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Tuberculosis in Upper and Lower Egypt before and after directly observed treatment short-course strategy: a multi-governorate study

Abstract

Background

Tuberculosis (TB) is a major problem in developing countries. TB in Egypt is considered an important public health problem. Egypt is ranked among the mid-level incidence countries.

Objective

To evaluate TB status in 19 governorates and to compare the TB situation in Upper and Lower Egypt over 20 years from 1992 to 2012 before and after the application of directly observed treatment short-course strategy (DOTS).

Patients and methods

This is a retrospective study involving record review. The registered data were collected from TB registration units in the 19 governorates.

Results

The highest percentage of TB cases was in the age group 15–30 years. Infection was higher in males than females and in rural areas more than urban areas. Pulmonary TB and smear positivity at diagnosis, second, third, and fifth month were higher in Lower Egypt. Treatment after failure or relapse was significantly higher in Upper Egypt, whereas default rate, failure rate, and death rate were significantly higher in Lower Egypt. Regarding treatment outcome, cure, complete treatment, and transfer out were significantly increased after DOTS than before. Failure, default, and death were significantly reduced after DOTS than before DOTS. Upper Egypt included higher incidence rates of TB, new adult smear-positive cases, new extrapulmonary TB cases, and sputum conversion rate at the end of the initial phase of treatment. Cure rate and treatment success rate were significantly higher among patients of Upper Egypt, whereas transfer out rate and retreatment failure rate were significantly higher among Lower Egypt patients.

Conclusion

TB is still a health problem in Egypt, with pulmonary TB more in Lower Egypt, whereas extrapulmonary more in Upper Egypt, but after the introduction of DOTS, there is a significant increase in cure and success rate, with markers of success being more in Upper Egypt.

References

  1. Sulis G, Roggi A, Matteelli A, Raviglione MC. Tuberculosis: epidemiology and control. Mediterr J Hematol Infect Dis 2014; 6:e2014070.

    Article  Google Scholar 

  2. World Health Organization. Global tuberculosis report. Geneva, Switzerland: World Health Organization. 2013.

    Google Scholar 

  3. NTP, National Tuberculosis Control Program. Manual of tuberculosis control in Egypt. Cairo Egypt: Ministry of Health and Population. 2002.

    Google Scholar 

  4. Hussein AS, Mohammed AM. Trend of application of World Health Organization control strategy of tuberculosis in Egypt. J Epidemiol Glob Health 2014; 4:195–202.

    Article  Google Scholar 

  5. Implementing The Stop TB Strategy. A handbook for national tuberculosis control programs. Geneva, Switzerland: World Health Organization 2008.

    Google Scholar 

  6. NTP National Tuberculosis Program. Drug Management Guidelines, Egypt 2008. Available at: http://ccs.gov.eg/NTPDoc/pdf. [Access on Feb 2018].

  7. NTP, National Tuberculosis Control Program, Egypt, programmatic management of TB, Egypt. 2012. Available at: http://ccs.gov.eg/NTPDoc/pdf.

    Google Scholar 

  8. Gadallah M, Mokhtar A, El-Moghazy E, Fawzy M, Baker A, Rady M. Measuring tuberculosis related stigma and its determinants in Egypt: a community based study. Egypt J Commun Med 2016; 34:83–93.

    Article  Google Scholar 

  9. Hendy MR, Yousef AA., Eissa AS, Salem SA. Assessment of Directly Observed Therapy Short course (DOTS) of Tuberculosis in Benha Chest Hospital, Master Degree, Benha University. Benha Faculty of Medicine Library. 2009. http://db4.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesisPages.aspx?fn=PublicDrawThesis&BibID=10364443

  10. Alwani AK, Al-Aarag AH, Omar MM, Abdelghaffar NA, Hibah MD. Incidence of tuberculosis before and after DOTS (direct observed therapy short course strategy) implementation in El-Behira Governorate, Egypt. Egyptian J Bronchol 2015; 9:101–108. DOI: 10.4103/1687-8426.153665

    Google Scholar 

  11. Khalifa HK, Al-Aarag AH, Omar M. Tuberculosis situation in Gharbia Governorate (1994–2010) before and after direct observed therapy short course strategy (DOTS) (Thesis for Master degree). 2014.

  12. Saad El Din WL, Okab AA, Essawy TS. Assessment of directly observed therapy short course (DOTS) of tuberculosis in Kafr-El Sheikh Governorate from2006 to 2012 [thesis for Master degree in Chest Diseases and Tuberculosis]. Egypt: Benha Faculty of Medicine. 2014.

  13. Alwania AK, Al-Aarag AH, Omar MM, Hibah NA. Incidence of tuberculosis before and after DOTS (direct observed therapy short course strategy) implementation in El-Behira Governorate, Egypt. Egypt J Bronchol 2015; 9:101–108.

