نقش بیمارستان های آموزشی در بهبود شاخص های بهداشتی برنامه ملی مبارزه با بیماری سل

Background and Aim: Tuberculosis (TB) remains a major public-health problem in Iran, despite employing the DOTS (directly observed treatment short course) strategy in the National Tuberculosis Program (NTP). The aim of this study was to determine the role of teaching hospitals in improving NTP indices.Materials and Methods: In a retrospective cross-sectional study, the medical files of treated TB patients in Tehran Razi Teaching Hospital and the Khuzestan Provincial Health Center were reviewed. Diagnosis, treatment and follow-up were based on the NTP procedures. The patients hospitalized for at least the first 2 weeks of treatment were placed in the hospitalized TB (HTB) group and the outpatients in the outpatient TB (OTB) group. The NTP indices (the sputum smear positive, fully cured, treatment failure, defaulted, and death rates) and pre-treatment counseling were compared between the 2 groups. Data related to demographic characteristics, risk factors, and the treatment outcome were compared by SPSS 11.5 using the chi square and fisher's testsResults: A total of 235 patients (mean age 38 years), 67 of whom were hospitalized TB patients, were studied. 122 men (51.9 %) and 42 women (17.9%) had a history of imprisonment, among whom 20 (47.6%) were positive for human immunodeficiency virus (HIV), 53 (22.5%) injection drug users, and 120 (51.1%) smear-positive for pulmonary TB. The rates of cured cases, treatment failures, defaulted and death were, respectively, 80.6%, 8.9%, 4.5%, and 5.9%, in the HTB group, and 66.6%, 17.3%, 10.1%, and 5.9% in the OTB group. Pre-treatment counseling had been done in 75% of the HTB and 52% of the OTB cases.Conclusion: Teaching hospitals can have an important role in improving pre-treatment counseling and NTP indices, such as increased sputum positivity, cured rate, and, probably, decreased treatment failure and defaulted rate.