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'TP) Po&i
Contemporary Issues
J. Tub., 1993, 40, 47
WHancc Io
<ubercUlOsis
Absiract . vii>
|
STD
24 J^y. 1992.
CONTROL PROGRAMME
- Allen E.a. Thc
eflc,ency virus
c°ntroj. Chest;
PrograXe^heteat S^Kund^thCOntr°'
Onna/ AfDs
^nence. 2nd
,n Asia and
^DS, ln<j j
of September, 1991 in wfilZh f
h10"^
country, representatives of st;,“Xl,,,'1,thC
organizations, WHO ICMR anT r/ ,
ary
Directorate Generalof Heakh S
7?
of Health & Family We fiS
eS/M,nistry
Various issuer
i
t farc Participated.
Programme including th® bottler' TB
?
implementation at slte/^
were discussed. The recommp j
eveIs
the Workshop are as under mendat,Ons made a>
"^?uP“''lan,Cities h“s ‘° be different compared
with the rural rareas. .......
White MPWs could
the case-finding in the rural
-J areas, for cities the
Jocus has to be on slums^Zr and outreach new
settlements.
In order that .
case-finding and later caseholding in the cities
3 is successful, it is imperative
that all the g
..J hospitals, dispensarL and
general
other institutions work
in an organised and coordinated manner S0-thaJ lhe TB services can be
rendered efficiently. In
i addition, voluntary
organizations can be c
organised to devote
particular attention to thp'
slums, bastis
outreach settlements as a ■eparTrfcn^
programme. It was
P . °f ,co'ordmatcd
government has a srh^
that. Ihe
Community Health Cent meestabHshing
and other facilities Th
™th ade<luale staff
«
■
*
National TB Control programme
are fully opL^Xte^ fof
eXd the
8
T Steps 5hould be taken to
case-finding cannot
recommendation.
be
the
th
nF^t*1118 Uf
ttcr of
Case-holding
Steps should be taken to accord NTP a hiah
pnonty among the national health programmes
7
off
°
CC
a^uate
i
recommended that stem ck
Case-finding
-Surp^X
availabilityoUnii
i?
DtetrtetTBTe
3. es but a,so in the PHIs.
Th TB F
as
7
*
NationalUChemo°LtaUpgyrporenS inC1Uded ‘n ‘he
-dueed to a
confusion. The Grmm
rfl 1
Tt
aVOld
w£:x,.‘.z".“d'a""
Che^0^
<where Short Course
Chemotherapy 1S not introduced) :
■mmediate steps are needed to takf jp the
2SHT/10HT
framtng aettvity for rural laboratory technicians in
per"her°aISSSthen 'he
™ a‘
c /c.r„ .
.
seriously ill patients
s (Streptomyin)-0.75 gm, H (Isoniazid).300 mE •
T (Thmacetazone) -150 mg daily).
’
mg ’
casIfie„jGrOUP unanimously recommended that
_
For sputum positive and
- For smear negative but radioogically positive case
(H (Isoniazid) - 300 mgplus
(Thioacetazone) - 150 mg daily).
!
48
CONTEMPORARY ISSUES
CONTEMPORARY ISSUES
If the patient cannot tolerate Thioacetazone, this
drug should be replaced by Ethambutol (E): 800
mg daily.
Short Course Chemotherapy
1. - 2EHRZ/6HT
2. 2 EHRZ/4 H2R2 (bi-weekly H-600-700 mg
with Vitamin B6 (Pyridoxine 10 mg, R - 600
mg in continuation phase).
R (Rifampicin) - >50 kg = 600 mg, > 50 kg =
450 mg, H (Isoniazid) - 300 mg, E (Ethambutol) 800 mg. Z (Pyrazinamide) - 1.5 g, T
(Thioacetazonc) - 150 mg.
(If the patient cannot tolerate ‘T’ then ‘T’ to be
replaced by ‘E’)
regional level
target setting should be continued with some
modification, if necessary.
Training
Voluntary Organizations
The training activities at the National TB
Institute, Bangaore must be continued and
modified in the light of the various
recommendations being made. However, io
reduce the training load of a big country like
India, it was strongly recommended that State TB
Demonstration Centres should take up the re
training and reorientation of their personnel.
It was strongly felt that the time had come for
voluntary organizations to become partners widi
the Govt, in making the NationaTTB Programme
successful. Besides health education, they could
Ereatly help in case-finding especially in the city
slums and case-holding by establishing Drug
Distribution Centres from where the patients
49
could collect drugs most conveniently. It was also
recognised that besides the TB Association of
India and its affiliated state organizations, there
are other voluntary agencies which arc doing antiTB work. The responsibility for bringing the
other small voluntary organizations under the
umbrella of NGOs should be taken by TB
Association of India. The process of establishing
closer communication, collaboration and co
ordination with the NGOs should be taken up as
soon as possible.
