THE NATIONAL TUBERCULOSIS PROGRAM IN VIET NAM IN 1977:
HOW TO APPLY DOTS
by
Dr Le Van Nhi
Chief of Planning Department
Pham Ngoc Thach TB & Lung Diseased Center
? - GENEAL INFORMATION:
Viet Nam is a South East Asian country with an area of 330.000 Sq. Km. The country is divided a administratively in 61 provinces, 28 in the North, 12 in the Central and 21 in the South. Further division is into 572 districts and finally into 10204 communes and hamlets.
The last census was carried out in 1989. Assuming 2% annual increase the population estimated for 1996 is 74 millions. The ethnic group is Kinh (Vietnamese) and account for 87% of the population. The remaining are 64 minority groups.
The census detected a female predominance in the population especially in the age group 45-54 years, these are persons that were between 30 and 40 years of age at the end of the American war.
The Tuberculosis Control has been carried out in Viet Nam since 1957. The National Tuberculosis Programme (NTP) was established by the National Institute of Tuberculosis and Respiratory Diseases (NITRD) in Ha Noi and launhed by the Ministry of Health (MOH) in December 1985. The Programme policies, which were designed in 1985 antedate the present tuberculosis strategy of the World Health Organization (WHO).
The technical recommendation of WHO and the operational recommendations of IUATLD are used but adapted to the Socio-economic condition of the country.
The principles of the strategy are:
-A decentralised diagnostic and treatment network based on existing health facilities and integrated with primary health care.
-A passive case finding for suspect patients who present cough for more than 3 weeks with direct microscopic examination of sputum after coloration of Zeehl Neelsen.
-Treatment is especially ambulatory near the home of the patient but under strict supervision: DOTS with gradual replacement of the old standard regimen by the Short Course Chemotherapy.
-Laboratory network in the district within the general laboratory services.
-Priority to detect and cure for smear positives cases.
-A regular drug and chemical supply.
-A built in system of supervision and monitoring and evaluation.
-Training and health education.
?- EPIDEMIOLOGICAL SITUATION:
According to investigation carried out during the years 1996 and 1994 with technical assistance from JSRU and ITSC the annual risk of TB infection nation wide is about 1.5% with a great difference between North and South, in the North 1% and in the South 2%.
According to the calculation with Styblo method
-IM(+) : 60,000
-I all form : 130,000 cases
?- OBJECTIVES AND TRAGETS AND STRATEGY OF THE VIETNAMESE NTP.
-To reduce mortality morbidity and disease transmission.
To prevent the development of drug resistance
Targets:
-To cure 78.5% of detected new cases of sputum smear positive TB.
These shall have an immediate impact on the TB prevalence and the rate of TB transmission.
-To detect 75% of existing cases of sputum smear positive TB.
STRATEGY OF THE NTP.
To provide standardised SCC under direct observation at least during the initial phase of treatment to all TB cases, whether in hospital ro ambulatory treatment.
?- ORGANIZATION:
-There are 4 administrative levels: national, provincial, district and commune.
