TB contact investigations: 12 years of experience in the National TB Programme, Morocco 1993-2004.

We reviewed data collected from 1993 to 2004 as part of the routine activities of the national tuberculosis (TB) control programme (NTP) in Morocco. More than 1 million household TB contacts were identified in approximately 200,000 investigations. On average, 77% of identified contacts were screened every year; overall prevalence was 2.5%. The proportion of TB cases identified in household contacts of registered cases was 5.6%. This was significantly higher in children under 10 years and in patients registered and diagnosed with symptomatic primary complex. Performing TB contact investigations as part of the routine activities of NTP services is feasible in low-middle-income countries.

The decline of tuberculosis epidemics under chemotherapy: a case study in Morocco.

BACKGROUND: Tuberculosis (TB) case notifications per capita fell by only 3-4% per year in Morocco between 1996 and 2005, despite implementation of the World Health Organization (WHO) DOTS strategy since the early 1990s. At the current pace of epidemic decline, there will be more than 10,000 new cases in 2050, the target year for global elimination. METHODS: Analysis of cases reported by the National TB Control Programme, disaggregated by age, sex, clinical form of TB and region, for years 1996-2005. The validity of observed patterns was judged using four criteria: statistical validity, precision of measurement, biological plausibility and the consistency and strength of different lines of evidence. RESULTS: TB incidence (case numbers and rates) is higher in urban than in rural areas and higher in adult men than in women. The most infectious (smear-positive) form of the disease is more frequent in men with TB than women. Men aged 15-44 years accounted for half of all smear-positive cases in 2005. TB incidence has fallen more slowly than average among men, but the decline was also unexpectedly slow among women. CONCLUSIONS: In Morocco, men living in cities should be a focus for prevention and control. Globally, routine surveillance data should be more fully exploited to guide TB control activities.

Improving the quality of cohort analysis by incorporating treatment outcomes of 'transferred in' TB cases.

Treatment outcomes of patients with tuberculosis (TB) who move between TB units ('transferred out') are often not incorporated in the annual cohort analysis. Experience from Morocco shows that using a simple method, the outcomes of these patients, notified as 'transferred in' cases, can be easily taken into account when compiling the annual report on treatment outcomes. With this method the treatment success rate increased in Morocco by a median of 5.8% (range 5.0-6.7), indicating that the country reached the global target of curing at least 85% of the new smear-positive TB cases detected during the period 1995-2003.

Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003.

OBJECTIVE: To analyse treatment outcomes by subcategory of tuberculosis (TB) retreatment cases. METHODS: All TB patients treated with the Category II regimen from 1996 to 2003 in Morocco were enrolled in this retrospective study. For each cohort, the retreatment outcome data were analysed as a whole and by the following sub-categories: 1) cases who relapsed after one course of anti-tuberculosis treatment; 2) cases who failed the Category I regimen; and 3) cases who interrupted one course of anti-tuberculosis treatment. RESULTS: The study population included 14 635 retreatment patients, among whom 81.7% were TB relapse cases, 5.2% had failed the Category I regimen and 13.1% were defaulters. The average treatment success rates were respectively 74.8% (range 71.8-76.6), 58.0% (range 52.4-74.0) and 51.4% (range 46.4-55.6) among relapse, failure and default cases. Failure and default rates were significantly higher (P < 0.001) among patients who failed Category I treatment and among those who defaulted, respectively. CONCLUSIONS: TB cases who fail the Category I regimen should systematically receive drug susceptibility testing, while defaulters should be given support to improve treatment adherence. Stratified cohort analysis by subcategory of retreatment has been shown to be useful for evaluating the performance of TB control programmes.