Evaluation and planning in national tuberculosis control programmes: the usefulness of the standardised patient...

Through systematic evaluation of information contained in tuberculosis patients treatment cards, we present an example of a rapid operations evaluation method for identifying issues important to a national tuberculosis programme (NTP). Analysis of all 279 treatment cards of patients scheduled to attend one specific clinic day was made ((Kinondoni district in Dar es Salaam, Tanzania). Two hundred and twenty five patients (81%) were diagnosed as having pulmonary tuberculosis. Males accounted for 61% of cases. Ninety two per cent were cases without prior history of treatment. Of all patients, those under 15 years and those aged 25 to 54 years were more likely to be sputum smear-negative compared with other age groups. A chest radiograph was obtained as recommended to support the diagnosis in only 61 (38%) of 160 cases diagnosed as sputum smear-negative pulmonary tuberculosis. Initial drug dosing based on weight (mg/kg) revealed frequent dosing errors of isoniazid (97%) and pyrazinamide (65%), almost exclusively overdosing, in sputum smear-positive patients. Systematic examination of patient treatment cards provided usefull information and raises issues important to NTP planning and operations. Weaknesses in the execution of the national programme in Dar es Salaam were identified: the under-utilisation of chest radiography to diagnose sputum smear-negative tuberculosis and overdosing of certain drugs.