TB STUDY 'PATIENT'S PERSPECTIVES'

Item

Title
TB STUDY 'PATIENT'S PERSPECTIVES'
extracted text
RF_DIS_5_A_SUDHA_PART_1

Mr. Joe Paul
REDS Rag pickers education and development
society
14.Curly street
Langford town
Bangalore - 560 0027____________________
Mr. Solomon
MAYA , Movement for youth Alternatives
111,6th main 5th Block
Jayanagar
Bangalore -- 560 0041
BOSCO
B, street
6l11 Cross, Gandhinagar
Bangalore - 560 009

Mr. Joe Paul

2214247

Mr. Solomon

6658134
6346053

Fr.Verghese

2253392

4.

Dr. Dennis Xavier
358, 8,h main road
Viveknagar
Bangalore - 560 047

Dr. Dennis
Tapfoundation@v
snl.com

5714897

5.

Sr. Lilly,
TREDA,
Sarjapur Road,
Carmalaram Post,
Bangalore - 560 035.
Ms. Indira Bandokar,
No. 601, North Block,
6'11 Floor, Manipal Centre,
47, Dickenson Road,
Bangalore - 560 042.
Sr. Elize Mary,
Navajeevan Mahila Pragathi Kendra,
Grape Garden,
Neelasandra,
Bangalore - 560 047.
Fr. Sebastian
Administrator,
St. John’s National Accademy of Health
Sciences, Sarjapur Road,
Bangalore - 560 034
Mr. Vijaya Kumar,
World Vision,
55, Lazer Road,
Cooke Town,
Bangalore - 560 005.
Joseph Chelladurai
YMCA Young Men Christian Association
6 Infantry roand
Bangalore - 560 001
Mr. Thyagarajan
DEEDS "
VI main S.K. Garden
Benson town
Bangalore - 560 046
Nandana Reddy
CWC Concern for the Working Children
303/2 LB shastri nagar
vimanapura post
Bangalore - 560 017

Sr. Lilly

8439505

Ms. Indira
Bandokar,

5583701

Sr. Elize Mary,

(PP)
5546895

Fr. Sebastian

5530724

1.

2.

3.

6.

7.

8.

9.

10

11

12

Mr. Vijaya
Kumar,

Joseph
Chelladurai

Mr. Thyagarajan

3331783

Nandana Reddy

3234270

13

14

15

16

17

18

Sr. Lauret Marie
Asha Deep
Montfortian Society
7/1 Venkatappa road
Tasker town
Bangalore - 560 051
Ms. Dona,
VIMOCHANA,
No.26, 17th Main,
HAL II Stage,
Bangalore - 560 008_____________________
Dr. Saraswathi Ganapathy,
Belaku Trust,
697, 15th Cross,
J.P.Nagar II Phase,
Bangalore - 560 078._____________________
Parsapara
71/2 First Floor
7th Cross, Bandappa road
Yeswanthpura
Bangalore APSA Association for Promoting Social Action
Nammane
Annasandrapalya
Vimanapura post
Bangalore - 560 017_____________________
Association of people with disabilities (APD)
6th Cross Hutchins road
Hennur Main road
Bangalore - 560 084

Sr. Lauret Marie

2864113

Ms. Dona,

5269307
/5360311

Dr. Saraswathi
Ganapathy,

6630463

Vnekatesh

3472701

Dr.Kshitij or
Mr.Laksha

5232749
5272111

Mr.
V.S.Basvaraju

5475165
5470390
604065

Welfare

19

St.
Lukes
Ragpickers
Programme
Pampa mahakavi road
Chamrajpet
Bangalroe - 560 018

20

Griha Karmika Okkoota
2, Mi Ilers road
Bangalore - 560 046

3330433
8/333083
8

21

Churches’ council for child and youth Mr.
Chakaraborty
care in south India
Lavelle road
Bangalore -560 001
Promod John
Prakruti
79,kariyanapalya
Lingrajapuram
Bangalore - 560 084

2210098/
2211412

Ms. Dorothy

5454653

22

23

New Horizon trust for disabled
354, 10lh main 100 feet road
Dodda Banaswadi
Bangalore - 560 033

5469550

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DEFINITIONS: THE REVISED NATIONAL TUBERCULQSiS CONTROL PROGRAMME
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CASE DEFINITIONS

TYPES OF CASES

Pulmonary tuberculosis, Smear-positive
TB in a patient with at least 2 initial sputum smear
examinations (direct smear microscopy) positive for

New
A patient who has never had treatment for

AFB,
Or: TB in a patient with one sputum examination
positive for AFB and radiographic abnormalities
consistent with active pulmonary TB as determined by
the treating MO,
Or. TB in a patient with one sputum specimen
positive for AFB and culture positive for M. tb.
Pulmonary tuberculosis, Smear-negative
TB in a patient with symptoms suggestive of TB
with at least 3 sputum examinations negative for AFB,
and radiographic abnormalities consistent with active

I

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pulmonary TB as determined by a MO, followed by a
decision to treat the patient with a full course of anti­
tuberculosis therapy,
Or Diagnosis based on positive culture but
negative AFB sputum examinations.
Extra-pulmonary tuberculosis

TB of organs other than the lungs, such as the
pleura (TB pleurisy), lymph nodes, abdomen, genito­
urinary tract, skin, joints and bones, tubercular
meningitis, tuberculoma of the brain, etc.
Diagnosis should be based on one culture-positive
specimen from the extra-pulmonary site, or
histological evidence, or strong clinical evidence
consistent with active extra-pulmonary TB followed by

tuberculosis or has taken anti-tuberculosis
drugs for less than one month.

TREATMENT OUTCOMES

Cured
Initially smear-positive patient who has
completed treatment and had negative sputum
smears, on at least two occasions, orre of which

Relapse
A patient declared cured of TB by a
physician, but who reports back to the health
service and is found to be bacteriologically

was at completion of treatment.________________
Treatment completed
Sputum smear-positive case who has completed

positive.___________________________ _____
Transferred in
A patient who has been received into a

initial phase but none at the end of treatment.
Or: Sputum smear-negative TB patient who has

Tuberculosis Unit/District, after starting
treatment in another unit where he has been

recorded._________________________ _
Treatment After Default
A patient who received anti-tuberculosis

treatment for one month or more from any
source and who returns to treatment after
having defaulted, i.e. not taken anti-TB drugs
consecutively for two months or more.
Failure
A smear-positive patient who is smear­
positive at 5 months or more after starting
treatment. Failure also includes a patient
who was initially smear-negative but who
becomes smear-positive during treatment.

Chronic
A patient who remains smear-positive after

a MO’s decision to treat with a full course of anti-TB
therapy.
Pleurisy is classified as extra-pulmonary TB.

completing a retreatment regimen.

A patient diagnosed with both pulmonary and extrapulmonary TB should be classified as pulmonary TB.

mentioned categories. Reasons for putting a
patient in this category must be specified.

“Other”
Patients who do not fit into the above-

treatment, with negative smears at the end of the

received a full course of treatment and has not
become smear-positive during or at the end of
treatment.
Or: Extra-pulmonary TB patient who has
received a full course of treatment and has not
become smear-positive during or at the end of
treatment.___________________________________ _
Died
Patient who died during treatment, regardless of

cause.____________________ _ _____________ Failure
Smear-positive case who is smear-positive at 5
months or more after starting treatment. Also, a
patient who was initially smear-negative but who
became smear-positive during treatment.
Defaulted
A patient who, at any time after registration, has

not taken anti-TB drugs for 2 months or more

consecutively.
_____________________
Transferred out
A patient who has been transferred to another
Tuberculosis Unit/Districtand his/her treatment

results are not known.

