Leprosy
mailing list, July 15th, 2005
To: all.
Ref.:
- comments on WHO/AFRO's
"post-elimination" strategy paper;
- treatment supervision.
From: B Ji, Paris, France.
Dear Dr Noto,
I would like to reply to Dr
Chukwu's question (LML, July 5th, 2005) whether my
recommendation that "In general, members of the patient's
family should not serve as treatment supervisor" is based on
evidence.
My recommendation is based on
the following observations. Although to my knowledge, there is no
comparison about the effectiveness of MDT between leprosy
patients supervised by the health workers and by the family members,
such comparisons had been made repeatedly in TB programmes. The cure
rate was significantly higher among TB patients supervised by health
workers (1), who were more likely to practice 'actual DOT' (2);
whereas most workers believe that supervision by family members is
less reliable and even ineffective (1,3), and some national TB
programmes, such as that of India, have clearly defined the DOT
supervisor as someone outside the family of the person being treated (3).
WHO also recommends that "in general, members of the
patient's family should not serve as treatment observers"
(4).
References:
(1) Mathema B et al.
Tuberculosis treatment in Nepal: a rapid assessment of government
centers using different types of patient supervision. Int J
Tuberc Lung Dis, 2001: 5:912-9.
(2) Pungrassami P et
al. Practice
of directly observed treatment (DOT) for tuberculosis in southern
Thailand: comparison between different types of DOT observers. Int J
Tuberc Lung Dis, 2002: 6:389-95.
(3) Khatri GR et al.
Rapid DOT expansion in India. Bull WHO, 2002; 80:
457-63.
(4) World Health Organization.
Treatment of Tuberculosis. Guidelines for National Programmes. Page
49, Third Edition, 2003.
Baohong Ji, M.D.
