| Dr. Rajnikant K. Patel | | | | |
| M.O. PHC Uvarsad 21/07/2008 | | | | Initial home visit by health worker along with |
| " Disease Burden of Tuberculosis in Gandhinagar" | | | | supervisor which make verification of address. Social |
| | | | | determinant and surrounding environment which |
| Introduction : | | | | provides sustainable supported environment to TB |
| | | | | case giving more emphasis on health education. |
| Tuberculosis is a chronic infectious disease with | | | | Decreases spread of disease in community it makes |
| varying clinical manifestation as likely affecting various | | | | patient more self reliant and self determined. Family |
| system of body. | | | | members are motivated for patient's support and |
| | | | | compliance. Regular intake of Drugs can make |
| - Ø Organism was discovered 100 years ago and | | | | patients free from TB. We realizes the community |
| still availability of effective drugs and vaccine it | | | | members that what importance the role of IP phase. |
| remains a public health problem globally. | | | | Initial 12 week treatment give symptomatic relief and |
| - Ø "Non - specific" determinants of TB Disease | | | | decrease infectivity that leads to less numbers of |
| spread, it but shown improvent in the standard of | | | | cases in the community. If patient is migrant then by |
| living and quality of life has declined death Rate in | | | | giving address to another TU. The treatment should |
| developed countries thus causing a more impact in | | | | be started at patient's residential place. |
| reducing the Burden of TB Disease in that area. | | | | |
| - Ø It kills more Adults than any other infectious | | | | - Ø If Dot's centre is far away accessibility is |
| disease especially productive age group of 15-49 | | | | making easier for drugs near by center for patient's |
| years. | | | | accommodation and needs. |
| - Ø Globally 20,000 people infected per day 5000 | | | | - Ø Suspected cases among family members who |
| develops disease in one day and 1 death occurs | | | | have cough within 1 week are examined for sputum |
| within 1 ½ minute. | | | | leads to early detection of cases in family and |
| | | | | surrounding area. |
| Mortality and Morbidity : | | | | |
| | | | | How many children they have are surveyed and |
| - Ø In 1962, NTCP was launched but due to poor | | | | confirmed during home visit and by doing weight of |
| patient compliance; Diagnostic criteria was not based | | | | that children and assured Isoniazid prophylaxis to |
| on sputum microscopy, sensitivity and specificity of | | | | children below 6 years regularly by preventing |
| diagnostic test was not there. | | | | tuberculosis incidence in children. |
| - Ø In NTCP area there were 35 case per 1,00,000 | | | | |
| population of sputum positive during 1977 to 1991 | | | | Regular visit by STS and STLS of poor working PHC. |
| sputum positive case was less and extra pulmonary | | | | Regular visit by medical officer and supervisor and |
| and X ray positive case were high. | | | | checking of box with treatment card. Field visit of TB |
| - Ø Standardize data abstraction in NTP District | | | | patient and evaluating dots by asking indirect question |
| indicates that 8% of patients were smear positive | | | | to them. |
| less than half the proportion in RNTCP Districts. | | | | |
| - Ø In NTCP Ratio of sputum positive case to | | | | Diagnostic algorithm displayed in medical officer room |
| sputum negative case was 1:3.6 which Declines to | | | | and laboratory diagnostic algorithm displayed in lab |
| 1:2.5 in 1999 after launching RNTCP in country. | | | | technician room. During routine surveillance activities |
| - Ø Patient compliance was less in NTCP and lack | | | | m.p.w. keep sputum cup with them and give to |
| of follow up and supervision made programme less | | | | symptomatic patients for further dignosis by sputum |
| effective and out come were poor. | | | | microscopy. |
| - Ø In NTCP single Drug therapy had caused | | | | |
| resistance to many Drugs. | | | | Laboratory technician and pharmacist prepared a |
| - Ø The programme was not Funded by external | | | | follow up list and give to all MPW and FHW of PHC |
| agencies like world bank made less availability of | | | | with referral slip and tell them for regular sputum |
| human resources and logistics. | | | | follow up of patients and asked to start continuation |
| - Ø Drug supply was irregular, erratic and | | | | phase within seven days of follow up result. They |