1

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revised national tuberculosis_contrQl_pI1Q^B^MM^

Tuberculosis Register

Year:

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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

Tuberculosis Register
TB
No.

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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

Year: u*0l

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TB
No.

41
4243

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Tuberculosis Register

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Year:

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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

Tuberculosis Register
TB
No.

Sex Age
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Name
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Date
of
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Date of Regimen/ Disease
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Tuberculosis Register
TB
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Name of
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Tuberculosis Register
TB

Date

No.

erf

Sex Age t
M/F

Name
(in full)

Name of
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Compiste address

regis­
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j

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M

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REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

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TB
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TB
No.

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Sputum examinatk

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in fi/Q

Age

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Name of
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M/F

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t

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Type of Patient

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Dear
Subject: A study on the patient’s perspective regarding TB treatment

Greetings from Community Health Cell!
2V>

oJl-Si— O—5-P

.

5

•£'‘11

/Yeu-may-be aware that tuberculosis contmues to be causing a lot ot
~suffeHng to the-patient'mid her B his family in many waysYThe poor kt
affected more because of their pM-"socio economic status.flt is hoped that
the finding of the study would help in
poh^y chMftW^r^

vSfcyKj
In Ihis connection we would like to request you to give the names of TB
patients from the slums where you are working, who
from the govemment^Ae private health institutions^ We may select some
of them for die study and we would need your W
6
would appreciate if you could send the list before^^M^2001.
..< ry'--'--:.

With Best Wishes!
Yours sincerely,

For Community Health Cell
S.J.Chander
'V

'.1

?>

WTBD brief access

Paue 1 o^'5

World TB Day 200! Brief
English

French

Spanish

World TB Day — 24 March 2001
"DOTS: TB cure for all"
" IVe have heard Ministers agree that no one should be denied access to DO TS. This means that DOTS
should be available to all who need it, wherever they live, whether they are young or old, man or woman,
homeless or housed, jaded or free. "

Dr Gro Harlem Brundtland. Director-General. World Health Organization
Ministerial Conference on TB and Sustainable Development. Amsterdam. 24 March 200G
The theme for World TB Day 2001, ’’DOTS: TB cure for all”, calls for equitable access to TB services for
anyone who has TB, free from discrimination—rich or poor, man or woman, adult or child, imprisoned or
free, and including other vulnerable groups such as people with HIV or drug resistant TB TB cure for all
contributes to the fulfilment of everyone’s right to the enjoyment of the highest attainable standard of health

The tw o main objectives of this year's campaign are:t

1) To mobilize political leaders and decision-makers around the world about the situation of TB sufferers, the
implications of TB for human development, and the fact that there is no excuse for inaction in the face of an
available, cost-effective cure
2) To raise awareness that a cure for TB is available and that accessing and completing TB treatment, without
stigma and discrimination, is an important step in realizing one’s right to the highest attainable standard of
health and well-being.
The theme, ’’DOI'S: TB cure for all”, promotes the principles of the Amsterdam Declaration to Stop TB
Through the Declaration, countries committed themselves on World TB Day 2000 to expand DOTS coverage
with the goal of making DOTS accessible to all who need it. They noted "with grave concern that the
magnitude of the suffering and death caused by TB is both alarming and unacceptable". The Declaration
further states that:

• Access to life-saving tuberculosis control programmes providing safe, high-quality drugs opens doors
to life's opportunities by getting people back to work and school
• Effective treatment and cure of tuberculosis is one of the most tangible interventions available to extend
the life of persons with HIV/AIDS
’’DOTS: IB cure for all” reflects the important role of governments and the private sector in providing TB
drugs and services It points to the need for health services to be patient-centred and non-discriminatory. It
challenges DOTS providers to continue to reach out and adapt DOTS to the needs of their TB patients. It
highlights the crucial role of DOTS workers and the community in ensuring that the right to health for each
patient becomes a reality, even in remote communities and among minority populations. It is a call to civil
society to provide an environment that encourages everyone with TB to seek treatment and cure DOTS is
used here in its broadest sense as an umbrella term for all DOTS-based strategies, including DOTS plus for
multidrug-resistant TB and TB/HIV

Home.New Stop TB Movement

'

Paiie I of 1

Stop TB Hone

the Stop TB Snitiptive

vf.'z III-1 I tttr’r>e-'>n
'■ •
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lobal
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World TB Day - 24 March 2001
"Dots: TB cure for all"

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World TB Day 2001 "DOTS: TB cure for all"
Contact Us
calls for equitable access to TB services for
anyone who has TB, free from discrimination— Fl Site Map
rich or poor, man or woman, adult or child,
Search
imprisoned or free—and including other
vulnerable groups such as people with HIV or
MASSIV>
drug-resistant TB TB cure for all contributes
t0 the fulfilment of everyone’s right to the
enjoyment of the highest attainable standard of
health.
Click here to obtain the World TB Day Material

Pack online.

WTBD brief access

Pane 2 of 5

TB Treatment for All" was also the theme of a 2000 campaign (www.iuatld.org) launched by the
International Union Against TB and Lung Disease (IUATLD), inspired
inspired by
by Archbishop
Archbishop Desmond
Desmond Tutu
Tutu
Archbishop Tutu made a moving and passionate declaration to attract the world’s attention to the fact that
despite the existence of a powertul and inexpensive tool to combat the disease, fewer than 25% of TB
sutterers worldwide have access to affordable and effective treatment strategy.

Desmond Tutu spoke on behalf of tuberculosis patients everywhere urging that governments, the United
Nations and development agencies the world over, take this responsibility seriously and make TB treatment
and cure available to everybody who needs it to stop the TB epidemic. "Every person with TB has the right to
treiated:!Or h'S °r her diSeaSe- TB Can be cured this scourSe can be defeated. So let us stop denying them
this basic human right”.
'
J 6
Back to Home Page - Top of Page

/

To
S J Chancfer
367 Srinivasa Nilaya
Jakksacfra 1 main 1st dock
Koramangala Bangalore 560 034
Sub; invoking GPs inTB Control

Dear Chandai,
Th Jinks for the letter. As per your requirement I am sending the addess list of our iwmlxxs. .
You can select as per your specification I will be announcing the same in old CME pro^amme on 25th Feb
2001.

