World TB Day 2003

Back

DOTS cured me - it will cure you too 
معالجة السل تحت الإشراف المباشر تحقق لكم الشفاء مثلما حققته لي

Regional Director's message

Dear colleagues and friends, 

2003 marks the 10th anniversary of tuberculosis being declared a global emergency by the World Health Organization. During these 10 years, countries in the Eastern Mediterranean Region, led by the ministries of health and supported by national and international partners, have worked hard to introduce the WHO tuberculosis control strategy, widely known as DOTS. The progress has been remarkable. By the end of 2002, 19 countries had achieved DOTS ALL OVER, namely implementing DOTS throughout the services of the ministries of health. Two more countries are on the way to accomplishing this. This means 21 out of 23 countries in the Region are using DOTS widely. Through the DOTS strategy around half a million people with tuberculosis were detected in the Region between 1997 and 2001. DOTS is one of the few health interventions that has been expanded so widely in such a short period of time. 

More importantly, DOTS has ensured the cure of tuberculosis patients. Before the use of DOTS, only 40% to 50% of the cases detected were cured in general. This was indeed very serious as many of those who were not cured would have remained a source of infection in the community. The situation has completely changed since the introduction of DOTS. More than 80% of patients are successfully treated. Many countries in reality have already achieved the global target of 85% treatment success rate. As a result, DOTS saved the lives of at least 250 000 people in the Region between 1997 and 2001. In addition, DOTS has given benefit to more than 1 million people who are family members of tuberculosis patients. DOTS has proved one of the best public health interventions, saving such a large number of lives in such a short time.

For this reason, the theme for World Tuberculosis Day 2003 is People with TB, and the slogan is DOTS cured me – it will cure you too!

Tuberculosis has long been considered incurable and associated with social stigma. Today, the situation is different. We have an effective public health intervention, namely DOTS, that can give cure to tuberculosis patients. We need to deliver this good news to the entire community, so as to put an end to unnecessary suffering and stigmatization. We also need to acknowledge and congratulate those who have been cured by DOTS, as they are the living proof that tuberculosis is curable and that DOTS works.

At the same time, we should ensure that more and more people with tuberculosis can benefit from DOTS and are cured from tuberculosis. This is actually very important because many people with tuberculosis have yet to benefit from DOTS in the Region. The global target is to detect and treat at least 70% of the existing cases of tuberculosis by 2005. However, only one quarter of people with tuberculosis in the Region benefit from DOTS at present. This rate varies among the countries, but many of them still have less than a 50% case detection rate. Countries may not achieve the global target of 70% case detection rate by 2005, unless we drastically improve the activities relating to case detection.

WHO, together with the countries in the Region, has started working to address this problem. Technically, two areas are important. These are: making DOTS of the highest possible level of quality, and making DOTS comprehensively accessible throughout different health sectors. Revision of the estimated incidence of tuberculosis may be relevant to some countries.

In order to make DOTS of the highest level of quality, countries have started activities to ensure the key components of DOTS are implemented very accurately. Laboratory services will be strengthened and expanded, as the diagnosis of tuberculosis is first made by sputum examination with microscope. Treatment services will be made available as close to patients’ homes as possible, and directly observed treatment will always be ensured. Surveillance will be strengthened to ensure activities are appropriately monitored and reported. Supervision is also important. All in all, these activities aim at ensuring people with tuberculosis are satisfied with the quality of DOTS.

In order to make DOTS comprehensively accessible, collaboration with different health sectors has started in many countries. This is particularly important nowadays as many countries have a variety of sectors involved in health care. These sectors include the private sector, social insurance organizations, and ministries of defense, interior and higher education, as well as the ministry of health. Involvement of these sectors is essential to improve the case detection rate.

Expansion of DOTS in Afghanistan and Pakistan is also important. These two countries account for 55% of the regional burden of tuberculosis in total, but their DOTS coverage is not as high as some other countries, primarily because they started DOTS expansion late. In 2002, the two countries made good progress. Rapid DOTS expansion is taking place in Pakistan, while Afghanistan has finalized its preparation for DOTS expansion. 2003 should become a year of rapid DOTS expansion for them also.

To facilitate all these activities, I have established a Strategic and Technical Advisory Group for Tuberculosis Control in the Region in early 2002. The Advisory Group is composed of a group of international experts on tuberculosis control from inside and outside the Region. They extensively reviewed the situation of tuberculosis control in the Region during the regional meeting of national tuberculosis managers in September 2002. The Group then developed a set of comprehensive recommendations that defined the activities that should be carried out and the outcome expected in 2003. We have translated the recommendations into plans of action, and have started implementation with the countries.

Dear Colleagues,

World Tuberculosis Day is an excellent opportunity to address the fact that we have now an effective public health intervention, namely DOTS, which can cure people with tuberculosis. At the same time, this is a day to remind ourselves that many people with tuberculosis have yet to benefit from DOTS. The regional case detection rate is only 25%, while the global target is to raise it to 70% by 2005. We have only 3 years to achieve the target, and naturally we have a lot of work to do. I sincerely hope that World Tuberculosis Day will help the Region to move forward to achieve the global target.

Thank you