Health Education
The Group underlined the fact that the
intention is to introduce short course
chemotherapy all over the country as soon as
possible. The conventional regimen will be used
till such time the short course chemotherapy
covers the entire country.
It was further recommended that all sputum
positive cases should be given short course
chemotherapy. The sputum negative patients
should be given conventional regimen.
Case-holding capability needs considerable
strengthening. For this purpose, operational
studies arc needed, specially focusing on drug
distribution and taking of drug defaulter actions.
It was also felt (hat in this area the NGOs can
play an important role.
The importance of health education was
realised by everyone. It was also agreed that the
responsibility of health education at the district
level too is that of the District TB Officer.
However, health education has to be co
ordinated and done in collaboration with health
education bureaus, voluntary organizations and
School Health Education, etc. US aided heaith~) zeducation project undertaken by TB Association
of India recently in 250 districts m the country -4
was quite encouraging. In the light of thecxperience, it was recommended that the pattern
of its work needs some modification. The
remaining districts in the country can be
implemented in collaboration with the agencies
concerned according to the modified pattern. In
this connection, better use of the electronic media
was suggested. ’
Management of the programme
Repeat Survey
The importance of supervision and monitoring
was stressed. It was pointed out that these two
have to be done at all the levels. At present
programme monitoring is being done by National
TB Institute, Bangalore from the quarterly
reports received from the states. This could be
continued. But in addition, states have to take up
this responsibility, leading folhe establishment of
a strong monitoring cell which can be a part of a
Monitoring Section for all the health
programmes. It was recommended that National
TB Institute should explore the need to train staff
in supervision as well as monitoring. To
strengthen central moniioring and supervision,
the regional health organization may be involved
to improve supervision and monitoring at
Noting that the available data on disease
prevalence and incidence in the country arc quite
old, it was stressed that the data have become
irrelevant. The Group realised that the need for
up-to-date data would be felt more strongly as
time passes. The possibility of conducting nation
wide surveys of a simpler kind is being explored
by some research institutions and National TB
Institute, Bangalore. When the methodology
becomes suitable, the question of repeating the '
nation wide survey can be re-examined.
Target Setting
In view of the experience gained from target
setting, especially in case-finding since 1982, the
Group strongly recommended that the practice of
I Women and AIDS
ZZ S
d.L
.ha.» .. 50% or
...eced
mothers get infected during birth or shortly after, through breast feeding.
Gene of Drug Resistance
A nene that makes tubercle bacillus resistant to INH has been identified. A breakthrough could
alternative.
k J
-
XT**?:
•Jkr-Ly I '16
NFWS AND NOTES
170
TECHNICAL
COMMITTEE’S
MENDATIONS
rate may also be substantially reduc
ed. What Is actually required is
the
strengthening
of
general
health services and their exercising
effective supervision to ensure that
the medical and para-medical person
nel perform the task assigned to them
under the DTP properly, diligently
and with commitment.
RECOM
A meeting of the Standing Technical
Committee of the Association was held on
20th April. 1987. with Dr. P.A. Deshmukh
in the chair. Some of the important decisions
and recommendations of the Committee at
this meeting are :
1. The Committee discussed the various
points raised in the Presidential Address
of Dr. S.P. Gupta at the 41st National
Conference and decided that the following
recommendations may be forwarded to the
Government :
(i) The para-medical stall' of the primary
health centres be trained properly
and effective supervision of their
work be provided to improve the
quality of sputum examination.
Vehicle should be placed at the dispo
sal of the staff of the District Tuber
culosis Centre for visits to the
P.H.I.s
(ii) The radiological examinations should
be used as a screening procedure
to identify the patients with abnor
mal shadows in their lungs, wherever
possible. Such patients can then be
subjected to bacteriologicai investi
gations to clinch the diagnosis.
(iii) In large towns and cities, where
a large number of patients suffering
from cough visit the General Hospi
tals, it will immensely help the case
finding programme under the NTP
if photofluorography facilities are
made available. Adequate diagnostic
facilities including examination for
sputum must also be made available
at all the general hospitals.
(iv) One additional District TB Centre
should be provided
in bigger
districts.
(v) An additional multi-purpose labora
tory technician, should be posted,
especially in primary health centres
with a heavy work-load. It would
not only considerably augment TB
case detection activity, but also help
to improve the quality of genera
health services. Similarly, if all the
multi-purpose health workers are
actively involved in motivation of
patients, their families and the com
munity to take regular treatment for
the prescribed period the defaulter
(vi) Tuberculosis Programme officers in
the Slate Directorates have to play a
very active role and must base the
requisite dynamism and drive to push
up the facilities and activities and
exercise necessary technical and admi
nistrative supervision on the function
ing of the programme in the field.
Every State should have a whole-time
State Tuberculosis Officer.