Thaniing you.
Yours truly

Dr Mohan
Hon Secretary- IAGP
613 2nd main first Stage
Indranagar Bangalore 560 038
dpanohaiig^vai^com

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Ind. J. Tub., 1995, 42, 101

Original Article

PERFORMANCE OF NATIONAL TUBERCULOSIS
PROGRAMME IN 1993: AN APPRAISAL*

///

L. Suryanarayana1, K. Veinbu2, R. Rajalakshmi’ and C. Satyanarayana'

fSummary : National Tuberculosis Institute^

5
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31

(NTI), Bangalore has been monitoring the
National Tuberculosis Programme (NTP)
since 1978. District Tuberculosis
Programmes (DTPs) numbering 390
registered by Directorate General ot Health
Services (DGHS), are covered under such
monitoring. The percentage of DTPs
implemented accounts for 81% ot the total
districts and 64% of such DTPs have been
covered under Short Course Chemotherapy
(SCC). As far as Peripheral Health
Institutions (PHIs) are concerned, 56% of
the available health institutions (His) have
been implemented. Reporting efficiencies
of the DTPs and the PHIs are 78% and
70%-respectively. Only 41% of the PHIs
have been supervised by the respective
District Tuberculosis Centres (DTCs) (i.e.,
at least once in a quarter). The smear
positivity rates are 12.3% and 4.8% at
DTCs and PHIs respectively. As far as
case detection efficiency of smear positive
cases is concerned, DTCs have achieved an
efficiency of 71%,and PHIs 36%. Quality
of X-ray reading and smear microscopy,
as reflected by smear confirmation rates,
among the pulmonary cases diagnosed are
20% and 24% respectively. Treatment
completion rates derived from the annual
cohort analysis reports are 34% for standard
regimens, 44% for SCC Regimen A and
52% for Regimen B. Out of the 276 DICs
reporting on the availability of trained
man-power and equipment, trained District
Tuberculosis Officers (DTOs) are posted
in 56%, X-ray Technicians in 60%,
Laboratory Technicians in 73%, rI reatment
^Organisers in 73% and Statistical Assistants^/

/in 46% of the DTCs. Only in 15% of the^

DTCs is there a full complement of trained
staff. As far as equipment is concerned, Xray equipment Is available in 84%,
microscopes in 96% and vehicles in 76%
of the DTCs. Achievements in all aspects
fall short of the expectations in fulfilling
the objectives set for NTP; therefore,
concerned • authorities have to take
appropriate remedial measures to achieve
the goal of NTP.

Introduction
NTI has been monitoring (he NTP since
1978. Monitoring is a continuous assessment of
certain key indicators of the programme through
periodic reports. Repons contain information on
case-finding and treatment activities and oilier
related aspects. The reporting under NTP involves
two tiers: the first tier is the Pills which report
to DTC and the second tier is the DTCs which
reports to the state and national levels. Reports
received al the Nd I are analysed in respect of
some key indicators developed as a result of
operational studies carried out al die NTI. The
results of the analysis are communicated to die
concerned disiricts/statcs for taking necessary
corrective actions.

Objective
This paper appraises the performance of
NTP in terms of implementation, reporting,
supervision, performance of case-finding and
treatment activities and availability of trained
manpower and equipment, for the year 1993.

• Paper presented at 49th National Conference on Tuberculosis and Chest Diseases. Pondicherry. 6-9 October. 1994
I. Chief Medical Officer. 2. Statistician. 3. Statistical Assistant.
National Tuberculosis Institute. No. X. Bellars Road. Bangalore 560003

Correspondence : Dr. C. Suryanarayana. Chief Medical Ollicer
NTI. No. 8 Bcllary Road. Banvalore 560 003





...

id

SURYANARAYANAET AL

102

positive cases
community*

Material & Methods

Four quarterly DTP Reports on case-finding
and treatment activities and Annual DTP Reports
on cohort analysis of the treatment results for the
prescribed cohort periods emanating from the
different DTPS constitute the material for this
paper. Reports received at NTI have been
scrutinised and consolidated state wise and on All
India basis. Incomplete and/or grossly incorrect
reports have been excluded from the analysis. In
all 1194 Quarterly Reports out of 1223 received
(1560 expected) have been considered for assessing
die case-finding activity. For the determination
of die treatment outcome, only 152 out ot 5/«
Annual Reports expected for Standard Regimen
(SR) for the cohort period July 1990 to June
1991,and 94 out of 234 reports expected from
SCC-DTPs (cohort period Jan-Dec 91) have been
considered. Data arc presented for DTC and PHIs

(iv)

Smear positivity irates, out of total spurn
examined are expectedt to be as follows:

Al DTC : 18%3
Al PHI : 8%

The above figures3 of expectations (based
of reasonably good performing
on achievements c. -D I'Ps) arc lower than the potential arrived at in
die operational studies conducted at NTI4-5.
Smear Confirmation of Pulmonary Cases

C.

i)

Expectations for the above indicators are
arrived at on the basis of :
(i)

(ii)

Population aged1 5 and above as per
mid 1993
1 — estimated population,

implenufH
of snidtfr
r<
"vsA
D * v^s will
the noiuc
sanciinrvd
stipuLmuDTPs inn
regisierd
fulfill ’He
enables T
Centra* f
cquipmrnl
Radiognp
in the
adininHU*.
they arep
chest chin
that all de.
under thi:
tubcrculoi

NTI4.

Case - finding

Sputum examinations, and
Detection of smear positive cases.

•Arfi
distric's-^
1991
Only ift’o
80% mrcspcd
48% of t
terriv'.^'
district
implonWf

the basis of 8rX« smear positivity rate.

The expectation is that 35% of pulmon^
cases deiccteu
detected arc
are smvcu
smear positive3 which is less
dian 55% potential as per studies conducted at

terms of

1)

It is
is expected
expected that
dial in
It
in an average district
....................
:
j
o
f
1.8
million,
DTC detects
with a population c.
500 smear positive cases per year @ 18% of die
conducted
total number of sputum (examinations
---------and PHls detect 2,0()6 smear positive cases on

Supervision

Efficiency of case-finding is measured in

II

(i)
(ii)

(d)

DTC is K)0%.

<1

patiedf-1
of tr(<yai<
trcathffii
liewtyt'iT/

Sputum Smear Positivity Rate

(c)

^T.

'(‘da

Achievements of a reasonably good
performing DTP in the country.

(v)

The expectation in respect of implementation,
reporting by DTCs to higher levels, and by
PHIs to DTCs and supervision of PHIs by

r

ii)

Coverage of PHIs under DTP and

Implementation, Reporting efficiency &

(a)
(b)

above
com pF.
>75% of

the

patients2.

Efficiency of a DTI’ is assessed by comparing
its achievements with the expectations. Expectations
from various activities are as follows :

B.

in

52% action taking by the tuberculosis

(iii)

separately, representing the average pcrtormance
of each district in a State for 17 big States and
collectively for 8 small Slates and 5 Union
Territories (as si. no. 18) in each Table.

A.

of 0.4%

Treatment outcome

Treatment Completion Rate

Standard Regimen (SR): Expectation here
is determined by percentage of patients making/
completing 12 or more drug collections/
consumptions over the treatment period of 18
months and is 100%.

Short Course Chemotherapy (SCC) :
.....................
Expectation is determined by the percentage of
ptients completing 75% and above of
expected
druo collcctions/consumptions and is 100 /o Hus
is based on the fact dial cure rate of 85 /o and

Prevalence rate of bacteriologically

? €: •

1I
'il

Ii

c
To in

the

•^bjculosis
and
good

country-

PERFORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME

above can be achieved only when all the patients
comply with the collcction/consumption of
>75% of the expected drug collections6.

