A key component of the World Health Organization's recommended TB control strategy (known as DOTS) is direct observation of treatment, which WHO recommends a health worker should undertake. However, in some areas direct observation by health workers is not feasible.
James Newell (University of Leeds, UK) and colleagues did a randomised trial to compare community-DOTS and family member DOTS in ten hill and mountain districts of Nepal. They found that both strategies met international targets and had similar success rates.
Dr Newell concludes: "Both strategies are acceptable for use in the hill districts of Nepal. They may also be appropriate in many other parts of the world where-because of difficult terrain, low population density, or conflicts- direct observation of treatment by health workers is not feasible."
See also accompanying Comment by Paul Garner (Liverpool School of Tropical Medicine, UK).
Also in this week's issue a Review looks at TB epidemiology in Africa.
Contact: Dr James Newell, International Division, Faculty of Medicine & Health, University of Leeds, 71-75 Claredon Road, LEEDS LS2 9PL, UK.
T) 0113 34 36950
j.n.newell@leeds.ac.uk
The Lancet