(vii)
(viii)
Steps be taken to create interest among
the general practitioners in the imple
mentation of the National Programme
and to update their knowledge about
the present philosophy of diagnosis
and treatment of tuberculosis through
Refresher Courses and “clinical meet
ings” at regular intervals in the DTC
in close’collaboration with the local
IMA branch.
Health education campaign in the
community should develop alongwith
the growth and proper functioning of
health and medical institutions. Perso
nal contact by the health educators
with the community and its leaders
would be the most profitable to
change the attitude and behaviour of
the people. Aids like ‘flip charts'
brought out by the TH Association of
India will be more useful than posters
etc. Highest priority be accorded to
the audio-visual methods and mass
media like Radio and Television.
The Committee also discussed in depth
Dr. Gupta’s recommendation about multi
drug formulations. The Committee felt that
many aspects like bio-availability of consti
tuent drugs, their quantity in such formula
tions. acceptability etc. have to be taken into
consideration before taking a stand on this
issue. The Committee noted that the Tuber
culosis Association of India is already con
ducting a chemotherapy trial involving such
formulations and agreed to wait for the result
of this trial regarding acceptability.
2. The Committee noted that the 42nd
National Conference on Tuberculosis and
Chest Diseases would be held at Lucknow
NEWS AND NOTES
7
£ppoinud anc?mmS Deccn,ber- >987 and
171
demy of Medical Sciences in i
Dr
D R
. *ca'
NThn„C7T,n!’,ICC a,s° dc«ded that
, P,,;;,ed,and
,.p3-
The Committee received a report on
m
J he Committee also noted thati th ' A0'Pbay'.
Academy of Medic d c,,
. c National
a grant of Rs 30 000 Hn\eS| l‘lJ sailcli°ned
in different parts 6f 'th hold"'e 15 cours«
four coursesP had
O1' which
Pleted and the remain^ beCn COn”
expected to be hHd
K C0Urscs "ere
2/3 months. The
ommh h’n ,hc "^xt
dismay that the
'c
no,ed with
lions in this
‘his respect
resp7ctPwls
w^
stin^v^^ Associawas felt that ./would K
?°.Or ?nd il
tangto make them
(a) The results of the two studies on
wffi'r-'iICd -L.’Vnlphadenit,sand Diat>eIes'
which were presented at the Hydera^the A'wn'lfRT^6 beCr ',llb'ished
Jounia^P'Tubercu'Ss.0'‘he 'ndian
•
rnJ ,beir
£0'n ,llc members of the
: .'’.land"’e Technical
Committee would
would be conli^ed'
to rccommend a m°d,fied Pal,Crn' ‘
11 necessary.
(W All cases included in the IVth ShortD?eUt7%?1|M|Otherapy lrial " ill comsim -n fo,,o,w-1uP P^od in August/
in8 action hfdXTn'r't nOIud ^al the fo,,ow°n the recommendadons^fb® GoY!crninent
Technical Committee Z-ti f ‘’^S^nding
trial ha 70r,.-C^rse Chemotherapv
‘ crntrh a,r.ead>’ ^n started in four
“kelv tn"?, liat t!’is study«als£
he res.mc be.I1c°mplc‘ed shortly and
• W,,1. be av“'lable for pre-
"rae r°rth'
(d) Three studies for which grant was
sanctioned last year have' already
been started
and
three
mor?
and
___
applications for grants for research
projects
have
been
received
recently
and
these are
under
scrutmy by the Research Committee.
The (omnuttee noted with dismay
the
poor response
from
the
research workers for this facility.
The Committee made a plea to the
members of the Committee that they
^nakcup this question at inffiv?dual level with research workers/
medical colleges in their respective
States with a view to make this faci
lity better known to the workers and
thus improve the response further.
4. _ The Committee
C„.
noted that only 53
refresher
—courses
---- were conducted during 1986
(b) The Directorate General of Health
(c) Multi-purpose workers and
Guides are being involved Health
in drug
distribution, surveillance, detection
and retrieval ot drug default for im
proving the patients' compliance in
domiciliary treatment. compliance in"
(d) lha!h|rh!aMt?- ,h<; commendation
Shcme
hr?*hau sta,cd lhat Hie following
feu™08 arealre»1y Wngim?
(0 Supply Of anti.TB drugs/equipntents to States on 50 : 50 sharing
^ between the Centre and th!
NEWS AND NOTES
172
(ii) Supply of anti-TB drugs/equipments to the UTs as 100% cen
trally sponsored scheme.
(iii) Supply of anti-TB drugs to TB
clinics
run
by
voluntary
bodies as 100% centrally spon
sored scheme.
(e) With reference to the recommedation
that private practitioners should be
supplied with drugs by the Govern
ment for free distribution to their
bonafide tuberculous patients, the
Government has reiterated their inabi
lity to do so.
(f)
With regard to the suggestion that
the tempo of TB Programme under
the revised 20 Point Programme
should be further intensified, the
Government has stated that with the
inclusion of the National TB Pro
gramme in the revised 20-Point Pro
gramme, its tempo had already been
intensified and the targets for case
detection had been enhanced.