I11

il

ii)

1
II

Cure rate

Cure rate is percentage of smear positive
patients converting to negative status at the end
of treatment period out of those initiated on
treatment. Expected cure rate is > 85% among
newly diagnosed patients according to the WHO

Guidelines7.
sputa
■I

103

Out of 390 implemented DTPs, (64.6%)
252 DTPs have been covered under SCO. Only
Gujarat has die distinction of covering 100% of
the districts under SCC. Only 5 States (including
Gujarat) have covered 80% or more of the DTPs
under SCC. Four States have implemented less
dian 50% and Bihar accounts for die lowest
percentage of 19. Small States/Uls have a
coverage of 77% of DTPs under SCC.
Here, it is suggested dial emphasis should
be on consolidating the gains of SCC in the
entirety of the implemented districts instead of
extending it piecemeal to new districts (DlPs).

OBSERVATIONS & DISCUSSION
Implementation of Bills

2)
I

TUt'rtgc district
jrre detects

1)

Il

Al national level, 390 DTPs out of 480
districts (81.2%) in different States/UTs (as per
1991 census) have been registered by DGHS.
Only 12 out of 17 big Stales have implemented
80% or more of the districts available in the
respective States. Assam has implemented only
48% of the districts. Small States & Union
territories pul together have only 45% ol the
districts implemented. No new I)IPs were
implemented during 1993.

of the
p.frv; conducted
cases on

u-inVi-.
- ^ipns (based
A^ipcrfonning

t miP^ri70^ al in
~ sdau NT I ■

^♦nary Cases

"

nulmonary
.ch is less
conduGtcd at

}:1 Expectation here
^■patients making/
collections/
w!|t period of 18

^I.rapy (SCC) ■
b,A).»e percentage ol
;?.,ye of the expected
wand is 1<X)%. This
,C; rate of 85% and

--------

Implementation ot I) IPs (I able 1)

IIII

I

1I

Some Slates have reorganised the originally
implemented districts (D TPs) into varying number
of smaller districts for administrative and other
reasons. Certain Stales have created additional
DTCs within the existing DTPS. It has come to
the notice of the Nil that certain States have
sanctioncd/crcaied splinter DlPs without the
stipulated infrastructure. 1 his needs to be avoided.
DTPs functioning in such districts may gel
registered by DGHS in course ol time, after they
fulfill the prerequisites. Registration by DGHs
enables the DIPS to gel assistance from the
Central Government such as vehicles. X-ray
equipment. 50%’ ot the drugs and Mass Miniature
Radiography (MMR) film rolls. Ninety districts
in the country remain unimplcmcntcd due to
administrative and financial constraints, though
they are providing tuberculosis services through
chest clinics or in some other form. It is essential
that all the districts in the country arc implemented
under the programme to have lull coverage ot
t ubereu losis scrv ices.

It is expected that there should be one
Primary Health. Centre (PHC) for a population
of 30,000 in plain areas and 20,000 in hilly areas.
The expected number of PHIs in the country
works out to 29,794 but there arc about 29,500
health institutions (His) of various categories
available for implementation. Out ol these, otdy
16,830 i.e. 56% of die His, have been implemented
under the programme. Only lour Slates have 80%
or more of the His implemented under D TP. Four
other States have achievement of less than 50%
in this respect. Small States & UTs have a
coverage of 56%. Among the DI Ps covered
under SCC, the coverage of PHIs under SCC is
47%- at all India level (not given in Table).
Since the His situated mostly in rural areas
cater to large proportion ol population in the
country, the stress should be on implementing all
of them under DIP, in general. In case ot Dlls
covered under SCC, all Pills should be brought
under SCC, before extending the SCC to other

DlPs.

a:

Reporting by I)IPs (lable 2)

At national level, 78% efhcicncy of reporting
overall.
Only 10 big States and all. Small
is
States and UTs pul together have a reporting
efficiency of > 80%. Bihar has less than 50%
efficiency.

Reporting is a prerequisite for cl fee live
monitoring ot the programme. Hence, il is

so?



SURYANARAYANA ETAL

104

Table 1 : Implementation of. DTPs

%

No.

%

3

4

5

6

7

23

23

100

19

83

59

48

8

73

41

23

11

19

15

51

63

6

Bihar

32

19

100

19

100

89

Gujarat

19

11

69

3

Haryana

16
12

11

92

6

Jammu & Kashmir

14

10

71

Karnataka

20

20

1

2
Andhra Pradesh
Assam

2.
3.
4.

5.

7.
8.

10.
11.

12.
13.

14.
15.

16.
17.

•i 1i

I

18.

Si:l

1.

Ai4-

2.

A^u

BU

58

5.

rice

55

224

6.

rm

70

44

7.

7

Jan

14

70

Ill

8.

Kn

100

55

14

7

■Kxr

86

58

9.

12

80

S3

45

100

36

Madhya Pradesh

45

100

26

87

Maharashtra

30

75

30

13

100

8

62

63

13

100

4

33

56

12

12

96

10

37

53

Orissa
Punjab

10.





11.

Mj

12.

Or

13.

Hi

-

Ra

Rajasthan

28

27

88

Tn

Tamil Nadu

73

14

15.

16

77

22

54

30

Ut

63

89

30

16.

56

94

11

69

36

17

16

26

45

20

77

56

Uttar Pradesh
West Bengal

Small States
and UTs

INDIA

58

17.
18.

A
IN


480

390

81

248 @

64

56

'

■ \-

@ Excludes 4 districts monitored by TRC. Madras

,7; 1 sl_.

'

1/

in
1

U1P

Go

Kerala

9.

SI
No

4.

Himachal Pradesh

6.

a-

Pills
imple­
mented

No.

No

1.

% of

DTPS under
SCC

Functioning
DTPS

No. of
dis­
tricts

States/
UTs

SI

1

PHIs and introduction of SCC according to Slates - 1993

......

* •



1

I

performance of national tuberculosis programme

lies - 1993

Table 2. Position oj Reporting <6 Supervision in DTPs

I

% Of

Pills
imple­
mented

SI
No

8

1

i

States/
UTs

105

according to States-1993

Quarterly DTP Reports

Received

%

Pills
Reported
%

3

4

5

6

7

92

81

88

86

43

44

41

93

57

28

128

56

44

37

17

Expected

2

Pills
Supervised
%

1.

Andhra Pradesh

2.

Assam

'S

3.

Bihar

89

4.

Gujarat

76

73

96

5.

97

58

I laryana

47

44

37

84

84

Himachal Pradesh

36

44

27

61

50

23

40

24

60

68

29

68

85

77

59

48

36

75

46

18

180

129

72

57

16

120

92

77

87

69

52

49

94

81

34
31

59
41

224

> I

I

6.
7.

Jammu & Kashmir

8.

Karnataka

55

9.

Kerala

S3

10.

Madhya Pradesh

75

11.

Maharashtra

63

12.

Orissa

13.

Punjab

48

43

90

14.

62

Rajasthan

108

88

81

52

36

64

63

98

62

39

196

88

67

42

35

55

22

14

104

85

82

66

44

1560

1223

78

70

41

44
111

56
53
77

I

30

36

56

56

I

}
I
II

II
1

.i:

80

15.

Tamil Nadu

16.

Uttar Pradesh

224

17.

West Bengal

64

18.

