Tuberculosis and It’s Control in

India and Uttarakhand

What is Tuberculosis?

An infectious disease caused by Mycobacterium tuberculosis

Who discovered

the Tubercle bacilli?

Robert Koch

Acid

Fast

Bacilli

How TB spreads ?

Inhalation of

droplets containing AFB in air

Most common Symptom of PT

Another Symptom of PT

Rise of Temperature in the evening

another Symptom of PT

What are the symptoms of PT?

Cough > 2 weeks

Loss of appetite

Loss of weight

Rise in temp. in the evening

Chest pain

Haemoptosis

India Accounts for Nearly One Third of the Global TB Burden

India has more cases of tuberculosis than any other country in the world & twice as many cases as China

Although exact and current information on TB incidence and prevalence is not available, studies show an incidence rate of more than 200 per lakh, among the highest in the world

Other coutries

28%Pakistan4%

Nigeria3%

China15%

India30%

Indonesia10%

Bangladesh4%

Russia1%

South Africa2%

Phillippines3%

TB - Disease Burden

> 40% of country’s population is infected 2 million new cases each year 450,000 deaths each year > 5,000 people develop TB every day > 1,000 people die every day TB kills more women than all causes of

maternal mortality put together

All this despite TB being nearly 100% curable

TB is the leading single infectious cause of death in India

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100

150

200

250

300

350

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450

TB Measles HIV Tetanus STD TropicalDis

Malaria

Number of deaths (1000s)

Source: World Health Report, 1999

Deaths from infectious agents in India

How many die in India in 2 minutes due to TB?

Status of TB Control in India 1950s-60s: Important TB research(TRC/NTI) 1962: National TB Programme 1992: Programme Review- only a third of patients

diagnosed and only a third of those treated successfully

1993: DOTS pilots (RNTCP) 1998: DOTS scale-up begins 2000: > 30% of country covered by DOTS Beginning of 2002: almost 50% of country covered

by DOTS (460 million population) 2006 – Whole India covered by DOTS

Directly

Observed

Treatment

Short Course

RNTCP :

Revised National Tuberculosis Control Programme

1.To achieve 85 % Cure Rate

2. To diagnose 70 % of estimated new Sp. Sm. Pos. cases after achieving the above.

Directly Observed Treatment, Short-course (DOTS)

TB Register

Political commitment

Diagnosis by microscopy

Adequate supply of SCC drugs

Directly observed treatment

Accountability

How TB is diagnosed ?

By the examination of Sputum for AFB

X-ray examination

What is the specific method for the diagnosis of PT?

Advantages of Sputum Microscopy

Simple

Less expensive

More reliable

Rapid

Take Home Messages

1. Anybody who is having Cough for more than 3 weeks with or without other symptoms should get their sputum examined at the nearest Health Facility

2. TB Diagnosis and treatment are available free of cost in all the govt. hospitals

Fight against TB

How many sputum samples are examined for diagnosis?

CATEGORY I New sp.pos. New sp.neg. but seriously ill

New extra-pulmonary but seriously ill

CATEGORY II

Sm. pos. relapse Sm.pos. failure Sm.pos treatment after default

CATEGORY-III

New sp.neg. not seriously ill

New extra-pulmonary not seriously ill

4 H R

I 2 HRZE(2 HRZS)

2 H3R3Z3E3 (2 H3R3Z3S3)

6 HE

4 HR

3 3

Recommended treatment regimens

Direct observation is recommended for all patients and is particularly essential when intermittent regimens are

used

Continuation Phase

Alternative treatment regimens(if smear + at end of initial phase of Cat I or Cat II,

one more month of initial phase is given)

TBtreatmentcategor

y Initial phase

III 2 HRZ

2 H3R3Z3

6 HE

4 HR

R4 H3 3

3 3 3(2 S H R Z E /1 H R Z E 5 H R EII 2 SHRZE/1 HRZE

3 3 3 3 3 3 3 3 3)

5 HRE

How many specimens are examined

during follow up examination?

During treatment, when do you examine the sputum for Cat-I patients ?

Month 2 4 6

During treatment, when do you examine sputum for Cat-II patients ?

Month 3 5 8

During treatment, when do you examine sputum for Cat-III Patients?

Month 2 6

What is to be done when the sp. sm. is pos. at the end of IP ?

IP to be continued for one more

month.

What is to be done when the patients default in the CP ?

Action to be taken within a week of

default.

DOTS triples treatment success in India

84%

25%

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40

60

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100

Non-DOTS DOTS

Anti TB drugs are available

free of cost in all the govt. hospitals.

Fight against TB