6. The Committee noted that the NewIndia Assurance Company has recently intro
duced a new Health Insurance Scheme for all
major illnesses including tuberculosis and that
the Association had suggested some revision
and modifications in the scheme in respect of
tuberculosis for which a reply from the Insu
rance Company is still awaited.
7. The Committee noted that the recom
mendations of the Standing Technical Com
mittee in respect of leaching of tuberculosis
at the under-graduate and post-graduate
levels were formulated 10 years ago and
many of these recommendations regarding
Rules and Regulations and Curriculum need
review in the light of advances during the
last 10 years. It was. therefore, resolved that
a Sub-Committee consisting of Drs. S.P.
Pamra, M.D. Deshmukh. K.C. Mohanty and
P. Bahadur be appointed to review these re
commendations and bring these uptodate.
REFRESHER COURSES
Andhra Pradesh : During the period
February to June, 1987, six refresher courses
were held in Irramnuma, Gudivada, Vizianagaram, Alwal, Nalgonda and Hyderabad. In
all, about 350 doctors attended these courses.
The Irramnuma course was sponsored by the
National Academy of Medical Sciences.
Goa : The TB Association of Goa,
Daman & Diu, in collaboration with the
American College of Chest Physicians, Western
India and Maharashtra State Anti-TB Asso
ciation and under the auspices of the TB
Association of India, organised a refresher
course at Mapuca on 29th March, 1987. It
was attended by 142 doctors and was sponso
red by the National Academy of Medical
Sciences.
Madhya Pradesh : The District TB Asso
ciation, Chhindwara. organised a refresher
course in Badkuhi on Sth February, 1987.
The course was attended by 55 doctors.
Maharashtra - The Maharashtra State
Anti-TB Association organised a refresher
course in Dhule on 22nd March, 1987. The
course was attended by 58 doctors.
Punjab: The TB Association of Punjab,
under the auspices of the TB Association of
India and in collaboration with the local
branch of IMA, organised a refresher course
in Ludhiana on Sth April, 1987. The course
was sponsored by the National Academy of
Medical Sciences and was attended by 95
doctors.
Karnataka : Under the joint auspices of
the Tuberculosis Association of India and the
Udupi Taluka TB Association and in col
laboration with the Udupi branch of the Indian
Medical Association, the TB and Chest
Diseases Department of the Kasturba Hospi
tal, Manipal, organised a refresher course on
24th May, 1987. It was attended by 95 doc
tors and was sponsored by the National
Academy of Medical Sciences.
42ND NATIONAL CONFERENCE
The 42nd National Conference on Tuber
culosis and Chest Diseases will be held at
Lucknow (Uttar Pradesh) for four days from
2nd to Sth December, 1987 under the joint
auspices of the Tuberculosis Association of
India and TB Association of Uttar Pradesh
and in collaboration with the National
College of Chest Physicians.
The registration form and other details
about the Conference can be had from the
Secretary-General, Tuberculosis Association
of India, 3, Red Cross Road, New Delhi110001.
GUJARAT STATE CONFERENCE
The XVth Gujarat State Tuberculosis
Conference was held on 21st and 22nd Febr-j
uary, 1987 at B.J. Medical College, Ahmcda-I
bad. Shri Jayendra Pandit, Mayor, AhmedaJ
bad Municipal Corporation, inaugurated thflj
NEWS AND NOTES
173
TB Association. Dr T B
S,ate
the Scientific Sessions Ind
'naug^atcd
Ambani, Managing Director 01Janlni.kbhai
Industries released thp
0 ■ of Reliance
doctors and 325 para nS“'T^ About 2°0
Conference.
Par™dICaIs attended the
t
IVTH ORISSA CONFERENCE
The IVth Orissa TB & Chest
at
R M "T WaS?e'd on 22nd “
WCM Swa^hya Nibas- Chanc
ANTl-TB week, ANDHRA PRADESH
G-TB Week
Ranga Reddy SS’aud TB aT at,°n of
Andhra Pradesh was held it A“?c,at,°n ot
(Secunderabad) on 31 5^9X7 1 ^"“'s'x-Try
EES.b
,y st"sdR-
C‘a"p
Welfare Department and
Social
Diseases
Chandpur. Dr.
H.C. Misra, Director of Health
Orissa, inaugurated the --—..a Services,
Conference.
91
doctors from different
attended the Conference. Parts of the State
Pah and
HEALTH CHECK-UP CAMP
for 21
roi2i«!
p^
,and thev were nut nn ?
Were detcctcd
children
were
Jiv n B CG DPT^'^ 'WO
<
Measles vaccination.
’ DPT’ Po'10 a"d
NEW TB SEAL
P/ade>h
"dabad Cudda.
