DETECTION OF ACTIVE MYCOBACTERIUM TUBERCULOSIS AT 6TH MONTH AMONG DECLARED SUCCESSFULLY TREATED CASES IN PAKISTAN
Arslan Ahmed Salam1, Sabira Tehseen2, Rabail javed1, Rafique ahmed3, Tayyaba Rahat1,Ahsanullah Mirbahar1, M adnan1, Aftab Khan1, Obaidullah1, Shakil Ahmed1, Allah Rakhia1, Safia bibi1, Najeeb Burgri4, atiqa ambreen5, Zaheer Ali6, Aamir Ikram1, Shejee Siddique, Sana Rehman1, Sumera Abid1, Najma Javed Awan1
Pakistan Health Research Council, 2 National Tb control Program, 3 Bolan medical College Quetta, 4 Provincial TB laboratory Kotri, 5 Provincial TB laboratory Lahore, 6 Provincial TB laboratory Karachi.
Background
Tuberculosis is a major public health concern and despite all efforts the disease is now developing a deadly form of resistance. For the efficient results and control of Tuberculosis the TB control programs needs to be evaluated and a some new processes needs to be explored for better results of TB elimination.
Methods
The cross-sectional interventional study was conducted in all 4 provinces of Pakistan and Azad Jammu Kashmir region. For sample size distribution, population based selection of TB DOTS centers was done. A detailed questionnaire was developed to record the information from patients at the time of exit after successful treatment of Tuberculosis. Their sputum was taken from all the cases who gave their consent to participate and sent to the Designated Tuberculosis Laboratories for the detection of live bacilli on L-J culture. ZN smear microscopy was also performed on all the cases. All the cases were of Pulmonary Tuberculosis and they had completed their Anti-Tubercular Treatment and were leaving the premises of TB control program.
Results:
Among 4000 TB confirmed cases,3355 cases were found to be eligible for the study. Male to female ratio is found out to be 1704(50.9%) and 1651(49.2%). Among these cases 1993(59.4%) cases were cured and 1362(40.6%) were declared as treatment completed case.
Sputa of all the 3355 cases were subjected to ZN smear microscopy and L-J culture. For ZN microscopy 324(9.65%) were found out to be ZN smear positive and 328(9.77%) were found to be positive on L-J culture at the time of exit. Culture positivity was not found to be associated with initial bacillary load. Several factors have found to be associated with culture positivity.
Conclusions
For the complete elimination of Tuberculosis form the world, new interventions needs to be used. All the cases that had been completing their treatment must be subjected for L-J culture rather than microscopy alone. This will ensure complete elimination of live bacilli from the patient. Additionally adherence programs needs to be started in the entire country so that the patients must complete the treatment and adhere to the standard guidelines.

Arslan Ahmed Awan MSc

Pakistan Health Research Council

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