Background: Tuberculosis (tb) is one of the greatest public health problems in the world. One third of the world’s population is infected with the tb-bacterium, and one new person is infected every second. To deal with this problem, WHO started the DOTS strategy in 1993. Despite good results from DOTS, the incidence of tb increases in the world.Objectives: The aim of this project was to look at the accomplishments of WHO`s DOTS-strategy in low income countries. We wanted to increase our knowledge of how cultural, social, economical and geographic factors in a local society would influence the delay of tb-diagnostics and patients compliance during treatment.Material and methods: We did a review of relevant literature. Searches were done in Medline and terms used were: ‘Tuberculosis’, ‘Directly Observed Treatment’, ‘Delay’ and ‘Compliance’. In addition to study the literature we wanted to make our own experiences in a field study. The field study was done in Okhaldhunga, Nepal. We interviewed tb patients, and health workers working with the DOTS strategy. Results: We found the most important issues leading to delay and non-compliance to be poverty, poor access to health care, social stigma and lack of knowledge, both among the patients and the health workers. Conclusion: To decrease delay and non-compliance, awareness of tb should be increased and tb treatment decentralized. Decentralization will make the access better, but to be successful it will demand good education of health workers in rural areas. The greatest challenge, in both literature and our field study, seemed to be economical problems. This means that the most important health promoting measure in tb treatment would be to fight poverty.
Supervisor: Per Fugelli