Performance of regional tuberculosis dispensaries in a province of Turkey in pre-DOTS era (1989-2002)

Abstract

Background: In recent years, very few dispensary staff has been striving to apply directly observed therapy (DOT) elsewhere in Turkey, but the overwhelming majority of TB dispensaries still continue their usual practice today. Therefore, practice of any regional TB dispensary may mirror Turkey's Tuberculosis Programme practice profile. Method: Statistical Year Books of Sivas Province Health Department (from 1989 to 2002) are the main sources of data. The mid-year population numbers obtained from Statistical Year Books of Sivas Province Health Department were preferred for calculating annual incidences. Pearson's correlation coefficients and, if data ordinal, Spearman's correlation coefficients were used to determine correlations. Results: There are three TB dispensaries in the Sivas Province. Total staff number at Sivas TB dispensaries decreased within years (r = -0.92, p < 0.001). TB incidence declined within years, also(r = -0.87, p < 0.0001). Chest X-ray examinations gradually decreased within years from 20,416 examinations in 1989 to 5856 examinations in 2002 (r = -0.75, p = 0.002). Annual microscopic examinations for acid-fast bacilli (AFB) declined within years with 1400 microscopy done in 1989 decreased to 445 examinations in 2002 (r=-0.62, p=0.018). Per each TB patient, the annual mean microscopy for AFB examination was 4.49 +/- 1.47 and the mean chest radiography was 8.25 +/- 3.27 at local dispensaries in this fourteen-year period. The annual tuberculin skin test (TST) and Bacillus Calmette-Guerin (BCG) vaccinations per 100,000 population performed by local dispensaries did not statistically different within years (r = -0.45, p = 0.106 and, p = -0.15, p = 0.605, respectively). Conclusion: TB incidence declined within years, but this situation seems to be not related with improving of dispensaries performance.