| inadequate. | | | | are drawing the attention of medical officer who are |
| - Ø Sanitorium base treatment made more | | | | not coming up for follow up examination. |
| psycho-social effect to the patieat and community. | | | | |
| And Not improving the status of the community. | | | | Regular meeting of pharmacist and lab technician |
| | | | | block level by DTO and BHO and giving them all |
| Due to above pitfall in programme morbidity and | | | | logistic supply including drugs for one month and |
| mortality was still high. So, RNTCP was launched in | | | | review the progrmme at grass root level. |
| 1993 in Mehsana District as a pilot project. In | | | | |
| Gandhinagar RNTCP was started in 2000. | | | | - Ø Those patients whose sputum are negative are |
| | | | | tracked down and re diagnosis is done. The patients |
| - Ø Total TB patients Diagnosed in 2005 were 488, | | | | who are negative during re diagnosis of sputum |
| 470, 417, 434 quarter 1, 2, 3, 4 Respectively. | | | | examination but having symptomatic complain |
| - Ø Total TB patients Diagnosed in 2006 were 463, | | | | continue are gathered at PHC and send to district TB |
| 474, 500, 455 in quarter 1, 2, 3, 4 Respectively. | | | | centre for X-ray examination along with worker in |
| - Ø Total TB patients Diagnosed in 2007 were 475, | | | | PHC vehicle thus by finding the extrapumonary cases |
| 542, 500, 427 in quarter 1, 2, 3, 4 Respectively. | | | | and started to them on RNTCP cat III regime. |
| - Ø It shows that there is gradual Increase in | | | | - Ø Monitoring of weight - The patients whose |
| number of TB patients diagnosed in comparison to | | | | weight was not increased are specially focused and |
| past year 2005 but still there is decrease in Number | | | | care to be taken for DOT compromised or not. The |
| of TB patient in quarter 4 in each year as compared | | | | poor patients are benefited by social welfare |
| to other quarter of year. | | | | department by collaborating through them. |
| - Ø Annualized total case detection per one lac | | | | - Ø Regular attending of M.O. meeting at District |
| population ranges from 120 to 145 but it averages | | | | level by DTO and encouraged who had done good |
| around 130. | | | | work and strict action are taken against who have |
| - Ø Number of smear positive cases diagnosed in | | | | worked poorly. |
| 2007 was 370, 411, 373, 315 in quarter 1, 2, 3, 4 | | | | - Ø World TB day are celebrated at District and |
| respectively. | | | | Taluka level. Reward are given who has done best |
| - Ø Number of smear positive cases diagnosed in | | | | work in RNTCP. The reward are given to all caders, |
| 2006 was 361, 424, 366, 358 in quarter 1, 2, 3, 4 | | | | workers, lab. Tech., Pharmacist, STS/STLS , M.O. and |
| respectively. | | | | BHO in presence of political leaders and District |
| - Ø Number of smear positive cases diagnosed in | | | | administrators. |
| 2005 was 371, 399, 358, 331 in quarter. | | | | - Ø The best DOTs worker and best cured patient |
| - Ø Total no. of smear positive cases 1455 in 2005 | | | | who had taken treatment regularly are also rewarded |
| increased to 1469 in 2007 showing marginal increase. | | | | at Taluka level. |
| - Ø New smear positive cases Registered for | | | | - Ø Exhibition of TB Disease related information in |
| treatment in 2005. Were 200, 216, 207, 191 in quarter | | | | forms of posters, pamphlet IEC activities by various |
| 1, 2, 3, 4 respectively. | | | | media during "GRAM SABHA" at village level. |
| - Ø In 2006 were 207, 212, 212, 213 in quarter 1, 2, | | | | - Ø The patients provider meeting are held at PHC |
| 3, 4 respectively. | | | | every 3 months attended by District level staff. |
| - Ø In 2007 were 212, 212, 208, 209 in quarter 1, 2, | | | | - Ø N.G.O. are involved in the RNTC programme |
| 3, 4 respectively. | | | | which are increased from 2 in 2005 to 6 in 2007. |
| | | | | public private partnership along with private doctors |
| - v New Smear Negative cases initiated on treatment | | | | and private lab technician are increased from 2 in |
| category III in 2005 was 101, 81, 46, 59 quarter 1, 2, | | | | 2004 to 12 in 2007. |
| 3, 4 respectively. | | | | - Ø Rootine immunization of B.C.G. coverage around |
| | | | | 65-70% had done impact on TB meningitis and Millary |
| - Ø In 2006 was 61, 65, 74, 52 in quarter 1, 2, 3, 4 | | | | TB cases in children. |
| respectively. | | | | - Ø Social mobilization is done by involving the local |