Small Stales & UTs

INDIA

i

4
!'
I

4“

ti

SURYANA.RAYANA ET AL

106

expected drat all die implemented DTPs submit
dieir quarterly and odicr reports to die Central
and State audioritics in time. As such, States have
to achieve die desired expectation of 100%.
About 3% of die reports received from Dlls
could not be considered for analysis due to large
number of discrepancies and inconsistencies.
Shortcomings in reporting, in terms of quantity
and quality are attributable to lack of trained
Statistical Assistants in DTPs. Also, rcmtmlers/
feed-back reports sent by NTI to die DTPs do
not seem to have been token note of by State/

throughout the district. Reasons for the low
performance in this regard are: i) non-avarlabihty
of trained personnel in the DTC, ii) non-availability
of vehicle, iii) diversion of available vehicle to
other programmes, iv) inadequate provision of
budget for vehicle and travel expenses and v)
lackof motivation of concerned staff even thoug i
facilities are available. Suite authorities have to
take appropriate measures to overcome die above
deficiencies.

Reporting by PH Is (Table 2)

-At DTCs

Bihar and West Bengal.

1;

Shortfall in diis regard is mainly due to
inadequate supervision of PHIs by the personnel
of Hie DTCs and higher dstncl level oilicers.
Medical Officers of PHIs need to be sintably
motivated by district level officers in despatch
of mondily reports to DTCs regularly and m tune.

Takino into account the efficiency of
reporting by DTPs (78%) and PHIs within them
(70%), die overall picture is truncated, rcllectmg
only 55% of die: expected reports from all the
DTPs in die
llic country. Steps are to be
I-- taken
------ by
the administrative authorities at S.
State/UI
—- - level
l0 improve thp.
the nerformance
performance inin (his
this respect.
respect.
5)

At D I
spu .1 pos
Andhra IYr
15.0% spin
sputum pos
15.0%. Six
could attaii
5.8% to 91

Efficiency of Case-finding

At all India level, only 70% of the PHIs
have reported to their respective DTCs compared
With the expectation of 100%. Only five b.g
States have achieved an efficiency of >80 A m
this respect. Reporting by PHIs is particularly
poor (less dian 50%) in three States viz... Kerala,

H

Achievemtf
(Tables 3 .

PERFORMANCE OF NIP

District authorities.
4)

should be x
observed sh
of Laboraw
of the Pin*
2.5% of 51
symptom aM
most of lift
case deteci

Supervision (Table 2)

• i 41% of the Pills
At national level, only
..J
\
j
the
have been supervised by t.-~ DTC staff al least
Maharashtra (69%) and
once in a quarter. Only
I
achieved efficiency of
Karnataka (59%) have
States
could not achieve
more than 50%. Seven
even 30% efficiency oni this score. Supervision
Pills by the key personnel ol the ^1^’

programme to ensure mamtenanee of work
standards, replenishment oi supplies and equipment

At national level, diough die efficiency of
sputum examinations is more dian 100% (not
shown in Table), die efficiency of case detection
'(sputum positive cases) is of die order of 71%
only. Four States and all small States and IT s
put together have achieved more dian 100 A
efficiency. Eight other States have achieved more
dian 50% efficiency and five States could achieve
only less than 50% efficiency. The performance
of Bihar is die lowest (15%), closely followed
by West Bengal (21%). Since trained personnel
are expected to be available at DTCs, perfomiancc
of 71% case detection is inadequate. Suitab e
remedial measures need to be taken by concerned

At
4.8%. Only
more than
positivity n
have attaim
pcrformanc
ranges fror

Expcc
positivity T
all 'car x
she > achi
average of
is quite di:

State authorities.
At PH Is (Table 4)
Al all India level, the efficiency of sputum
examinations is 61%. While Maharashtra and
Small States and UTs could achieve more than
80% efficiency, the performance ot all odier
States is not satisfactory. Eleven out of 17 States
could achieve efficiency of less than 50%
[performance of West Bengal (10%), Assam
(15%) and Bihar (18%) being very poor]. As
regards detection of sputum positive cases, die
alf India average is only 36%. Only two big
States (Gujarat & Maharashtra) have achieved
more than 50% efficiency. The performance of
14 Slates is even below 30% efficiency.

The
achieving tl
for strengtl
DTC and
supervision
providing
Technician;
ensuring si
stains. Mic
in proper *

Smear Co
pulmonary

It is relevant io point out that all the
eligible chest sympiomalics attending the PI Us

Tabic

■'





PEKI-ORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME
)r the low
-availability
ravailability
• vehicle to
jrovision of
ises and v)
even though
tics have to
ic the above

j

should be subjected to smear examination. The
observed shortcomings arc due to non-availability
of Laboratory Tcchnicians/Microscopists in most
of the PHIs. Generally, it is expected dial about
2.5% of die new outpatients would be chest
symptomatics. Vast improvement is needed in
most of die Stales to step up die efficiency of
case detection, both at DTC & PHI levels.

I
efficiency of
i 100% (not
asc detection
>rdcr of 71%
ties and UTs
dum 100%
chicvcd more
could achieve
performance
scly followed
icd personnel
;, perfonmmce
date. Suitable
by concerned

ncy of sputum
iharashtra and
eve more than
i of all oilier
ml of 17 States
jss titan 50%
(10%), Assam
very poor]. As
ilive cases, the
Only lwo big
have achieved
performance of
tfficicncy.

Achievement of Sputum Positivity Rates
(Tables 3 & 4)
At DEC level, only Maliaraslitra has achieved
sputum positivity rate of about 20.7%. Gujarat,
Andhra Pradesh and Rajasthan have more than
15.0% sputum positivity. Seven other Stales have
sputum positivity rate in the range, of 10.0%15.0%. Six big States and small States and UTs
could attain smear positivity rale in the ram’e of
5.8% to 9.8%.



At PHI level, the national average is only
4.8%. Oidy West Bengal & Gujarat have achieved
more than die expectation of 8.0% sputum
positivity rate. Karnataka, Maharashtra and Punjab
have attained > 5.0% sputum positivity rale. The
performance of ad other Stales and UTs which
ranges from 1.9% to 4.6% is not satisfactory.
Expecting that DTCs should achieve 18%
positivity in detection of smear positives among
all smear examinations carried out, while Pills
should achieve al least 8% positivity, the all India
average of 12.3% for DTCs and 4.8% for Pills
is quite discouraging.

I
I

The poor performance by the States in
achieving the desired sputum positivity rales calls
lor strengthening of laboratory sendees, both at
DIC and PHIs. And proper and adequate
supervision by DTOs. This could be achieved by
providing adequately trained Laboratory
Technicians both al DTC and PHI levels and
ensuring supply of good quality chemicals and
stains. Microscopes also need to be maintained
in proper working condition.

Smear Confirmation among all
pulmonary cases

ul that all the
aiding the PHIs

I able 5 gives percentages of sputum positive

4'

■■■■■

V.

107

eases confirmed among pulmonary cases, (smear
positive and X-ray suspects), both at DTC and
Pills.
It may be observed dial die confirmation
rate is only 20% in die case of DTCs and 24%
in respect of PHIs, at national level. It is expected
dial diis rate should be about 30-35% (as in a
reasonably good performing DTP) at DTC level.
This confinnation rate is more relevant in
DTCs where ease-finding is based upon
MMR screening followed by smear examination.
In the ease of PHIs, the diagnosis is by
smear examination preceded by symptom
screening.

