Ten-year experiences of the tuberculosis control programme in the southern region of Ethiopia

SETTINGS: The tuberculosis control programme, southern region of Ethiopia. OBJECTIVE: To assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. DESIGN: Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. RESULTS: Of 136572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear- positive case notification rate increased from 45 to 143 per 100000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26 % to 6 % and from 7 % to 1%, respectively. DISCUSSION: There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms