Involvement of Non-allopathic Private Practitioners under DOTS in an urban area of north India.

Background: In an urban area of a north Indian district (population 150,000), nine private practitioners of non-allopathic medicine, including five with no qualification and two private paramedical staff, were trained as per programme guidelines before being involved as treatment observers in the DOTS-based Revised National TB Control Programme and supervised. They were not given any financial incentive. Material and Methods: During 2002, they managed 185 TB patients (85% of the cases in the urban area) and amongst the 63 new smear-positive patients, the cure rate was 84%. Over a 6 month period, 6% of the total new smear-positive patients detected in the area were referred by these private practitioners. Results: Results suggest that non-allopathic practitioners and paramedical staff from the private sector can make a significant contribution to TB control, by increasing case detection and treatment observation.

Effectiveness of community-based angan-wari workers in the directly observed treatment of tuberculosis patients in a rural area of Haryana.

Setting – A Tuberculosis Unit (TU) with a population of 600,000 in Gurgaon district, Haryana. Objective - To compare the treatment success rate among TB patients taking DOT from community-based Angan-wari workers (AWWs) with that of TB patients with other DOT providers. Design - AWWs were given a two-day modular training, included in the local DOT directory and were directly supervised by the TB Programme staff. From the TB register held at the TU, treatment outcomes of all new sputum positive (NSP) patients registered in Gurgaon TU from 1st January to 31st December 2002, were evaluated. Results - During 2002, AWWs observed the treatment of 115 (11%) patients in the TU. The cure rate amongst the 41 NSP patients, who had AWWs as DOT providers, was significantly better than for those who had other DOT providers (95% vs. 78%) respectively (p=0.02). Conclusion - Community-based Angan-wari workers, with adequate training and regular supervision, can contribute effectively to a TB programme as DOT providers.

A study of dental caries in school children from rural Haryana.

The prevalence of dental caries among rural school children (688 boys and 331 girls) in the age group of 12-16 years in Haryana was found to be 39.4%. It was 37.9% in boys and 42.6% in girls. The difference between males and females was statistically not significant. A significant increase in prevalence of dental caries with age was observed (i.e. 33.1% in 12-year-old children to 45.8% in 14-year-old children). The mean DMFT per child was found to be 1.03 and DMFT per affected child was 2.6. The mean of D, M and F was found to be 1.0, 0.03 and 0.0 respectively.

Epidemiological evaluation of BCG vaccine efficacy in Delhi--1989.

A field evaluation of efficacy of BCG vaccine to prevent tubercular meningitis was undertaken in a case control study in Delhi during 1988-89. Each case of tubercular meningitis was matched by age and neighbourhood with 2 controls from the community. Thirty-seven cases of tubercular meningitis were matched with 74 controls and thus 37 triplets were analysed. ODDS RATIO between BCG vaccinated and non vaccinated individuals for acquisition of tubercular meningitis was 11.3. This gives 84 per cent efficacy of BCG vaccine in the prevention of TB meningitis under the field conditions prevailing in Delhi. Paired matched analysis of tubercular meningitis with the control group 1 and 2 separately revealed the ODDS RATIO to be 9.5 and 15 respectively. The corresponding BCG vaccine efficacy worked out were 90 and 93 per cent respectively. Authors suggest that this method of evaluating BCG vaccine efficacy is fairly reliable and cost effective. This methodology could be further simplified by using hospital patients as control and be introduced to evaluate BCG vaccine efficacy in different areas with reference to its role in preventing tubercular meningitis under the programme of immunisation.