At D1C level, only the performance of
Andhra Pradesh, Karnataka, Maharashtra and
Orissa could he considered as satisfactory. Five
other big States have achieved confirmation rale
in the range ol 20-29%. The performance of
Assam and Bihar is very poor (i.c. below ten
percent).
At PHI level, three States - Andhra Pradesh,
Orissa and Maharashtra have achieved >35%
confirmation rate. Six other big and all small
States mid UTs have attained 20-29% confirmation
rale, while all oilier States are below dial level.
The performance of Bihar and Himachal Pradesh
is very poor.
Bacillary confirmation rate of pulmonary
cases rellects the quality of X-ray reading by
Medical Officers. Confirmation rate around
35% could lie considered as reasonably good,
while rates below 35% indicate over-reading
of X-rays, assuming that the quality of laboratory
services is of reasonably good standard. In
such cases, quality of X-ray reading by Medical
Officers needs to be reviewed. The NTP aims
at detection and treatment of smear positive
cases on priority basis in order to cut the chain
of transmission of the disease. But, in reality,
it is the X-ray cases (smear negative but Xray positive) which outnuml>er the smear
positive cases by about 3*/2 times. T his causes
wastage of scarce resources as all may not be
tuberculosis cases.

SURYANARAYANA ET AL
108

District) according to Stales-1993

Table 3. Case-finding in DTCs (Average per

SI
States/
No. UTs
2

1

k

L

5
4

ij

r.

ft

1.

Andhra Pradesh

2.

Assam

3.

Bihar

4.

Gujarat

5.

Haryana

6.

Himachal Pradesh

7.

Jammu & Kashmir

8.

Karnataka

9.

Kerala

10.

Madhya Pradesh

n.

Maharashtra

12.

Orissa

13.

Punjab

14.

Rajasthan

15.

Tamil Nadu

16.

Uttar Pradesh

17.

West Bengal

18.

Small States & UTs
INDIA

New sputa
examined
(No)

+ve
cases
found

Positivity
rale
(%)

Expected
sputum
+ve cases

Effi­
ciency
%

4

5

6

7

3

581

16.3

812

72

3558

96

7.4

274

35

71

6.9

476

15

711

17.4

610

117

493

289

171

4743

10.4

5.8

121

107

2207

129
91

9.8

155

59

270

11.9

631

43

273

10.4

583

47

243

14.3

413

59

804

20.7

739

109

387

684

57

2931

13.2
13.0

474

65

2356

307
298

15.7

441

68

393

6.7

713

55

620

54

335

9.8

1124

21

231

13.9

89

194

173

8.0

12.3

495

71

1293
1036

4077

925

2278
2627
1703

3889

1897
5882
3435

1657
2151

2851

350

SI. StarisZ.
No Ull^!

1

2

1.

A'dh

2.

3.

Bfcu

4.

Gmi

5.

Hirr.

6.

Him

7.

Jam;

8.

Kan

9.

Kex7

10.

M$'

11.

Mdt

12.

Ori<

U.

Pun

14.

Raji

15.

Tmi

16.
17.
18.

Snr
& ’

INI

PERFORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME

109

Table 4. Efficiency of sputum examinations & sputum positive cases diagnosed in PHIs
according to States-1993

Effi­
ciency
%

New sputa examined
SI. States/
No UTs

7

Sputum + ve cases diagnosed

Sputum
positi­
vity
rate
%

Expec­
ted

Perfor­
mance

Effi­
ciency

Expec­
ted
%

Perfor­
mance

Effi­
ciency
%

3

4

5

6

7

8

9

72
1

2

1.

Andhra Pradesh

23950

8705

36

1916

397

21

4.6

117

2.

Assam

6838

995

15

547

26

5

2.6

171

3.

Bihar

11888

2125

18

951

42

4

2.0

4.

Gujarat

27162

14229

52

2173

1193

55

8.4

5.

I laryana

8375

4881

58

670

181

27

3.7

6.

Himachal Pradesh

6050

1608

27

484

30

6

1.9

j

7.

Jammu &. Kashmir

3875

1133

29

310

35

11

3.1

'■'i

8.

Karnataka

31575

8372

27

2526

528

21

6.3

9.

Kerala

16050

4226

26

1284

112

9

2.7

10.

Madhya Pradesh

17125

4194

24

1370

124

9

3.0

11.

Maharashtra

27700

23226

84

2216

1346

61

5.8

12.

Orissa

21538

10265

48

1723

361

21

3.5

13.

Punjab

13288

9653

73

1063

484

46

5.0

14.

Rajasthan

11688

2705

23

935

111

12

4.1

15.

Tamil Nadu

27450

18641

68

2196

562

26

3.0

16.

Uttar Pradesh

15500

9966

64

1240

351

28

3.5

17.

West Bengal

28112

2744

10

2249

262

12

9.5

18.

Small States
& UTs

3342

• 3588

107

267

117

44

3.3

INDIA

13862

8416

61

1109

404

36

4.8

35

I

15

107

59
43

47

59

57

i

65

I

109

68

55
54
21
194

71

I

I
i
I

1
i
IL

SET?'

p;.'-

.4

SURYANARAYANA CT AL

110

Table 5.

and PH Is according to States-1993

Cob
PHIS

DTC

|?S

SI
No

States/
UTs

I

2

L
r

I

4

4'
I
4'- '

4

refe
a gi
of

Pulmonary
cases

Sputum
+vc

%

Pulmonary
cases

Sputum
+ve

%

3

4

5

6

7

8

30

1087

397

37

1.

Andhra Pradesh

1918

581

1088

96

260

26

10

2.

Assam

9

yea
bee
arc

71

6

42

8

a)

3.

1098

538

Bihar

711

28

5061

1193

24

Gujarat

2546

832

181

22

Haryana

493

28

5.

1786

783

129

436

30

7

Himachal Pradesh

16

6.

341

91

241

35

15

Jammu &. Kashmir

27

7.

270

33

528

25

8.

826

2148

Karnataka

1530

273

698

112

16

Kerala

18

9.

1306

243

589

124

21

Madhya Pradesh

19

10.

Maharashtra

804

30

3886

35

11.

2670

1346

387

34

361

37

12.

1136

986

Orissa

1687

484

29

Punjab

307

25

13.

1244

1177

298

25

111

22

Rajasthan

506

14.

393

19

562

15

15.

2057

3852

Tamil Nadu

335

12

351

19

16.

2802

1808

Uttar Pradesh

2375

262

11

West Bengal

231

15

17.

1504

173

106

22

919

484

Small Slates & UTs

19

18.

1711

350

20

1704

404 ■

24

INDIA

4.

XT

TRI

Confmnation of sputum positive cases among pulmonary cases in DTCs

b)

(a)

Re
coi
anof
ref
co
av
pa
sc';
tie
co
m
fa
cc
sa

tn
4
4(
lc
tc

• t

1
!
PERFORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME

!

I

nCs

TREATMENT OUTCOME

iI

%

Cohort Periods
Analysis of treatment outcome is done with
reference to smear positive patients diagnosed in
a given cohort period which is fixed on the basis
of optimum treatment period.

8

0

In diis paper, die Annual Reports for the
year 1992, received from DTPs during 1993 have
been considered. The prescribed cohort periods
arc as under:

8

a)

For standard regimens, for which the optimum
treatment period is 18 months, the cohort
period considered is 1.7.1990 to 30.6.1991,
as the patients diagnosed during this period
were expected to complete optimum
treatment period in the course of 1992.

b)

For SCC, die cohort period is from 1.1.1991
to 31.12.1991. Patients diagnosed and pul
on treatment during this period were expected
to complete die treatment latest by December
1992.

