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_ TUBERCULOSIS

CONTROL IN INDIA _

Since the upgradation, LRS has been serving as a specialised institute of TB and respiratory diseases. It pursues the following activities in relation to TB control: Execution of the Revised National TB Control Programme The LRS was included in the Extension Phase (Phase II) of the RNTCP within the country in 199528. Encouraged by the results from the pilot sites, the programme was formally launched two years later for the entire nation. The Department of TB Control has been responsible for pursuing various activities in connection with implementation of the DOTS strategy within the Institute. Case Management About 6,000 to 7,000 TB cases (amounting to 15-25 percent of new symptomatics) are diagnosed annually at the out-patient department (OPD) of LRS and its 23 DOTS centres, with both pulmonary and extra-pulmonary forms of the disease. These centres have been specially developed to act as model DOTS and microscopy centres, in order to provide both diagnostic and curative services to the catchment area of 18 lakh population in South Delhi. The quality of microscopy services has been maintained under the programme, which is reflected by the smear positive to negative ratio of 1:1. Treatment of new smear-positive cases has resulted in an overall sputum conversion rate of 84 percent and a treatment success rate of 87 percent in adults29. The default rate has been low and retrieval attempts have generally been effective in bringing patients back into treatment. Patients, not belonging to the specified area of the Institute and/or residing outside of Delhi, have been referred for treatment to their respective chest clinic or DOTS centre depending upon their place of residence. Despite diagnostic problems in children with TB, about 9-10 percent of the total cases diagnosed belong to the paediatric age group. The Department of Paediatric TB and Respiratory Diseases has effectively managed cases with complications such as pneumothorax, haemoptysis, meningitis, drug resistant TB, etc. The treatment of new smearpositive paediatric cases with DOTS has resulted in an overall sputum conversion rate of 93 percent and treatment success rate of 96 percent in children29. Between April 2002 and March 2003, more than 30,000 follow-up visits (amounting to 36 percent of the total OPD workload) were made by TB cases after their diagnoses 3. About 2,000 cases with all forms of TB (totalling 71 percent of all hospital admissions), needing either conventional or reserve drugs, were admitted for in-patient care during this period3. Indications of admission consisted of haemoptysis, secondary bacterial infection, meningitis, hypotension, pneumothorax, empyema, hydro/pyopneumothorax, respiratory failure, cor pulmonale, etc. The majority (68 percent) of TB cases were discharged after clinical improvement, whereas 13 percent succumbed to their disease 30. Programme Operation with Quality The Institute has been strictly practicing the recommended RNTCP guidelines with respect to various programme components, such as case finding, drug administration, case registration, recording, reporting, monitoring and evaluation at all DOTS centres, through its outdoor and indoor management sections. Requisite cross-checking mechanisms have been adhered to. Data on OPD and indoor patients have been compiled into monthly, quarterly and annual reports and, wherever found necessary, corrective actions taken. Monthly statistical meetings, attended by all doctors and officers, continue to find innovative

Tuberculosis - community-based standardised treatment

WHO provides technical support to the RNTCP in the areas of planning, training, monitoring, surveillance, evaluation, drug distribution, electronic connectivity, publicprivatemix and operational research.

Revised National Tuberculosis Control Program is the State-run Tuberculosis Control Initiative of the Government of India. It incorporates the principles of Directly observed treatment -Shortcourse (DOTS) - the global TB control strategy of the World Health Organization .

CHARACTERISTICS OF A TB PROGRAM I. Assign Responsibility II. II. Risk Assessment, Tuberculosis Plan, and Periodic Reassessment III. III. Identification, Evaluation, and Treatment of Patients with Tuberculosis IV. A. Patient Masks V. B. Tuberculin Skin Test (TST) for High Risk Patients VI. Rooms should be under negative pressure VII. B. Medical, Surgical, and Neurological (MS&N) Nursing Acute Care Units CALCULATED POTENTIAL UNSCHEDULED DESIGNATED TB EXAM/ SIKI TB PATIENT VISITS (PER YEAR TREATMENT ROOMS 500 OR LESS Use emergency area isolation room 501-1000 One additional TB room each additional 1000 One additional room

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operational research

training

publicprivate mix

monitoring

electronic connectivity

surveillance

drug distribution

evaluation

MBT attacks the

person

transmit

S/S OF TB

BCG vaccination

DOS Programme