A Comparative Study Of Home-Based Lay Worker Supervised And Facility-Based Health Worker Supervised Dots In Enugu, Nigeria

Setting: The chest clinic of the University of Nigeria Teaching Hospital, Enugu Nigeria, the main referral tuberculosis treatment centre for Enugu and its environs. Objective: To compare the efficacy of home-based lay worker supervised DOTS with facility based health worker supervised DOTS during the intensive phase. Design: 600 consecutive newly diagnosed and previously untreated smear positive pulmonary tuberculosis patients were randomly assigned to either of 2 groups: study and control. A relation trained as DOTS supervisor supervised each study group patient at home while the clinic nurses supervised the control group patients at the clinic. Results: At the end of the study, 77.3% of the study group compared with 72.7% of the control group achieved sputum conversion (X 2 = 1.7422; P > 0.05). Similarly, 92% of the study group compared with 90% of the control group completed treatment (X 2 = 0.7326; P > 0.05). Conclusion: Trained lay supervisors were able to supervise DOTS at home during the intensive phase, and patients supervised by them achieved slightly better results than those supervised by clinic nurses, though the differences were not statistically significant. It is therefore recommended that home based DOTS using trained lay supervisors be incorporated into the national tuberculosis control programme in Nigeria. Key Words: Tuberculosis, Control Programme, DOTS supervision, Nigeria Orient Journal of Medicine Vol.16(2) 2004: 1-6