Mukhtiar Zaman, Uma M Irfan, Shaukat Ali.
Implementation of DOTS strategy in Peshawar district - issues and challenges.
Pak J Chest Med Jan ;9(2):25-31.

The National Tuberculosis Programme (NTP) was revised in line with the WHO recommended DOTS strategy in 1994 and technical guidelines were established. These guidelines were updated in April 1999. Under the current operational structure the objectives of the Provincial TB control program, NWFP is to implement DOTS strategy by the year 2005 in the district of Peshawar There are many inherent problems in implementing DOTS strategy effectively in District Peshawar. The knowledge of doctors on TB diagnosis and treatment is variable and the one time DOTS training of doctors is not adequate and comprehensive. Only 36% doctors after DOTS training are able to correctly diagnose and treat TB. The TB desktop manual may not be available to all physicians at all times which may contribute to the misdiagnosis and improper management of TB patients. Tertiary Care hospitals are a parallel system offering TB treatment that has been influenced by personal preferences of doctors, their previous experience, and/or marketing strategies of pharmaceutical companies. Furthermore the mismanagement of TB in Tertiary Care hospitals may be attributed to the non-acceptance of the NTP strategies. This article reviews the TB control program in district Peshawar and has concluded that the WHO DOTS strategy does not seem to work effectively in the current environment of TB control programs in the district of Peshawar. The year 2005 target for DOTS implementation is doable but it requires strengthening of the current TB control Programs with managerial, logistic support and manpower.

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