ABSTRACT
Introduction: Having consistently achieved a success rate of more than 85% in the Revised National TB Control Programme (RNTCP) implemented areas of the country, it is time to expand the coverage with greater involvement of the community. Against this backdrop, it was decided to conduct a study using “shopkeepers” as Directly Observed Treatment (DOT) providers under RNTCP in Bangalore Mahanagara Palike (BMP). Objectives: To study the feasibility of using shopkeepers as DOT providers, their strengths & weaknesses and effectiveness in terms of success rates. Methodology: All new smear positive (NSP) and X-ray active cases diagnosed from the six (6) TUs and the MCs attached to it under BMP were offered treatment facility through DOT Provider till 300 patients were enrolled. The intake criterion was by purposive sampling technique. The period of intake was from April 2002 to June 2003 and during this period, the total number of patients diagnosed and registered for treatment from whole of BMP was 2009 NSP and 1371 X-ray active cases. Following the diagnosis, the Health Supervisors (HS) of National Tuberculosis Institute (NTI) and Senior Treatment Supervisors (STS) of BMP identified the potential shopkeeper in consultation with the eligible patients attending the health facilities. Result: During the process of purposive sampling, 300 patients were enrolled for treatment through DOT provider while 49 patients refused and opted treatment from Health Facility which served as control for comparing the outcome. Among the 300 patients who were enrolled for treatment through shopkeeper, 224 (74.6%) were NSP and 76 (25.3%) were X-ray active. Of the 49 (13.75%) patients who refused and opted for treatment from the Health facility, 40 (81.6%) were NSP and 9 (18.4%) were X-ray active. Out of 300 patients who opted for treatment from shopkeepers, 244 took treatment continuously and their success rate was 89.3%, the patients who refused to take treatment from shopkeepers the success rate was 90% and for those who registered & took treatment from BMP during the period of the study (excluding cases treated under shopkeepers) it was 84.8%. Success rate for 224 New Smear Positive cases who initially started treatment with shopkeeper was 81%. Conclusion: Shopkeepers can be used as DOT providers because of their accessibility, availability being less time consuming and the place being convenient to the patients. Shopkeepers are an example of persons drawn from the community who can play a complementary role as DOT providers. No major problem was encountered during the treatment through shopkeepers.
ABSTRACT
The Central TB Division (CTD), Government of India, initiated a systematic drug resistance surveillance (DRS), as per the global guidelines, among new TB patients reporting to health facilities under RNTCP. The data obtained from two districts of the eastern part of the country conducted by National TB Institute (NTI) are presented in this study. Objective: To measure the levels and pattern of resistance to anti-tuberculosis drugs among “newly diagnosed” sputum smear positive pulmonary tuberculosis cases in two identified districts, namely, Hoogli of West Bengal and Mayurbhanj of Orissa. Results: Of the total 693 smear positive specimens subjected for culture from both the districts, 545 (78.6%) were culture positive for M. tuberculosis, 62 (8.9%) were culture negative and 86 (12.4%) were contaminated. Culture negativity and contamination rates were 7.9% & 9.9% from Mayurbhanj district and 10% and 14.9% respectively from Hoogli district. The resistance to any drug was 5.4% in Mayurbhanj and 16.7% in Hoogli district. The resistance level to all the four primary drugs ranged from 0.4% to 3.9% in Mayurbhanj and 1.9% to 13.7% in Hoogli district. MDR was 0.7% (95% CI: 0.0% - 1.7%) and 3.0% (95% CI: 1 % - 5.1 %) in Mayurbhanj and Hoogli districts respectively. Conclusion: The study demonstrates that the levels of H, R and MDR in these two districts are within the expected levels, when compared with other studies conducted in India as per global DRS guidelines. However, in order to document success of RNTCP in reducing the levels of MDR TB, particularly in younger population, it is now necessary to conduct DRS in much larger population.
ABSTRACT
TheTB problem in India was first recognised through a resolution passed in the All India Sanitary Conference, held at Madras in 1912. The TB picture started becoming clear with the introduction of tuberculin testing. The Bhore committee report issued in 1946 estimated that about 2.5 million patients required treatment in the country with only 6,000 beds available. The first open air institution for isolation and treatment of TB patients was started in 1906 in Tilaunia near Ajmer and Almora in the Himalayas in 1908. The anti-TB movement in the country gained momentum with the TB Association of India was established in 1939. WHO and UNICEF took keen interest in providing assistance for introducing mass BCG vaccination with low cost in 1951. In the 1940s streptomycin and PAS were introduced in the west followed by thiocetazone and INH is 1950s. National Tuberculosis Control Programme (NTP) was formulated in 1962 which was implemented in phased manner. The deficiency in NTP was identified in 1963 and Revised National TB Control Programme (RNTCP) was developed. There is a commitment for Government of India to expand RNTCP to cover the entire country by 2005.