.ntX’sZs aXXr -organised. Posters and pamphlets on’?tuberculosis were also distributed Dnr" "“1'
werepro5ra'Pme 206
the
°flhe
tre. S
Juxkivo.
gr“»flh«eeXTwe^%OT°tef^yhssPor;
LU
got?
ON -SPt.
s PurS,-d
C/oEko X-r'-.v 54hrhna' .‘^‘ary-General,
eutta-700 OH7’ ’ Chowr"'gh>-’e Road. Cal-
■
4
•
■
•
ind. J. Tub., 1989, 36, 127
/a three year comparison of performance of the
NORTH ARCOT DISTRICT TUBERCULOSIS PROGR MME*
1
k
C.K. Babu**
Introduction
exam: lations at D FC, the rate of sputum positiv
ity (abent 1Q%) ;s at the expected leveLVCS and
The Dh .rict TB programme (DTP) has been
CHS have shown considerable improvement in ,
in opera;. . in North Arcot district sh-cejd64.
sput: m examination and the rate of positivity is
Howeve ’ c c^ctatioas both in <
~ "
. also at the expected level. But, in the case of
as per
per / PHCs, although there is a vast improvement in ;
DTP pctential.Trhe inclusion of National Tubersputum examinations, ti s rate of positivity is far !| \
L culosis 1
:
■ ne in Goverament’s 20
below the expected level and has been falling. // '
•■•s fe.
. ...-p.;
; c...ce added a new diu.en(•h8%Jo 1.7%). All in all, the number of exami- ’1
:
^ca
'■ :'r ?iC^eving the potential goals,
r.'.Oi-ts
las steadily ns
and the positivity rate
flB J and ’.t wo . be of Lite rest to know if case-finding’'
steadily fallen.
1 1 a 1C” '
ue steadily improving or . .o: in
No
rcc cistrict.'
Conti nation of NewSp- um Positives Amon^
PmStndDTC
Ivie*
Methods
I
.1^
- \
........ i: one of the pioneer dis^
coursecnemo^Bqfpy
. J
‘ Pfogramm^ conditienc.
i
. X
iWitbred
;
by:th«lCMRt
n
1983
tel
aft..wards,
1 1?-^ dJ All
mi the r
z sputum positive patients.who were
more th: - ■ years of age and had not ta’-.e::. cheJ inothcra
2 months pred . -dy, if
®L at,?’ wer~
“ ^rjsyj^rh.e
>CC. The North
Non / -.of
j
/hlch
j1
1515are
arex-ra;
x-ray.
4 55 • o.
and 17 referral centres.' ..
■/
A cohort analysis/or the years 1984,1985 an<^
... .1986 fas
.-.i done and.an attempt has been
;; made M c...
the performance of the E isiriqt
micrc;..
| in the progrtronc
<
i
'
■liclpatiou of ?HIS ;
■'....................
Case rr'...'.
Since the • ohort analysis for SCC pertaLs only
to sputum pc
>atients, case-findi
turn examii on only Las been reviewed. Sputum
; positive nr/'
•
the disaL t '..-'jm
’ar to 30th -e Q- next yea-, • vou’di
thus coaslitu a cohc.w.
Epidemiologically, s .:. urn positive cases are
equals prevalent in urbm and rural areas. It
might ce of interest, therefore, to analyse the
coni.: ', -..a from 80% of -.he rural population,
compared with 20% of Ahe urban. Since DTC is
SQ'y inban and PHC is solely rural m operatlo?., • : .?■- arison of s; ' n ;ositive cases in the
cohorts from DTC and FHCs will show their re
spective contribution (I .., 2)
■ Table 2 shows that sputum positive cases detecte 1 i DTQ arc about 22% to 24% whereas in
Pills it is about 76% to 78% as against the na
tional average of DTC and PHI$ contributing
50% each.
It is further noted that he contribution of spu*um positive from PHCs is Haying an upward
trend whereas at DTC it.. going down due to the
decent.. . ..,,.n of services, which is a welcome
development. On the whom, there is a downward
trend
new sputum positive cases discovered
from 1984 to 1986 (Table. 1).
iwm
Case HcMiiig of Spulun. Positive Patients
'
Table 1 d
'■ gradual J: :'
Case detection is important but equally impor
tant is tbo necessity for st .- ting treatment and de
livering adequate and regular treatment. .Table 3
shows that m 1984 nearly 31% cases were “initial
i
■ \ ev-' -Js that although there h a
se.ir. ti number of new opihum
g 'Fapcrpresen!.:: ’ at the 43rd National Co: ^enc^n fiiTchest Diases, Calcutta, 1988.
^StatisticalN sistant, District T3 Centre, Vellore
............................................................................................
'
■
'
/• • LX
I
Bfcj
C.K. BABU
Table 1. Case-Finding by Sputum Examination in different types of Haith Institutions from 1984 to 1986
T®.:
1984 .
% '
New sputum
exams.
No.
Pos.
%
New sputum
exams.
No.
