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Times of India
13 July 2010
By Sumitra Deb Roy
Mumbai, India

Affluent, Educated Avoid DOTS Treatment for TB
The government may like to think that India is on the threshold of becoming a tuberculosis–free nation with its claims of 100% nationwide treatment coverage since the past three years. A study by a city hospital, though, could well act as a reality check. It reveals how the direct observed TB treatment, touted as one of the largest and the most successful universally, is not highly preferred – worryingly – by the affluent and the educated.

A study by the P D Hinduja Hospital at Mahim, including 200 tuberculosis patients, found that all the hoopla surrounding the success and reach of Direct Observation Treatment Short (DOTS) course may be premature, as a significant chunk of the population is still ignorant of the concept. And, the chunk, worryingly, happens to be educated and from the higher social–economic strata.

Published in renowned public heath journal BioMed Central on June 22, the study found that a whopping 85% of 200 patients interviewed were unaware of any concept called DOTS. The USP of DOTS, started under the Revised National Tuberculosis Control Programme in 1998, is the fact that patients are administered TB drugs in the presence of a doctor inside a designated medical centre where each patient has an individual medicine box to himself or herself. The patients have to frequent the centre three times a week for the doses.

But the USP of the programme itself does not seem to be working for many as respondents found the concept “kiddish” and meant for “illiterates”. In the course of the study, when the patients were explained the concept of DOTS, about 136 out of 200 found it as an unacceptable form of treatment. A whopping 91.5% of the patients preferred to buy TB medicines from a chemist shop rather than visiting a government DOTS centre even if treatment was absolutely free.

Consultant chest physician Dr Zarir Udwadia said that the success of the DOTS programme in India was indubitable. “But, the success and universal access of the programme does not commensurate with a universal preference for it,“ he said. ”About 50–70% of Indian TB patients still continue to choose private healthcare, and unless these patients are attracted to DOTS, they will remain at the mercy of an unregulated private sector.”

Co–investigator Dr Lancelot Pinto from the department of respiratory medicine said that those who preferred private sector for TB treatment voiced out concerns right from lack of trust on a public health system to privacy issues. “About 90 patients (45%) did not want to be observed while taking drugs.”

Every 185 people out of 1 lakh population is believed to be suffering from TB. “But, in Mumbai, the programme has reached out to 237 of 1 lakh population, much beyond national targets,” a BMC officer said.

‘I chose a pvt specialist’
Mauli Shah (31) rushed to a bone specialist when she incessantly suffered chest pain. Soon, she learnt that it was not a bone problem but water had filled in her lungs. Initially, she brushed it aside as some health problem, but found it hard to believe when the doctor informed her that she was suffering from a form of tuberculosis. ”I was stunned when I was told that it was TB,“ said the creative designer in an advertising agency. “It could be our mindset that such an ailment cannot affect us,” she said, explaining why she found it hard to believe. But, without wasting much time, she started her TB treatment that lasted six months. The hospital where she was treated did inform her about DOTS. “But, I chose to see a private specialist,” she said.

‘I found visiting centre cumbersome’
Banker Anil Waghmare (42) was diagnosed with TB when he was on his way to one of the most important meetings of his career. He was informed that it was contagious and he could spread it to others. “First, I brushed it aside as a wrong diagnosis, but gradually I came to accept it,” he said. As recommended by his doctor, he visited a DOTS centre near Ghatkopar. “But I found it cumbersome to go to the centre three times a week. Also, I found the treatment module strange and so I purchased my drugs from the nearby chemist,” he said. Waghmare also had issues with the behaviour of the centre doctor.

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