ABSTRACT
A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1-9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72 h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11 mm and a mode at 18 mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2-22.5%) and the ARTI was 3.9% (95% CI 3.5-4.3%). The corresponding figures were 21.1% (95% CI 18.3-23.8%) and 3.9% (95% CI 3.4-4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4-22.5%) and 4.0% (95% CI 3.2-4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area.
Subject(s)
Tuberculin Test/statistics & numerical data , Tuberculosis/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , India/epidemiology , Infant , Male , Mycobacterium bovis/immunology , Prevalence , Risk Assessment , Rural HealthABSTRACT
OBJECTIVE: To describe the status of cases 2-3 years after the initiation of treatment under DOTS. SETTING: After DOTS implementation in Tiruvallur district, south India, we followed up a cohort of smear-positive TB patients registered during 2002-03 after initiation of treatment. RESULTS: The overall mortality rate was 15.0% and among the remaining 18.6% had active disease. In multivariate analysis, a higher mortality rate was independently associated with age, sex, occupation, treatment outcome and initial body weight of patients. CONCLUSION: The mortality and morbidity rates are still high during follow-up and needs to be curtailed by addressing these issues effectively in TB control programme.
Subject(s)
Directly Observed Therapy , Health Status , Tuberculosis/therapy , Adult , Aged , Female , Follow-Up Studies , Humans , India , Male , Middle Aged , Risk Factors , Rural Population , Time Factors , Treatment Outcome , Tuberculosis/mortalityABSTRACT
OBJECTIVE: To identify risk factors associated with relapse among cured tuberculosis (TB) patients in a DOTS programme in South India. DESIGN: Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion. RESULTS: Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95% CI 1.4-4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95% CI 2.0-11.6) and smoking (aOR 3.1; 95% CI 1.6-6.0). The relapse rate among non-smoking, treatment adherent patients with drug-sensitive organisms was 4.8%. CONCLUSIONS: The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking.
Subject(s)
Tuberculosis, Pulmonary/epidemiology , Adult , Directly Observed Therapy , Female , Humans , India/epidemiology , Male , Middle Aged , Recurrence , Risk Factors , Smoking/epidemiology , Smoking Cessation , Tuberculosis, Pulmonary/drug therapyABSTRACT
SETTINGS: A general hospital and three peripheral health institutions (PHI) in Tiruvallur District, south India. OBJECTIVE: To validate the case detection strategy for diagnosis of pulmonary tuberculosis by smear microscopy of two sputum specimens versus three. METHODS: In the Revised National Tuberculosis Control Programme (RNTCP), three smears from every symptomatic patient attending the PHI were examined for acid-fast bacilli (AFB) by Ziehl-Neelsen (ZN) microscopy. The data from the Tuberculosis Laboratory Registers from the above centres were analysed. RESULTS: Of 7843 chest symptomatics who had provided three sputum specimens for examination, 895 (11.4%) were smear-positive on at least two specimens. Examination of two specimens--first spot and early morning specimens (837, 93.5%) or early morning and second spot specimens (843, 94.2%)--yielded the highest number of cases. CONCLUSION: The examination of two sputum smears (one spot and an early morning) is as effective as examination of three smears.