Pos.
%
1
476
207
11
347
1153
10.3
-
2194
5.8 g sv
«¥ -
6934 ’
4635
390
1839
15459
645
130
35
202
1592
9.3
2.8
9.0
11.0
103
5808
10616
140
2695
15062
552
191
II
202
1389
9.5
.1.8,
IM
■ DTC
PHC
GD
VC
GH ‘
7.5
9.2
4622
12167
129
4086
fM80
fCotal
29257
2604
8.9
34321
2345
6.8
37484
I
8.5 •
8.5 ‘
7.0 |
X*
•
•
'
I
.'
•
'•
. ’
•<1984 ' " y .
85
"h.
:4
$
-
.
-I ■!. ■■■■■
■ ■
M— >
I
VC
GH & GD
24.7%
23.5% "
4.9%
8.2% .
7.7%
8.7%
/ <52.7^,.
59.6% j
21.8%'.
9.2%
d^8%
53.2%
50.5%
Table 3. ' '
r
y: - ■ ■ ' '
NO;
detected
. . | . eriod
,1
.
■ i
Put on
Standard Treat
ment
Put on
SCC
Ni
ti
(
---- :
Not started »;. ■
Treatment j
ft.
j
~
i
\ 493 (22%),
l
ell.
jin
For SCC patients, those . /ho had taker. 52'
•j ^doses sje considered as having completed 100%
Table 5 gives an overview of the 1985 cohort of •
patients and the 1846 (78.7%) patients among |
them in respect of whom treatment cards could •
be located for analysis.
j.
2 For', standard regimen, those who had taken more than 12 collections are considered as having
completed lW%cHemoffierapy.
Table 6 shows that the completion rate for
females was higher than that for males in respect :
of SCC in 1985.
Table shows a better rate of treatment com
pletion among SCC patients compared with those
Whether .there was an/ difference in case- [
e;.
holding for SCC among DTC patients compared F .
2345
1359
j
1986
2194
1238
463
312
defaulters’’^which proportion fell to 21% later,
but is still very high. It represents 2a totally
'/* wasted^.effort.
Treatm
nipletion Rate
f
W1
on standard regimens. Earlier, Table 3 had shown •
that in 1984, only 312 out of 1797 (17%) cases re- j.
ceived SCC while in 1986,1238 out of 1701 (73%)
_ : 85’
’got the SCC regimen.
5 • SC
if
-
Cc
n
i
1985
a
Pu
499 (21%)
a
O ■
: Ca
[.Ni
f 807(31%)^
.
1485
487
I
!
M
Positive Patients put on SCC & Standard Treatment
2624
11
avi
■ Ar
7
1984
■f.
d=
Or
S;
49.5%
S
W; . a
go f
__ :•
Sp
■■»■■■
^National yearly •
average
6-
PHC
DTC
I
V*. •
'Table 2. Cc.Unbution of Sputum Positive Cases from different types of Health Institutions (1984 to 1986)
Cohort period
19
19
19
■J
^“'DTC =' DL/rict Tuberculosis Centre; PHC = Primary Health Centre; GD = Govt. Dispensary;
§ VC = Voluntary Centres; GH = Govt. Hospitals.
i
Pt
New sputum No.
Pos.
exams.
Type of
Centre
i
1986
1985
'■fc®m.yti9fcfc; fcj/lfefc-.:';fc X
Ofc
•
th.
alt
G
-t,
.PERFORM/ NCE C •• D.T.P. IN NORTH ARCOT DISTRICT
986
Table 4. Completion rate forSCC and Standard
Treatment
Period
i
%
103
1.7
8.58.5
7.0 '
SCC
%
Standard
% .
! 48.7
18.0
. 41.3
24.0
J/ 35.4
223
1984
1985
j
1986
I
Table 7. Proportion of SCC Completed Treatment
among different types of centres
Treatment completed (100%)
91
(j; A.
Tab:. 5. CoJiort Period of 1985
86)
D
■3
2345
2090 (89.1%)
244 (10.4%)
1846 (78.7%)
1359 (73.6%)
*
487 (26.4%)
_____
( Females ■
Males
Put on SCC
staric'd
itment
Completed 100%
treatment
(31%)
(21%)
(22%)
■1 shown
Tses re(73%)
>hort of
among
s could
ate for
respect
i casenpared
961
ten*-
368
(38.3%)
Total
;
1236*
<7 (52%) '
511
(413%)
275
143'' v
2
|
* Out of 1,359 patients put on SCC, 123 are not ineluded due to migration, change of regimen or death...
1
<
with other type of centres as regards 100%
treatment con. letion is shown in Table 7.
>
.
■-
Table 7 shovs that case-load at all the PHIs C
y 85.5% compared to, that of 14.5% at DTC. But
J SCC completion rate a^X'TC is 50.3%, and tha&i
I in VCs even 75.9% but just around 38% in rest qf
|
I
ji
the Pills. The most discouraging aspect is that.
although about 55.5% of the case-load is held by
GHs (mostly Paluk Headquarters Hospitals),
their completion
completion rate is just
just 38.3%.