| - Ø In 2007 was 66, 58, 59, 49 in quarter 1, 2, 3, 4 | | | | leaders and competition in school children for TB |
| respectively. | | | | awareness in particular area and community by |
| - Ø Total new smear Negative case was in | | | | various types of IEC programme and try to change |
| 2005-287 in 2006-252. In 2007-232 it's Decrease year | | | | the mind set of community and individual that TB is |
| wise. | | | | not a social stigma now and responsibility of every |
| - Ø Extra pulmonary cases remains same in 2005 | | | | citizen to fight against tuberculosis. |
| and 2007 and decreased in 2006. | | | | - Ø ICTC centre works for TB - HIV con-infection. |
| | | | | |
| - v Retreatment case No. of sputum smear positive | | | | Above all programme had made success of this |
| patients started on category II regime. | | | | programme in best way in Gandhinagar District by |
| | | | | performing more then 70% detection rate more than |
| - Ø In 2005 was 92, 81, 82, 114 in quarter 1, 2, 3, 4 | | | | 90% sputum conversion rate and more then 85% |
| respectively. | | | | cure rate. |
| - Ø In 2006 was 104, 107, 119, 106 in quarter 1, 2, | | | | Limitation of Date Bases |
| 3, 4 respectively. | | | | |
| - Ø In 2007 was 112, 129, 127 & 82 in quarter | | | | - ü Data are not showing that how many |
| 1, 2, 3, 4 respectively. | | | | suspected were examined and from them how many |
| It is increase from 369 in 2005 to 450 in 2007 it | | | | are not come for treatment. |
| suggest more Failure. Relapse and defaulter cases are | | | | - ü Date does not shows how many patients are |
| increased may be due to lack of supervision, not visit | | | | not put earlier on Dot's regime and what was the |
| done by MPW. Not retrieval action was carried out | | | | prognosis in that type of cases. |
| etc. | | | | - ü Data does not shows that how many cases |
| - Ø Paediatric cases out of New cases were in | | | | are treated as sputum negative are re sputum |
| 2005-46 in 2006-61 and in 2007-88. Due to availability | | | | examination was done. |
| of paediatric boxes the more patients are initiated or | | | | - ü Data does not show that why retreatment |
| started on Treatment in 2007. | | | | cases are increased it is due to Dot's compromised or |
| - Ø Cure rate is increased from 83% in 2005 to | | | | lesser effective drugs or other reason etc. |
| 89% 2006. | | | | - ü Data does not show how many patients are |
| - Ø Failure rate is decrease from 2.6 to 2.2%. | | | | restarted by retrieval action within 2 month period. |
| - Ø Death rate is increased from 3.5 to 4.7 in 2006. | | | | - ü Data does not show actual prevalence of |
| - Ø Defaulter rate is Increased from 6-7% to | | | | disease in the community. |
| 11-13% in 2005. | | | | Though the last survey was carried out in 1958 by |
| - Ø Treatment completed case increased around | | | | Chennai for actual prevalence of Infection and |
| from 80% to 85% in 2005 to 2006. | | | | incidence of disease which is followed in RNTCP |
| | | | | programme for giving goals, targets and Norms to |
| - v Seasonal Trends: | | | | achieve. |
| | | | | |
| No seasonal Trends is seen. But due | | | | - ü Data does not show actual annual risk of |
| to some reason less cases are found in quarter four | | | | Infection according to that the occurrence of cases |
| of any year in comparision to other quarters of year. | | | | pulmonary, extra pulmonary and retreatment. Cases |
| | | | | yet. Some cases are missing. |
| - Ø Socio- environmental and economical factors | | | | - ü Data does not shown that how many patients |
| leads to more occurrence and spread of diseases. | | | | whose one sputum was only given and they are |
| In Dehgam Taluka of Gandhinagar District due to | | | | positive but they are not come again to the health |
| more presence of lower socio-economic group cases | | | | care system. |
| are more seen in that area as compared to other | | | | - ü Data does not shows that how many patients |
| Taluka of District. | | | | have not given their last follow up and they are |
| - Ø Though Gandhinagar urban area have more | | | | declared as cured or treatment completed. |
| population despite the occurrence of cases are less in | | | | Data does not show Multi-Drug resistance cases. |
| urban area. | | | | |
| - Ø It is mostly seen in poor people, less income | | | | |
| lower hygienic and sanitation practices and over | | | | Source - Central TB Division |
| crowding area. | | | | Health and F.W. |
| | | | | New Delhi. |
| Intervention | | | | India. |