Today, the international humanitarian and medical organisation Médecins Sans Frontières (MSF), in close collaboration with the Ministry of Health and Medical Industry of Turkmenistan, is officially launching the implementation of the 'DOTS for ALL' strategy, in Dashoguz City.
Patients from Dashoguz City newly infected with Tuberculosis (TB) will start undergo treatment based on the DOTS strategy (Directly Observed Treatment, Short course) recommended by the World Health Organisation (WHO).
Although most new cases of TB are curable, high numbers of people continue to become ill and die from the disease. Many cases remain undiagnosed due to a lack of awareness on the part of the patient and health staff.
The DOTS medical protocol is already being implemented in 119 countries worldwide and is recognised as being the most efficient and effective treatment currently available for new infectious TB cases.
The DOTS programme in Turkmenistan was initially started in Dashoguz Velayat because this is the region with the highest incidence of TB. In August and November 1999, MSF and the Ministry of Health and Medical Industry of Turkmenistan launched the DOTS strategy on an experimental basis in two etraps Ã? Turkmenbashi and Kunya-Urgench.
Based on the positive results achieved in those two pilot sites, a further expansion of the DOTS strategy to Dashoguz City was decided. Until 1 July 2000, 367 patients had been registered in the DOTS programme in Kunya-Urgench with 93% achieving an early positive response to the treatment, and 336 patients registered in Turkmenbashi with a rate of 86% positive response.
A Memorandum of Understanding (MoU) was signed between the Turkmen government Ministry of Health and MSF on 26 June 2000, officially supporting the full-scale extension of the DOTS strategy to the whole Dashoguz Velayat.
A successful DOTS treatment relies on five main elements:
- Governmental support. In the case of Dashoguz Velayat, the 'DOTS for ALL' strategy benefits from the full support from the Ministry of Health and Medical Industry of Turkmenistan as well as from the regional and local health authorities.
- Diagnosis. Only patients affected by pulmonary TB are potentially infectious. Therefore, a sound laboratory analysis of the patient's sputum proves crucial for a successful DOTS treatment.
- Treatment and observation. An effective DOTS treatment consists in providing patients with the right combination of drugs and ensuring the full compliance of patients to the treatment through direct observation of drugs intake by health care workers.
- Drugs supply. An efficient DOTS strategy relies on regular drugs supplies in order to prevent interruptions in the treatment. For an initial period of five years started in 1999, MSF will supply medical drugs, equipment and material free of charge. In the longer term, the Ministry of Health and Medical Industry of Turkmenistan is to ensure the sustainability of drugs supplies.
- Monitoring. In order to ensure a good follow-up of the DOTS protocol, reliable statistics and data on the treatment progress are of crucial importance.
In order to optimise the outcome of the DOTS strategy, it is crucial that all stakeholders thoroughly play their respective role. In that respect, appropriate training of health care workers is of significance importance.
During the month of July, DOTS training was undertaken in Dashoguz central Tuberculosis hospital for the main categories of health care workers involved in the treatment. 35 doctors, 105 nurses and 7 laboratory technicians were trained, through state-of-the-art teaching methods such as videos and practical exercises.
The importance of educating patients about the need for a rigorous implementation of the DOTS treatment was also highlighted. In fact, many patients after having started treatment do not complete their course of medicines. This behaviour threatens the successful outcome of their treatment and contributes to multidrug-resistant tuberculosis (MDR-TB), which is very difficult to treat.
In order to improve patients' adherence to the DOTS treatment and health care workers' appropriate monitoring, MSF will emphasise the development of health education material in the coming months, in close collaboration with local counterparts.