38.3%. /
“•
Conclusions
;
The gradual downward trend in sputum
examinations at DTC is understandable since it is.
Proportion
put on SCC
Completed 100%
treatment
%
DTC
14.5
50.3
PHC
18.3
36.3
GH
55.5
38.3
GD
7.0
36.8
VC
4.7
75.9
observed that the diagnosti. facilities at the PHIs
have been utilised to a greater extent. However, it
is a matter, of concern that sputum positivity rate
at PHCs is on the decline J' om 2.8% to 1.7%)
which leads us to think t. .. either selection of
symptomatics or the quality of technical'
procedu es adopted at i' ; laboratory needs
improvement. It is also observed that the
contribution of new sputa . positive cases in '
PHCs and VCs has steadily increased which
shows better involvement of the rural population.'
But, overall there has been a declining trend in
new sputum cases found. While starting of
treatment has improved, yet the.proportion of,
initial defaulters is high. Completion rate in SCCi
is better than that oi Standard regimen.
Completion rale is higher in females than in
males. With -.gard to sharing of SCC case-loadr
among different types of ii.„.‘T ions, it is evidenf
that only 14.5% of the c..n.~, were treated at
DTCs compared with 85.5C, ’.i. all the PHIs. This
may be due to the fact that tl r treatment facilities
available at the peripheral level have been better
utilised. The high 100% con pletion rate of SCC
at DTCs (50.3%) is u. lerstandable since
specialized personnel are loc king after initial and
subsequent motivation and for taking defaulter
actions but it should have been higher, especially
when the competion rate at. VC is 75.9%. It.is
discouraging to note, however, that the
completion rate at Govt. Hospitals is only 38.3%
whereas they carry a maxim in load of 55.5% of
the patients put on SCC. It may be that this is-due
to no separate personnel be'r.g assigned io look
Table 6. Cohort of 1985 SCC Patients who completed
treatment, according to sex ofpatients
|
Type of
Centre
DTC = District Tuberculosis Centre
PHC = Primary Health Centre
GD = Government Dispensar;
VC = Voluntary Centres 6
GH - Government Hospitals
.5------------------------------------
Sputum positive cases
.!
diagnosed
2 Original treatment cards
1 available for analysis -1‘
.1 Among them old cases
7 Cards eligible for analysis
4 Number put or. SCC
Number put on standard
1
treatment
129 '
1-
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,7 $
.
:
:•
f -
■
■
■
'
' ■
♦
?
after initial motivation, subsequent, motivation, or
defaulter action taking at GHs. As it is true that
improvement in case-holding will directly
increase the overall efficiency, of the programme,
something positive should be dore at the G.Hs.
fo ■ better case-holding. .
■
■■
r
.•
• •
Ii
C.K, BABU
.J
Acknowledgement
My sincere thanks are due to the Director of Medi
cal Services and Family Welfare, Madras-6, Joint Di
rector of Medical Services (Thoracic Medicine), Ma
dras-6, -and the District Medical Officci for having
granted permission to present this work and to Dr. A.
Subramanian, District T.B. Officer for his valuable
guidance.
I
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■'
Statemen t about ownership and other particulars of the Indian Journal of Tuberculosis as per
’ Form IV under Rule 8 of the Registration of Newspapers (Central) Rules 1956.
■■
.N
■
L 1.
Place of Publication
: New Delhi
SI 2.
Periodicity of Publication
:
Quarterly, published in the month of
January, April, July and October.
Printer’s name; nationality &. address
:
V.N. Swamy; Indian; 3, Red Cross Road,
New Delhi-110 001.
■
|
■
3
3.
;W
Vi.
Publhher’s name; nationality & address
: V.N. Swan.y; Indian; 3, Red Cross Road,
New Delhi -110 001.
5.
Editor’s name; nationality & address
: Dr. S.P. Pamra; Indian; Q-5, Model Town,
Delhi.
'6. Names e nd address of individuals who own
tlie newspaper and partners or shareholders
holding more than one percent of the total
capital.
';N ; -
■
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Sd/- V.N. Swamy
on behalf of the Tuberculosis Association of
India.
K
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si'
J.
■ Bsw
I-
I, y.N. Swamy, Secretary-General Interim I/c. of. the Tuberculosis Association of India, 3, Red
!
Cross Road, New Delhi -.10 001, hereby declare that, the particulars given above are true to the
j best of my knowledge and belief.
si a
m
(
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: Secretary-General Interim I/c.,
The Tuberculosis Association of India,
3, Red Cross Road, New Delhi-110 001.
!