    Google Scholar 

  14. Zedan M, Al Wakeel E, Shaarawy AT, Nour M. Pattern of tuberculosis in patients of a university hospital during the period (2004–2011). Egypt J Chest Dis Tuberc 2015; 64:85–89.

    Article  Google Scholar 

  15. Abu Shabana SM, Omar MM, Al Mehy GF, Mohammad OE, Eldesouky RSH. Tuberculosis situation in Port Said governorate (1995–2011) before and after Direct Observed Therapy Short Course Strategy (DOTS). Egypt J Chest Dis Tuberc 2015; 64:441–447.

    Article  Google Scholar 

  16. Sobh E, Kinawy SA, Abdelkarim YMA, Arafa MA. The pattern of tuberculosis in Aswan Chest Hospital, Egypt. Int J Mycobacteriol 2016; 5:333–340.

    Article  Google Scholar 

  17. Negm MF, Al Mehy GF, Ali TM, AbdElfadil SS. Tuberculosis situation in Ismailia governorate (2002–2012) before and after direct observed therapy short course strategy (DOTS). Egypt J Chest Dis Tuberc 2016; 65:211–217.

    Article  Google Scholar 

  18. Eissa SA, Okab AA, Essawy TS, El Ghany EA. Assessment of tuberculosis situation in Cairo governorate from2006 to 2012 after application of directly observed therapy short-course strategy. Egypt J Bronchol 2016; 10:52–57.

    Article  Google Scholar 

  19. Nafae RM, Elshahat HM, Said AM, Ibrahim MA. Reviewing treatment outcomes of tuberculosis patients at Zagazig Chest Hospital (2008–2012). Egypt J Chest Dis Tuberc 2017; 66:623–630.

    Article  Google Scholar 

  20. Negm MF, Allam AH, ElZeheiry AH. Assessment of directly observed therapy short-course (DOTs) of tuberculosis in Dakahlia governorate chest hospitals from2006 to 2011. Egypt J Bronchol 2017; 11: 88–97.

    Google Scholar 

  21. Mohammadien H, Alkhayat K, Hamed A, Shaaban M. Patterns, trends and treatment outcomes of extra-pulmonary tuberculosis in Sohag, Upper Egypt. Egypt J Chest Dis Tuberc 2017; 66:313–316.

    Article  Google Scholar 

  22. Mohammad OE, Okaba AA, Zakib ME. Situation of multidrug-resistant pulmonary tuberculosis in Alexandria governorate fromJuly 2008 to December 2012. Egypt J Bronchol 2016; 10:64–66.

    Article  Google Scholar 

  23. Eldahshan NA, Mohamed RA, Abdellah RF, Hamed ER. Assessment of TB stigma among patients attending chest hospital in Suez Canal University area, Egypt. MEJFM 2015; 13:21–28.

    Article  Google Scholar 

  24. Eastwood SV, Hill PC. A gender-focused qualitative study of barriers to accessing tuberculosis treatment in The Gambia, West Africa. Int J Tuberc Lung Dis 2004; 8:70–75.

    CAS  PubMed  Google Scholar 

  25. Mohamed A, Mohamed G, Ahmed F, et al. A study of Tuberculous cases admitted at Assiute Chest Hospital During Period (2005–2009), South Vally University, 2010, Thesis for MSc. degree in chest Disease. the publication was master degree thesis acessessd through Benha Faculty of Medicine Library. http://db4.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesisPages.aspx?fn=PublicDrawThesis&BibID=10364443. [Access on Feb 2018].

  26. Smyth NK, Whalen C. Active case finding of undetected tuberculosis among chronic coughers in a slum setting in Kampala, Uganda. Int J Tuberc Lung Dis 2009; 13:508–513.

    PubMed  PubMed Central  Google Scholar 

  27. Banu S, Rahman MT, Uddin MKM, Khatun R, Ahmed T, et al. Epidemiology of tuberculosis in an urban slum of Dhaka city, Bangladesh. PLoS One 2013; 8:e77721.

    Article  CAS  Google Scholar 

  28. Ragab AR, Girgis H, Zaki H, Osman M, Al-Khorazaty N, Hamed R, et al. Population situation analysis Egypt 2016. 2016.

  29. Ogbudebe CL, Chukwu JN, Nwafor CC, Meka AO, Ekeke N, Madichie NO, et al. Reaching the underserved: active tuberculosis case finding in urban slums in southeastern Nigeria. Int J Mycobacteriol 2015; 4:18–24.

    Article  Google Scholar 

Download references

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Correspondence to Amira H. Allam.

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Negm, M.F., Allam, A.H., Goda, T.M. et al. Tuberculosis in Upper and Lower Egypt before and after directly observed treatment short-course strategy: a multi-governorate study. Egypt J Bronchol 13, 722–729 (2019). https://doi.org/10.4103/ejb.ejb_47_19

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