(a)

Standard Regimens (Table 6)

37

24

22

7
15

i

25
16
I

21

6

35

1

37

4

29

1

22

2

15

1

19

,2

11

•>6

22

)4

24

a

I
!

I

I
■;!

I
.

I
I
IL.
-..

.

For die . year 1992, out of 378 Annual
Reports expected, (from DTPs relevant for the
cohort period), 247 Reports (65.3%) were received
and 152 of diem (61.5% of received and 40.2%
of expected) were analysed. Based on die analysed
reports, out of 81,180 patients included in the
cohort, treatment cards* of 74,210 patients were
available for analysis at the DTPs and 72,075
patients were initiated on treatment. It could be
seen diat only 34% of patients initiated on
treatment could make 12 or more monthly
collections of drugs. As patients making 12 or
more collections/consumptions are likely to have
favourable outcome in terms of bacteriological
conversion and hence deemed to have completed
satisfactory level of treatment, only 34% of the
patients could be considered to have completed
treatment. Completion rate is above 50% only in
4 States, between 40-49% in 4 States and below
40% in other States. The completion rate is the
lowest in West Bengal. It has not been possible
to work out cure rates due to non-availability of

111

results of final follow-up smear examinations for
most of die eases.
Cure rate is the best mediod for analysing
treatment outcome. It is determined by percentage
of patients becoming smear negative at die end
of the -treatment period out of those initiated on
treatment. Availability of final follow-up results
of smear examinations of all the patients initiated
on treatment is a prerequisite to arrive at cure
rates. Most of the DTPs do not subject die
patients to final follow-up of smear examinations.
In the absence of such data the next allcmativebut less reliable indicator - i.c. treatment completion
rate, has been considered. As die treatment
completion rale is very low, it is necessary that
case-holding is improved considerably by all
Medical Officers and Treatment Organisers
■concerned.

Il should be ensured that all cases diagnosed
arc effectively treated for the full period so that
the chain of transmission of disease by die smear
positive patients can be checked to a great extent.
Il is mandatory to subject patients to final follow­
up smear examination and results recorded on the
treatment card which will facilitate calculation of
cure rates.
(b)

SCC Regimen ('fable 6)

A total of 119 Annual Reports were received
against 234 reports expected for the year. Out
of diese, only 94 (79% of received and 40.2%
of expected) reports were analysed.
As per die analysis, 2055 patients put on
Regimen A (2 S2H2R2Z2/4 II2R2) and 35,097
patients put on Regimen* B (2 EIIRZ/6 TH or
6 EH) were considered for analysis. It is observed
dial only 44% of the patients put on Regimen
A and 51.8% of the patients put on Regimen B
had collected > 75% of the doscs/collections
expected.

The completion rate is above 50% only in
2 big and one small State for Regimen A.
Number of patients put on Regimen A is too
small in many of die States reported.
As regards Regimen B, the completion nite

rr

••

/

SURYANARAYANA ET AL

112

SCC Regimen

SR Regimen

States/
UTs

SI
No

2

1

Andhra Pradesh

1.
3

i-

1
»•

I

5

6

7

8

9

10

391

47

4380

46

0

378

44

8732

56

20

10296

33

13

42

6

cost el
impact
of 55?.
which’
getting
of one
lias hi
shoukl
smean'
of cafci*
made j
patieiti
and •ct

Assam

7

Bihar

3

308

36

0

3.

Gujarat

14

14729

25

12

56

4.

28

1

0

5.

1388

32

3

25

Haryana

52

2

0

6.

84

19

1

68

Himachal Pradesh

78

47

0

78

1

155

Jammu & Kashmir

1

7.

22

11

911

1291

8.

6223

40

14

53

Karnataka

40

5

33

1849

9.

789

28

4

6

Kerala

52

2

25

40

258

47

11869

56

36

10.

Madhya Pradesh

10

4283

Maharashtra

8

3723

63

9

0

11.

40

4

29

1201

12.

5084

40

10

140

Orissa

53

3

63

738

13.

3696

59

7

19

Punjab

25

2

40

60

14.

5558

308

13

0

Rajasthan

415

33

46

Tamil Nadu

28

7

15.

1541

1596

6

36

4

23

44

16.

11267

351

15

9

Uttar Pradesh

14

29

1361

61

57

18.

2

1363

14

3
9

67

537

14

39

15

Small States
& UTs

885

72075

34

94

2055

44

35097

INDIA

152

West Bengal

* Cohort jx'riod: SR:
1st July 90 to 30th June 91
SCC: Year 1991

the ii

re-ew

both

2.

17.

ft

4

3

780

’•r
(

Regimen B
Regimen A
Comple­
Reports
ted
analysed Inilia- Comple- Initia- Comple­
12+
ted
ted
ted
ted
collec%
%
tions
%

Initia­
ted

Reports
analyed

is a lx;
States?
40 to-*
comfit
that v
5.5^)
Regiir
of tl*i*

SR and SCC regimes according to States-1993

Table 6. Treatment completion* on

n

examii
complt
"'an be
.c tree
all car
to moi
out tht
Greater
tasks a
prognu
1
■ ‘"P

? W- of trairT
52

DTC a
■?. ?•’ observe
reporte*
ftT DTCs
comple

■ft-:
. •

Availa
& equ

T

I
1

I

PERFORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME

is above 50% in six big States besides all small
States and UTs. The percentage varies between
40 to 49 in 7 States. Three States have achieved
completion rate less dian 40%. It could be seen
that only 2,055 patients out of 37,152 (i.e.
5.5%) have been put on intermittent SCC
Regimen A. This indicates the poor acceptability
of this regimen. Retention of this regimen in
the chemotherapy policy needs to be
re-examined.

993

i
£n B

Comple­
ted
%

I

10

I he completion rate of 51.3% in respect of
both Regimen A and Regimen B put together is
neither commensurate with the effort put in nor
cost effective. This is not likely to have an
impact, on die epidemiological situation by way
of 5% reduction in Annual Risk of Infection,
which is defined as the proportion of population
getting infected with M. tuberculosis over a period
of one year. To achieve this reduction rate, it
has been suggested dial countries like India
should first achieve 85% cure rale among all the
smear positive patients before enlarging the scope
of case-finding activity further. Efforts should be
made to improve the treatment compliance by
patients to achieve a higher rale of completion
and consequent higher cure rate.

44

56

1

32

*

19

S

78

1

40

9

28

;s

47

59

56

•)1

9

38

59

■08

60

>96

46

553

44

361

61

537

57

!

III

I
II

5I
i

V-

M197

52

I

1

if

I
........

It would also be useful if follow-up
examinations are conducted for all patients
completing treatment period so that the cure rate
can be worked out to assess die real impact of
die treatment activity. The Medical Officers and
all concerned para-medical staff have not only
to motivate die patients suitably but also carry
out die work as prescribed in DTP Manuals.
Greater awareness and better devotion to the
tasks assigned, by all personnel involved in the
prognunmc, would help in achieving belter results.

It is pertinent to note dial only 127 (46%)
out of 276 DTCs had trained Statistical Assistants
(SAs). This would reflect both on die quality and
die number of reports received. Only 73% of the
reported DTPs had trained Laboratory Technicians
(LTs) and Treatment Organisers (TOs) which
would affect adversely die quality of case-finding
and case-holding activities.
Non-availability of trained key personnel at
DICs is due to : i) posts not being sanctioned
by Slate Governments, ii) sanctioned posts
remaining vacant, iii) lack of budget to depute
key personnel for training, iv) diversion of
trained staff to odier schemes/programmes.

