore, extensive efforts should be established to maintain the achieved TSR and to increase the low level of CDR for all forms of TB cases through implementing alternative case finding strategies.
authors.affiliation: Department of Clinical, John Hopkins University-TSEHAI Project, P.O. Box 5606, Addis Ababa, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Sisay
authors.affiliation: Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, P.O. Box 1234, Addis Ababa, Ethiopia.
authors.forename: Belete
authors.initials: B
authors.lastname: Mengistu
authors.affiliation: Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia.
authors.forename: Woldargay
authors.initials: W
authors.lastname: Erku
authors.affiliation: Department of Public Health, School of Medicine and Health Sciences, Addis Ababa Science and Technology University, P.O. Box 16417, Addis Ababa, Ethiopia.
authors.forename: Desalegne
authors.initials: D
authors.lastname: Woldeyohannes
keywords: Case detection rate; Directly Observed Treatment Short-course; Gambella region; Treatment success rate; Tuberculosis