A Tuberculosis Program Evaluation at an NGO Hospital in Rural Pakistan

In 2009 there were an estimated 1.7 million deaths from Tuberculosis(TB) worldwide. Pakistan ranks 6th among the countries with the highest global burden of TB, and contributes about 44% of the burden of TB in the Eastern Mediterranean Region. In order to continue addressing the need for effective TB treatment in Pakistan we sought to examine the quality of care being delivered at a small non-profit hospital in the Khyber Pakhtunkhwa province. This program evaluation was especially timely given the proliferation of DOTS (Directly Observed Therapy-Short course) treatment centers in the area which provide free TB diagnosis, medications and follow-up care. Care was examined in three domains: diagnosis, treatment and follow-up, to DOTS standards. The DOTS standard for TB diagnosis is: 65% of newly diagnosed cases should be AFB positive; at the hospital only 22% of patients diagnosed with TB were AFB positive. In the area of treatment; 91% of patients at the hospital were prescribed an appropriate treatment regimen as outlined by DOTS. The DOTS program involves resource heavy methods to ensure that patients are not lost to follow-up; at the hospital a reminder postcard was sent out to patients, but approximately 30% of patients defaulted on their treatment and are therefore at risk for development of resistant strains of TB. Upon reporting these findings to the hospital it was decided to refer future patients, suspected to have TB, to other treatment centers where they might benefit from greater resources.