Tuberculosis control

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MEETING OF
NATIONAL MANAGERS OF THE
TUBERCULOSIS CONTROL PROGRAMMES IN THE EASTERN
MEDITERRANEAN REGION Rabat, Morocco, 17th 19th
June 2003
Tuberculosis control DOTS in Iraq
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Back ground Iraq has an intermediate
incidence of TB. The estimated incidence rate of
TB cases 110 per100.000/ Pop. Every year 26400
people are estimated to have TB in the country
75 of the cases occur in the productive age
group. DOTS had been adopted in Iraq
since 1st of April 1998 fully expanded and
integrated TB control to all health services (85
D.T.C.)(947 P.H.C.C.) within two years despite of
socio- economic difficulties facing the country

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Iraq has been Subjected to destruction of
its infrastructure all over the governorates
under the last war in addition to looting , arson
direct dilapidation of ministries, governmental
buildings including hospitals and health care
centers. These facts were obvious to all of you
through Satellite channels. In 2002,
(11898)cases of TB were notified in NTP/ MOH
health facilities working under DOTS of which
3895 smear positive new cases. DOTS
case detection rate in 2002 is 32. Treatment
success rate was 90 in 2001 .
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Fig 1 TB cases in Iraq from 1980-2002
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New smear positive 3559
Success fully treated 3168
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Fig 6 New smear positive PTB cases in Iraq
during the last 3 years according to Age group
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• The post war situation in Iraq can be summarized
  as follow
• The government is not yet fully function .
• Total destruction of communication system.
• Extremely limited transport system.
• Very poor water supply destructed electricity
  grid.
• Disorganized daily life loss of security.

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• DOTS in the current crisis
• No political commitment No financial support
  both nationally internationally .
• Big shortage of essential anti TB drugs.
• 3. Lack of proper diagnostic activities due to
  limited materials, tools stains are necessary
  for direct smear examination. This limitation
  with other factors enforce us to request single
  sputum examination for diagnosing new PTB cases.
• 4. Poor human resources including the executive
  health worker delivering TB control service.

It is near to failure because of the following
obstacles -
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• 5. Lack of direct treatment observation which
  had been substituted by ambulatory domiciliary
  treatment (every 15 days) with patient family
  member observation.
• 6. Improper registration monitoring of TB
  patient.
• Patient lost a considerable number of patients
  registered within DOTS strategy had been lost in
  addition to tremendous number of Tuberculosis
  prisoners were disappeared among the society when
  the government declare the general amnesty.
• Completely Damaged looting of the national TB
  hospital (Ibin Zuhur)and some TB centers in many
  governorate.

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• Planning for TB control
• (Emergency action)
• Effort has been conducted urgently to
  rehabilitate N.T.P activities and to restore the
  main elements to reactivate DOTS programme these
  include-
• Rapid assessment of TB centers in the governorate
  , D.T.C PHCC .
• Redistribution of the available anti-TB drugs
  from national stock to TB centers in the
  governorate.
• Procurement of essential anti- TB drugs through
  WHO, NGOS, Donors for the next six months.

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4. Essential laboratory tools equipments. 5.
Training rehabilitation of human resources in
national TB programme DOTS strategy. 6.
Enhancing collaboration with anti-TB association
other national public organizations . 7.
Proposal emergency plan for budget needed for the
next six months through WHO Donors.
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• Recommendation
• Urgent fund support from Donors with WHO
  collaboration to rehabilitate NTP and to achieve
  the WHO recommended targets.
• Urgent drug supply through WHO.
• Establishment of Technical Agency to support the
  continuation of the NTP activities, Its
  sustainability quality.

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Thanks for your attention