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Year : 2002  |  Volume : 56  |  Issue : 1  |  Page : 16-18

Dots strategy for control of tuberculosis epidemic

Department of Community Medicine, Kasturba Medical College, Mangalore,

Correspondence Address:
M S Murali
Department of Community Medicine, Kasturba Medical College, Mangalore

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Source of Support: None, Conflict of Interest: None

PMID: 12508626

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How to cite this article:
Murali M S, Sajjan B S. Dots strategy for control of tuberculosis epidemic. Indian J Med Sci 2002;56:16-8

How to cite this URL:
Murali M S, Sajjan B S. Dots strategy for control of tuberculosis epidemic. Indian J Med Sci [serial online] 2002 [cited 2016 Apr 29];56:16-8. Available from:

Tuberculosis (TB) kills 2 million people every year globally[1] The global epidemic is growing and becoming more dangerous. The emergence of multidrug resistant TB (MDR-TB), and the spread of HIV/AIDS are contributing to the worsening impact of the disease. Ir 1993, the WHO declared tuberculosis "a global emergency".[1]

Tuberculosis is one of India's most serious health problems. Despite a long and distinguished tradition of TO research in India and the existence of a national program since 1962, tuberculosis is a common cause of morbidity and mortality. India accounts for 28% of the global T.B. burden, and everyday, more than 1000 people die of tuberculosis in India, more than 1 person every minute.[2]

The Objective of this study is review the DOTS Strategy (Directly observed Treatment, short-course), the most effective strategy to control the growing T.B. epidemic. DOTS, known as the Revised National Tuberculosis Control Program (RNTCP) in India, is based on scientifically sound technology and direct observation of drug intake of the patient by health staff, thus preventing the drug default problem, which is a major cause of MDR-TB. The Secretary-General of WHO had declared in 1994 that "The DOTS strategy represents the most important public health break­through of the decade in terms of lives which will be saved."[2] Since DOTS was introduced on a global scale, cure rates among new cases in China and Peru were 96 percent and 91 percent respectively.[1] It was introduced in India in 1993, and DOTS sites are being established in a phased manner in the country.

WHO targets regarding DOTS are to detect 70 per cent of new T. B. cases and to cure 85 per cent of those detected.[3]

Components[3]: DOTS is a systematic strategy which has five components. (1) Political and administrative commitment (2) Good quality diagnosis - High quality microscopy, at designated microscopy centres is provided. Three sputum samples are examined from persons with cough of more than 3 weeks duration. A person is labelled "Smear positive' only if at least two sputum samples are positive for AFB or if one smear positive result is supported by radiographic evidence. Other cases (with radiographic abnormalities present and history / clinical evidence consistent with TB) are labelled "smear-negative (3) An uninterrupted supply of short-course chemotherapy drugs. (4) Standardized intermittent drug regimens administered under direct supervision - This is the "heart" of the DOTS strategy. During the intensive phase of treatment, the health worker directly observes and records the drug-intake by the patient. During the continuation phase, the patient is issued medicines for one week in a Combi pack. The drug intake is checked by return o1 the empty Combi pack, when he reports to collect drugs for the subsequent week. Thus the responsibility of the treatment compliance is placed on the health staff not on the patients. (5) Systematic monitoring and evaluation-The T.B. cure rate is the main indicator of program success.

DOTS drug regimens[4] Are presented in [Table - 1] according to categories I, II and III.

Advantages of DOTS : (1) DOTE produces high cure rates upto 95 percent.[1] (2) DOTS prevents the emergence of MDR - TB.[2] (3) The World Bank has rated DOTS as" one of the most cost effective of all health interventions"[1] (UE $ 11 per patient)[1] (translates to approximately Rs. 500 per patient) (4; DOTS, by controlling TB among AIDE patients, improves the longevity of AIDE patients.[5]

The Future of DOTS in India : The Govt. of India has significantly increased the budget for DOTS. The RNTCP will be implemented in a phased manner in a population of nearly 300 million in the next few years.[6] Working together to implement DOTS, we can win the age­ old battle against TB.

 ¤ Summary Top

The article reviews the elements of the DOTS strategy to control the tuberculosis epidemic WHO declared TB" a global emergency" in 1993, the impact of which is worsened by the emergence of multi drug- resistant TB (MDR-TB) and the spread of HIV/AIDS. DOTS (directly-observed treatment, short-course) is an intermittent, supervised system of drug-intake by patient, which eliminates drug-default. It has been described by WHO as "the most important public health break­through of the decade in terms of lives saved"

The 5 major components of DOTS are i) Political will, ii) High-quality microscopy, iii) Uninterrupted supply of short-course chemotherapy drugs, iv) Directly - observed chemotherapy regimen use, v) Systemic monitoring using the TB cure rate. Standardized, intermittent DOTS regimens are classified using three categories of disease. The main advantages of DOTS are (i) Cure rates of upto 95%, (ii) Prevention of MDR - TB emergence, (III) Improvement of longevity of AIDS patients by TB control, (iv) It is "one of the most cost-effective of all health interventions", according to World Bank.

 ¤ References Top

1.WHO: Tuberculosis-Fact Sheet No. 104, pp 1-3. Geneva, WHO 2000.  Back to cited text no. 1    
2.Govt. of India. Ministry of Health. Central TB Division : RNTCP, pp 1-5 New Delhi, Govt. of India, 1997.  Back to cited text no. 2    
3.Govt. of India, Ministry of Health. Central TB Division : RNTCP : A Guide for Medical Officers, pp 2-9, New Delhi, Govt. of India, 1997.  Back to cited text no. 3    
4.Govt. of India Ministry of Health : Proceedings of National Consensus Conference on TB Control (Nov 1997), PP 19-22, New Delhi, Govt. of India, 1997.  Back to cited text no. 4    
5.WHO : Stopping TB, p 22, New Delhi, WHO (SEARO), 1997.  Back to cited text no. 5    
6.WHO : controlling MDR - TB in Third World Countries, pp 6-8, New Delhi, WHO (SEARO), 1997.  Back to cited text no. 6    


[Table - 1]

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