WelcomesHONOURABLE VISITORS

Dr.S.K.SRIVASTAVAMEMBER SECRETARY

N.T.P.-IntroductionBackground

A National Sample Survey Was conducted by G.O.I. During 1955-58 in which :- 1.7% of the population was suffering from radiologically positive disease, while 0.4 % had bacterilogically positive (INFECTIOUS) disease.

Policy

G.O.I.formulated a Programme “National Tuberculosis Control Programme”

ImplementationAt G.O.I. Level in 1962 and at State

level in 1968

Salient features of N.T.C.P

1.State T.B.Officer at The State Level

2.Every Distt will have a D.T.C. 3.Distt. Progr.Officer to be D.T.O

4.D.T.C.to be manned by a team of Key Personnel viz Lab-Tech,

Treat.Org, X-Ray Tech & S.A.

5. Diagnosis at the D.T.C.by X-ray & Sputum exam.as also by Mantoux

test

6.Programme at the periphery implemented at CHCs/PHCs/P.H.Is where X-Ray,Sputum exam was done as per availability of equipment. Mantoux test available only at D.T.C.

7.Drugs were issued on monthly basis to T.B. patients for 6/9/12/18 months.

8.Default retrieval was to be done in the urban areas by Treatment Organizers,whereas in rural areas it was to be done with the help of M.O.,Supervisors & A.N.Ms. 9.A Vehicle was provided for doing Supervision at all the P.H.Is.

Shortcomings of N.T.C.P

1. Too much emphasis was being laid on X-Ray exam.,though it was neither specific nor sensitive. It was available only at 2 or 3 centers in the Distt. 2. Only one specimen of sputum was being examined that too with Mono-ocular Microscope.

3.The programme was not decentralized.Mostly it functioned at the District level, it never reached rural areas in true sense.Patients had to travel long distances to collect drugs and for check up & sputum exams 4. As per survey conducted by W.H.O.Private/ Public Practitioners were prescribing 110 regimens, resulting in unscientific treatment & emergence of drug resistance.

Shortcomings of N.T.C.P.(Contd)

5.On many occasions there were shortages of anti-T.B.Drugs at the Distt level.At the periphery quite a few drugs(specially S.C.C.)were in short supply on many occasions. 6.Concept of Cure/ Cure rates was not developed. 7.The Outcome of the patients was not monitored.

8.Default Retrievala)Urban Areas :- To be carried out by Treatment Organizers.The activity was confined to letter writing which was done somewhat satisfactorily. Home visits which were to be done for at least sputum positive patients were done only by some enthusiasticworkers,but not as routine.

8.Default Retrieval b)RURAL AREAS It was to be carried out by the supervisors & A.N.Ms with the help of M.Os. This activity was never undertaken seriously. Default retrieval was confined to letter writing from the D.T.C. for the D.T.C. patients.

9.Role of B.C.G.Technicians After handing over the role of B.C.G.Vaccination to E.P.I. No specific role was alloted to these workers.They should have been asked to supervise the quality of T.B.Control programme in the rural areas including building up of default retrieval system,which they were neither asked nor they did.

Shortcomings of N.T.C.P.(Contd)

10.Concept of I.E.C.Campaigns was not developed.Public was therefore not aware that T.B.is Curable. They were neither told about the importance of taking full course of treatment nor about the magnitude/ infectiousness of the disease.

11.N.G.O./Private sector It was never encouraged

or

involved in the programme, Though

64% of T.B.patients were patronizing the Private/N.G.O. Sector Only 29%

were patronizing the Govt.facility.

Patient’s preference for Govt/Private Health Facility

First action taken by Chest Symptomatics

0

10

20

30

40

50

60

70

PrivateProvider

GovtFacility

Self&HomeRemedies

Pt's Choice

Knowledge of the Subcentre Clinic

1.Knowledge in the Subcentre villages –52%

2.Between P.H.C.& Subcentre villages -40%

3.Between two Subcentre Villages -31%

4.In Remote Villages -13%

(K.N.Udupa-1991)

Awareness &Utilization of General Health Services in U.P.

