Abstracts 121

des patients identifi6s comme tuberculeux afin de lutter contre les abandons de traitement anti-tuberculeux et arriver ~ une proportion de 85% de malades gudris.

Methodes: Au sein d'une cohorte de patients mis sous traitement et suivis par des enqu&eurs, raise en place de relances ~ domicile darts les 72 heures lorsque le malade manque un rendez-vous hebdomadaire pour son traitement. Une enquate sociologique a 6t6 men6e para- ll~lement pour am61iorer l'accueil des patients et le suivi du traitement.

R~sultats: 150 nouveaux cas de tuberculose cons6cutifs darts chaque CAT (au total 300 patients) sont inclus en novembre et ddcembre 1994. Au 15 avril 1995, ces pa- tients ont eu en moyenne 4 mois de suivi (4043 visites hebdomadaires et 465 visites m6dicales de contr61e). Les enqueteurs ont effectu6 88 relances ~ domicile (2% des visites). 88% des patients (N = 264) suivent correctement leur traitement. Les d6c6s, malgr6 le traitement anti- tuberculeux repr6sentent 9% de la cohorte (N = 27, dont 17 patients infect6s par le VIH). A l'inverse, il n 'y a que 2% de perdus de vue. 1% des patients ont eu une interrup- tion de traitement et ont 6t6 remis sous traitement initial.

Conclusions: Alors que darts les conditions habituelles de suivi, les CAT ~ Abidjan ont 20% de perdus de vue parmi leurs patients, dans cette cohorte il n 'y a que 2% de perdus de vue. Par contre, les d6c~s repr6sentent 9% des patients inclus malgr6 l'efficacit6 des traitements anti-tuberculeux. Au bout de 4 mois, 88% des patients sont sous traitement et suivis. Ceci a 6t6 rdalis6 avec des moyens simples. L'identification d'une personne qui "s'interesse ~ leur maladie" fid~lise les patients. Ces mesures permettant de diminuer les abandons de traitement seront institudes sur une plus large 6chelle dans les CAT d'Abidjan.

368-PA12 TB C.P.*: Experience in two regions of Ethiopia

Mariani, D., Desta, A., Wolde, B. Italian Cooperation TB C.P.

*TB, C.P. = Tuberculosis Control Programme SCC = Short Course Chemotherapy

420-PA12 Gender and tuberculosis control: a model

Smith, I. United Mission to Nepal, Kathmandu, Nepal

More men than women are registered for TB treatment in Nepal. The proportion varies between programmes and regions, but in general, the ratio of males to females is between 1.5 to 1 and 3 to 1. This gender inequality is not peculiar to Nepal, but is observed in most countries of the world. Though usually ascribed to gender differ- ences in susceptibility to the disease, this situation is also attributable in part to socio-cultural factors. Either women don't get the disease, don't get treated, or get treatment outside the formal health system.

However, this simple classification masks a complex situation. Gender inequalities in tuberculosis control involve an array of issues, including susceptibifity to infection and disease, health beliefs, cultural values and customs, access to education, access to health services, health education strategies, and health service staffing policies and practices.

Gender inequalities can arise at each of four stages in the development and cure of TB: infection, progression to disease, diagnosis and treatment. These four stages provide a model for considering gender inequalities in tuberculosis control. Examples of how this model can be used to investigate gender inequalities in tuberculosis control are given.

Conclusions: Unless specific steps are taken to consider and overcome gender inequalities, the cultural climate in many developing countries is such that many TB control initiatives will continue inadvertently but consistently to discriminate against women. Attempts to improve TB control will need to incorporate an understanding of the many sociological factors, including health beliefs and illness behaviour, which influence people in their search for health.

A three year experience with the main objectives of detection rate of 70% of expected smear positive cases, cure rate of 85% and establishing an appropriate recording and reporting systems will be presented.

A total of 15,145 cases were put on treatment from 1992 to 1994. Among these, 5,282 cases were smear positives and 70% of them were on SCC.

About 2,960 cases who were detected in the first two years have been evaluated. An overall cure rate was 51% while defaulter rate was 33%. Out of these patients, 1,872 were on SCC with a cure rate of 60% and de- faulter rate of 26%.

The project has shown that the programme can be replicated to other regions in the country. Poor health service coverage and poor communication and transport facilities hamper the speed of progress to a certain ex- tent. However better organizational setups, supervision and evaluation skills, and improvement of recording and reporting formats have been attained.

423-PA12 Baseline survey in National Tuberculosis Control Programme in Nepal

Shal~a, T.M, (NTC, HMG/N), Komatsu, R. National Tuberculosis Control Project II (NTCP [I), Kathmandu, Nepal," Hoshino, H., Yamakami, K., Kato, J., (NTCP II), Pokhara, Nepal

Objective: This survey aimed to collect information on present tuberculosis control activities and to utilize the findings for successful implementation of the new Na- tional Tuberculosis Control Programme (NTP) in Nepal.

Methods: Information was collected by interview from the staff of each facility with standardized questionnaire and investigation of TB register. TB medicine stock in- out record and actual medicine stock. Fifty-three Health Posts (HP) and 1 Health Center (HC) were surveyed from August 1994 to February 1995.

Main findings: The qualification of HP/HC In-charge