Comparison of Pulmonary TB DOTS clinic medication before and after the introduction of daily DOTS treatment and attitudes of treatment defaulters in the Western Division of the Gambia.

BACKGROUND Over a third of the world's population is infected with the tuberculin bacteria. In 1993 WHO launched the DOTS-strategy to enhance treatment compliance. Despite Gambia's adaption in 1985 it falls below WHO target of 85% cure rate. The defaulter rate was 14% in 2001, which reached 16% in the urban areas of the Western Division in 2003. OBJECTIVES This study aimed to compare TB treatment and outcomes before and after the introduction of daily directly observed therapy (DOTS) medication and the perceptions/attitudes of defaulters in the Western Division of the Gambia. METHODS The study employed a mixed study design; a quantitative cross sectional study that reviewed the clinic records of pulmonary TB patients before and after the introduction of daily TB-DOTS medication and an in-depth interview of defaulters on the daily medication. The study was conducted at the Brikama TB-clinic in Gambia, located at the main hospital of Brikama serving all satellite villages. It registers on average 110/100 000 new smear-positive pulmonary TB-cases per annum. The quantitative arm compared clinic-based records of TB-DOTS medication before and after the introduction of daily medication. The qualitative arm explored the perceptions of daily medication defaulters. RESULTS There was no statistically significant difference between the treatment outcomes of the two medication policies. However patients were less likely to have had three sputum tests reviewed in the daily medication period (22% v 72% Odds Ratio 6.2 (p <0.001). However, they reported that daily medication with its fixed-dose combination was more convenient. CONCLUSION Patients' full compliance with daily medication was hindered by socio-economic factors. The daily medication with its increased workload undermines the proper implementation of fundamental DOTS-elements, particularly follow up and sputum review.