INVOLVEMENT OF COMMUNITY HEALTH WORKERS IN TUBERCULOSIS CONTROL IN BANGLADESH

Tuberculosis is a major public health problem in Bangladesh. It is estimated that about 52, 000 deaths due to tuberculosis and 300, 000 new tuberculosis cases occurred in 1997 in Bangladesh. Bangladesh Rural Advancement Committee (BRAC), a Bangladeshi non government organization is implementing a community based program for tuberculosis since 1984 in collaboration with the national tuberculosis program. Community health workers are the nucleus of this initiative. All of them are female and selected from rural community. They identify suspected persons for sputum test and provide treatment to the patients in their own community. In the middle of 1998 this program was reviewed, and the achievements in 1996 and 1997 were analyzed. Treatment outcomes were evaluated through cohort analysis according to WHO/International Union Against Tuberculosis and Lung Disease (IUATLD) guidelines. Outcome indicators defined by WHO/IUATLD were used. A total of 7, 946 patients were detected in 34 thanas in 1996 and 1997. Out of them, 6, 163 (77.6%) were new sputum positive patients. Their sputum conversion and cure rates were about 90% and 86.7% respectively. This program has achieved the WHO target of 85% cure rate. Community health workers are playing a key role to control tuberculosis in this approach. Thus this model could reduce burden on health facilities, reduce patient's costs and increase case detection and cure rate.