Abstract
Current Problems of Controlling TB (Tuberculosis) in Thailand Two major problems of controlling TB in Thailand were lack of new vaccines and drugs development and increasing phenomena of TB drug resistance due to inconsistent drug taking by most patients. Controlling TB by DOTS (Directly Observed Therapy, short course) was a new strategy determined by most international health organizations. One of the DOTS was simply to have the patient’s helper who monitors his or her drug consumption so as to keep continuity of drug taking. The helpers may be the TB official, the health official at a health center, the health volunteer, the community leader, and the family member. Current situations and problems of controlling TB in Thailand by the DOTS were reviewed in this study. The DOTS coverage was found 34.1% of all districts by December 1999 while its operation was lower than the WHO target and likely to decrease. Its effectiveness was found better than the conventional based on the RCT study whereas no significant difference was found under the non-RCT study. Most operations at district level did not have quality monitoring and evaluation process while a number of the patients’ helpers were not trained. The problems of DOTS operation in Thailand were regarded into firstly, policy level at which policy makers gave relatively low priority of TB controlling than many communicable diseases, secondly, a number of personnel dealing with TB control neither trained nor interested in getting trained, thirdly, less motivation in health officials to put forward the DOTS operation in their own areas, fourthly, poor reliability in performing the DOTS by family members, and fifthly, lack of based-cohort study to illustrate levels of success or failure in addition to less qualitative study on this topic so far. Establishment of research networking on the DOTS and its policy-based research were recommended. The research topics should be on the DOTS efficiency, the DOTS model development, factors related to its success and failures, and criteria for the DOTS performed by family members.
