Tuberculosis mortality trends in Delhi after implementation of RNTCP.

Objectives: To study the impact of Revised National TB Control Programme on mortality among tuberculosis patients in Delhi and to correlate mortality trends with programme indicators. Methods: Record based evaluation of mortality trends from TB registers of all chest clinics of Delhi after implementation of Revised National TB Control Programme. Results: The study showed a statistically significant decline in tuberculosis mortality among new smear positive cases after the implementation of Revised National TB Control Programme (z=4.478 p<0.05). The mortality among new smear negative and extra pulmonary cases also showed reduction, though not statistically significant. Conclusion: Mortality due to tuberculosis has been considerably reduced in Delhi over the years with the Revised National TB Control Programme implementation since 1997.

DOTS in drug addicts with TB : Delhi experience.

BACKGROUND: Drug abuse is on the rise. Drug addiction lowers the general immunity of the body. Tuberculosis is known to be one of the major infectious diseases with a high incidence among drug addicts. Treatment of drug addicts suffering from tuberculosis is a challenge to the treating physician. METHODS: An interventional prospective study which involved free de-addiction drugs and motivation along with free anti tubercular drugs under Revised National Tuberculosis Programme was undertaken among drug addicts. Sixty drug addicts suffering from tuberculosis, registered under RNTCP in SPM marg TB Clinic (Pili Kothi) between 2002-2007 and treated under DOTS along with de-addiction treatment by an NGO (Sharan) formed the study sample. OBJECTIVES: Objectives of the study were: a) To study the profile of drug addicts with tuberculosis, b) To assess the success results of DOTS in drug addicts with tuberculosis (along with de-addiction treatment). RESULTS: Extensive counselling for de-addiction and motivation of the study patients along with nutritional food supplements improved the compliance and adherence to treatment with equal success rates as in non-addict tuberculosis patients. The overall success rate in drug addicts was 83.3%. The default rate of 3.3% and failure rate of just 1.7% among study group were also within the permissible range of RNTCP (< 4%). CONCLUSION: DOTS along with supplementary intervention was observed to be quite effective in drug addicts with TB.

Adverse drug reactions observed during DOTS.

A total of 8.37% of the 1195 patients treated at NDTB Centre with DOTS under RNTCP between January 2002 to June 2003 presented with adverse drug reactions. Patients showing any sort of adverse reactions were studied in detail by personal interviews and a semi-structured questionnaire. The profile of patients presenting with adverse reactions showed that majority of the patients (53%) had gastrointestinal reactions, the commonest presenting complaint being nausea and vomiting. General aches and pains were complained by about 35% and giddiness was the presenting complaint in 27% irrespective of the use of streptomycin, although giddiness was observed more often in Category II patients (59%). Skin rash and itching was complained by about 17% of patients and 11% complained of arthralgia, while only 1% had hepatotoxicity during treatment. Majority of the adverse reactions (67%) were observed within the first four weeks of treatment and only 0.25% of patients treated with DOTS had interruption of treatment for short periods.

Treatment of tuberculous pleural effusion patients and their satisfaction with DOTS - 1½ year follow up.

Background: Under the Revised National Tuberculosis Control Programme, patients who are sputum negative after 3 smear examinations are subjected to radiological examination after they fail to respond to a course of antibiotics for a period of two weeks. Those showing radiological evidence of pleural effusion are examined physically and investigated further by tuberculin testing and diagnostic aspiration. Those confirmed to be suffering from tuberculous pleural effusion by naked eye examination, biochemical tests and cytology of pleural fluid are given a fixed schedule of drugs. The treatment is stopped after six or eight months as per category, and outcome is reported as “Treatment Completed”. Many a time, patients question the validity of stopping treatment without radiological examination. Physicians treating are also at times not confident themselves and often fail to reassure such patients. Presence of residual symptoms in such patients before stopping treatment creates further uneasiness among the treating physicians. Methodology and Results: A study carried out among 58 patients of TB pleural effusion, of which 36 (62.1%) could be followed for a period of 1½ years, revealed that 63.9% were satisfied with the DOTS policy of stopping treatment without x-ray at the end of treatment whereas 36.1% expressed dissatisfaction with this policy. As many as 16.7% even got their x-rays elsewhere before stoppage of treatment, for their own satisfaction. Conclusion: The 1½ year follow up revealed only one case of relapse i.e. a relapse rate of 2.8% after DOTS therapy. Almost all (97.2%) were, however, satisfied with the medicines dispensed under DOTS.