The Slate Governments concerned have to
ensure that all key personnel tire trained in the
DTP and those trained are deployed in the
programme, avoiding diversion outside the DTP.
Il may also be seen that some of the D'fPs
have not reported the information on the availability
of trained manpower and equipment. It is observed
dial out of those reported, vehicles and X-ray
equipment are not available in some D'fPs. It has
also come to notice that allotted vehicles are
diverted to other purposes not connected with TB
Programme. It is also observed that adequate
budget for petrol and oil expenses, repair and
maintenance is not allotted which affects the
supervision and maintenance of die programme.
It is essential that the equipment is maintained
in good condition so dial the overall efficiency
of die programme docs not suffer.

Conclusions
a)

Measures are to be taken to implement all
the districts in die country under District
Tuberculosis Programme (Dl'P) and all the
health institutions available under the existing
DTPs.

b)

Reporting by OTPs needs vast improvement,
both in number and quality.

c)

It has to be ensured dial trained key
personnel, as full team, arc available in all
DTCs.

Availability of trained key personnel
& equipment
Table 7 furnishes the position of availability
of trained key personnel and equipment in the
OTC as on 31st December, 1993. It could be
observed that only 276 out of 390 DTPs have
reported particulars on these aspects. Only 43
DTCs (i.c. 15% of reporting DTCs) have full
complement of trained team.

113

' - -■

-' 3
" "Sa



W'

i

SURYANARAYANA ETAL

114

■ 7 availability of equipment in DTCs as on 31.12.1993
Table 7. Posting of trained key personnel &
according to states

States/
UTs

SI
No.

DTO XT

LT

TO

Equipment in order
DTCs
(No. of DTPS)
with full
trained
V
M
X
teams
SA

Availability of trained
staff

FuncStaff
tioning position
DTPs reported

5

6

7

8

9

10

11

12

13

4

1

2

3

20

20

18

15

21

1.

18

17

21

10

23

10

Andhra Pradesh

6

8

8

7

3

10

Assam

7

8

10

10

11

3

5

0

0

3.

Bihar

0

4

0

5

6

4

32

19

18

3

11

1

Gujarat

14

4.

12

19

18

19

19

1

5

6

0

8

5.

2

8

9

8

11

4

Haryana

3

4

4

I

1

5

6

5

2.

Ef
by
to

c)

Cr
irr
qu
ah
Pr
P<
ire
nc

0

C
th
to

g)

i

Himachal Pradesh

11

7

4

I

3

3

0

3

Jammu & Kashmir

3

4

5

4

10

0

Ft
oi
tc

15

9

2

17

8.

Karnataka

15

ACKN

6

11

14

17

13

20

1

3

1

0

10

9.

5

10

11

8

12

9

Kerala

23

26

22

21

18

10.

25

29

30

22

45

7

Madhya Pradesh

19

20

18

3

0

23

Maharashtra

5

22

24

22

30

8

11

9

9

1

6

Orissa

1

11

11

10

13

3

3

5

3

0

2

Punjab

1

11

11

9

12

12

14

2

18

Rajasthan

2

12

8

0

27

18

15

T
Ukc, ID
his vvkw
membe
for the
Sri M.'
Com pi
nssistm
kune’

14

15

8

15

Tamil Nadu

12

15

REEE

11

16

16

15

16

30

9

32

1.

16.

Uttar Pradesh

26

27

30

20

32

35

6

56

6

4

4

I

6

17.

2

7

7

5

16

6

West Bengal

11

15

13

3

13

19

17

127

43

232

266 212

6.

7.

11.
12.

13.
14.

15.

18.

Small States
& UTs
INDIA



26

19

16

13

390

276

156

167 202 203

w.
:■

X

i

d)

X-ray equipment (Col.

ID; m = Microscope (Col. 12); V

Vehicle (Cot. 13)

. ;7:'is#

I



I
1

PERFORMANCE OF NATIONAL TUBERCULOSIS PROGRAMME

I

993

115

d)
!

ipnunt in order
No. of DTPs)

c)

h'l!

V

12

13

ft

21

17

10

8

II
I

4
19'

19

18

8

8

6

5

4

3

17

14

10

10

29

18

23

22

•n

11

6

'Ji

11

2

J

12

16

15

32

27

7

6

19

17

266

212

•r?

S

232

Effective and adequate supervision of Pills
by the DTC personnel is very much required
to maintain the programme.

Case-finding activity in DTPs has to be
improved both quantitatively and
qualitatively, after ensuring that (he cases
already detected are treated adequately.
Priority is to be given to detecting smear
positive cases and initiating patients on
treatment based on X-ray evidence alone
needs to be discouraged.

0

Case-holding activity needs improvement
through considerable comprehensive steps
to achieve higher cure rales.

g)

For achieving the above objectives, adequate
organisational, administrative. Financial and
technical supports are very essential.

Report series No. 34; Indian Council of Medical
Research, New Delhi, 1959, 49.

2.

Bancrji D & Stig Andersen : Sociological study
of awareness of symptoms among persons with
pulmonary tuberculosis; Bull. Wld/Hlth/Org ■
1963; 29, 665.

3.

National Tuberculosis Institute ; Report on
performance of National Tuberculosis Programme
for the year 1993. National Tuberculosis Institute,
Bangalore.

4.

Baily G.V.J.; Savic D. Golhi G.D., Naidu V.B.
and Nair S.S; Potential yield ol pulmonary
tuberculosis cases by smear microscopy of
sputum in a district of south India; Bull. Wld.
Hllh.Orgn. 1967, 37, 875.

5.

Nagpaul D.R.. Naganathan N
Prakash M:
Diagnostic photofluorography and sputum
microscopy in tuberculosis case finding,
IVocccdings of the combined 29lh National
Tuberculosis Workers’ Conference & 9th
Conference of Eastern Region of IUAT, New
Delhi, 1974. 330.

6.

Chaudhuri K. Jagota P and Parimala N: Results
of treatment with a Short Course Chemotherapy
regimen used under field conditions in District
Tuberculosis Programme; Ind. J. Tub. 1993 40
83.

7.

World Health Organisation : Tuberculosis research
and development - Re|x>rt of a WHO working
group meeting. Geneva 9-11 Sep. 1991, WHO,
Geneva.

8.

Baily G.V.J.. Rupert Samuel G.E., and Nagpaul
D.R. A concurrent comparison o! an unsujxn’viscd
self administered daily regimen and a fully
supervised twice weekly regimen of chemotherapy
in a routine out patient department; Ind. J Tub
1974. 21 152.

ACKNOWLEDGEMENT

I
I
{

The authors are very grateful to Dr B.T.
Ukc, Director, National Tuberculosis Institute for
his wholehearted support and encouragement and
members of the technical Coordination Committee
for their valuable suggestions. They also thank
Sri M.V. Jaigopal and Sri S.G. Radhakrishna,
Computors in the Monitoring Section for their
assistance in compiling the data and Miss T.J.
Alamelu, Stenographer for her secretarial assistance.
REFERENCES

1.

I

J

Indian Council ot Medical Research : I ulxnculosis
in India - A sample survey. 1955-58. Technical

Position: 2215 (4 views)