1.In P.H.C.Village -83 %

2.Between P.H.C. & subcentre -65 %

3.In Subcentre Village - 55 %

4.In Between 2 subcentres -40 %

5.In Remote Villages -27 % (K.N.Udupa-1991)

Tuberculosis – A Global Emergency

T.B.kills 5000 people a day –2 million each year.

1/3 of the world’s population is infected with T.B.

More than 100,000 children will die needlessly from T.B. this year.

T.B.- A Global Emergency(Contd) Hundreds of Thousands of children will become orphans this year.

HIV and MDRTB will make the T.B. epidemic much more severe unless urgent action is taken

Extent of Problem In INDIA Every Year:- 20 Lakh people develop T.B. Nearly 5Lakh die from T.B.

1 PATIENT DIES FROM T.B. EACH MINUTE IN India

Extent of T.B.Prob. In INDIA Everyday:- More than 20,000 people

become infected with T.B.

More than 5,000 develop T.B.

More than 1,000 die because of T.B.

Social Implications Every year 3 Lakh children are forced to leave school because their parents have T.B

1 Lakh Women lose their status as mothers and wives because of the social stigma.

ECONOMIC BURDEN OF T.B.

Every Year

Tuberculosis costs India more than Rs 13000

Crores($ 3 billion)

(W.H.O.-Research for Action –2000)

Do You Know ? That :-

1. Economic burden of T.B. is 3.9 % of the total expenditure of India of Rs 3,35,523 Crores

2 Economic burden of T.B.is 22.2 % of the total expenditure on Defence of Rs 58587 Crores. (Revised Budget Estimates For The Year 2000-2001)

In addition Every year,

T.B.Patients spend more than

Rs 645 Crores(U.S.$ 180million)

on Private T.B.Care

Impact of H.I.V./A.I.D.S on T.B.

S.No. H.I.V.Status Infection with Tuberculosis

Lifetime risk of developing active T.B.

1 Not Infected Infected 10 % Lifetime

2. Infected Infected 60 % lifetime

3. Not Infected Infection developing to Disease

10 % lifetime

4. Infected -Do- 8 % per Year

Expectations in a good T.B.Control programme 1.Detect at least 135 T.B. Cases in a population of 1 Lakh,out of which :-

50 should be SPUTUM POSITIVE,

50 should be Sputum

negative, 25 should be Retreatment cases & 10 should be Extra-Pulm

cases

The ratio of Sputum-positive to

sputum-negative cases should ideally be 1:1.2

Expectations from Distt. Prog.Managers(C.M.Os)

1.Improve the overall quality of services.

2.Ensure that the health facility is always attended by M.Os. at designated hrs.

3.All the doctors attending the O.P.D. are well aware of, and follow the diagnostic algorhythm 4.The Clinicians should not lay too much emphasis on Chest X-Rays.

Cough for 3 Weeks or more

Diagnostic Algorhythm

3 Sputum smears

3 or 2 positives

1 positive

3 Negatives

Register as Sp+ve give Anti T.B.Tt

Chest X-Ray

Positive

CXRNeg

Non- T.B.

KindlySee the

Next chart

Diagnostic Algorhythm(Contd)

All 3 sputumSpecimensNegative

Give Broad spectrum Non Tubercular antibioticsFor 10-15 days

Symptoms persists

Chest X-ray

Negative PositiveNon-T.B. Register asSputum negativeGive anti T.B.Tt

3.Proper selection is done of all the chest symptomatics. 4.As a rule Three good quality samples of sputum are collected from all the chest symptomatics.

5.Procure top quality (from Standard & Reputed Firms) lab consumables and Binocular Microscopes. 6.Ensure that the staining & Microscopy is of a very high quality.

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