An 18-month study of tuberculosis patients treated using the 6-8-month short-course chemotherapy in Luuq district situated in the north-east of Gedo region in the south-west of Somalia is presented. From July 1994 to December 1995, 213 patients were passively identified, started on treatment and followed up. Sputum smear-positive patients were monitored using smear examination. The outcome of treatment for all patients was evaluated at the end of July 1996. An overall cure/treatment completed rate of 70% was achieved. The paper concludes that short-course chemotherapy under directly observed therapy is a useful tuberculosis control strategy, even in areas of conflict.
PIP: War, famine, and poverty, and the resultant restricted access to health services, have exacerbated the incidence of tuberculosis in Somalia. A study conducted as part of an African Medical and Research Foundation community-based health program in the Luuq district, Gedo region, documented the effectiveness of short-course, directly observed chemotherapy, even in war-torn areas. Passive case finding of patients who presented to the Luuq district hospital in an 18-month period in 1994-95 identified 213 with tuberculosis symptoms. 192 suffered from pulmonary tuberculosis and 156 (81%) of these patients were sputum smear-positive. 70% of pulmonary tuberculosis patients were either cured or completed treatment. 14.5% of pulmonary tuberculosis patients, most of whom were from outside the district, defaulted before treatment was completed. The overall case fatality rate was 8%. After 2 months, the smear conversion rate for new smear-positive patients was 93%. Measures such as more evenly distributed tuberculosis control programs, improved coordination between control programs, introduction of cross-border programs, and facilities where nomadic patients remain for the duration of chemotherapy could further enhance treatment uptake and compliance.