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Ind. J. Tub., 1994.41,223
Article
FATE OF SMEAR POSITIVE PATIENTS OF PULMONARY
lERCULOSIS AT AN URBAN DISTRICT TUBERCULOSIS CENTRE,
FIVE YEARS AFTER TREATMENT*
P. Jagota1, E.V. Venkatarama Gupta1 and R. Channabasavaiah’
iSumman/- The fate of smear positive
jtienti, five year* after their treatment at an
District Tuberculosis Centre is reported
0ng with the problems faced by the patients
Ith regard to persistence of symptoms, the
ltd for subsequent treatment and
lifployment status following treatment.
^Among the 1,227 patients treated with
flier Standard Regimen (SR) or Short Course
hemotherapy (SCC), only 502 (40.0%) could
t traced out: 370 on SR and 132 on SCC. Of
lose on SR, 40.5% were reported to be dead
nnpared with 12.1% on SCC. The higher
tath rate among the SR cases was mainly
Ktontributed by those not completing
■treatment (lost cases).
Taking culture negative status as the
■avourable outcome, 80.8% of the patients on
®CC compared with 45.7% on SR had a
■avourable response. Emergence of drug
^resistance was not seen to be a major problem.
[{Persistence of chest symptoms was observed
kmong 355% of the satisfactorily interviewed
taiienls and significantly higher among those
ost on SR (48.3%), than 'SR completed' and
SCC completed' or lost patients.
About 75% of those who were lost from SR
and 50% from SCC had treatment
lubsequently. Favourable outcome was
reached among the SR lost who took
lubsequent treatment to the same extent as
unong those who did not. This effect was not
teen in the SC lost group. There was no
change in employment status in about 80% of
the patients, whether on SR or SCC.
The overall outcome was the best among
patients completing treatment with SCC. The
ate of the SR loet group wm similar to those
>*ho had no chemotherapy.
I
Information
on
the outcome
of
chemotherapy under programme situation,
immediately after treatment is completed and
over a longer follow-up period, is needed by
planners for evolving the most appropriate
treatment policy. Whereas the fate of
tuberculosis patients for a five year period
under 'no chemotherapy' situation' is known,
as also the potential and efficiency of
treatment under programme conditions with
Standard Regimen (SR) and Short Course
Chemotherapy Regimen (SCC) respectivley2-4,
information on the results of such a
programme intervention over a longer period
of time is lacking. The sociological problems
faced by patients following their treatment
have also not been studied. It becomes
necessary to investigate the behaviour of a
patient with respect to his efforts to cope with
the changed situation following prolonged
suffering, as are the treatment results in terms
of deaths, bacteriological conversion and
emergence of drug resistance.
Objective
The present study investigates, five years
after the anti-tuberculosis treatment of smear
positive patients of pulmonary tuberculosia,
the
(a) outcome oftieatment in terms of
(i) survivaf/deeth and
(ii) bacteriological status, as well as
(b) perceived health status in terms of
(i) penbtence of symptoms.
Paper preaented al the 41th National Coofereacc oa Tuborculoau aad Cheat Dieeaaea at Bbopal : 9th-l2tb
December, 1993.
2
M’dical Officer, National Tuberculosis Institute (NTI), Bangalore;
3. Statistical Assistant, NTI, Bangaloi
- .
B
*
1
(ii)
self-rating of well-being,
(iii) reasons for getting hist from
treatment, and
(iv) employment problems faced.
f
Methods
Ii
>/■
I-
The study was conducted during the
period April to June 1991. A cohort of smear
positive pulmonary tuberculosis patients,
aged five years and over, diagnosed and
treated with SR or SCC (Primary Treatment)
during the calendar year 1985 at the Lady
Willingdon State TB Centre (LWSTC),
Bangalore and residing within Bangalore city
limits, constituted the study group. This
Centre functions as an urban District
Tuberculosis Centre. The proportion of
patients on SR and SCC depended on the
acceptability of the regimens offered to
patients and the availability of SCC drugs at
the Centre.
Going by the identification particulars and
addresses on treatment cards. Health Visitors
(HVs) of both National Tuberculosis Institute
(NTI) and LWSTC contacted the patients 4-5,
years after being put on treatment. On
verifying the identification particulars of the
contacted patients, the HVs collected two
sputum specimens (one spot and another
ovemight/spot) from those alive. These sputa
were processed in the NTI laboratory for
direct smears and culture for M. tuberculosis
on Lowenstein Jensen's medium. Sensitivity
tests were carried out for Isoniazid,
Streptomycin, Rifampicin, Ethambutol and
PAS.
The HVs and social workers also collected
from the patient himself or from any of the
adult family members or a neighbour,
information about the patient's current
health status (or cause and time of death),
presence or absence of chest symptoms with
duration, employment status and treatment
taken, if any, subsequent to the primary
treatment.
Though the analysis of the results of
treatment pertains to the culture positive
patients, there was a high degree of
correlation between smear and culture
examination results, as given in Annexure 1.
225
MTBOFSMMKSnVB
JAGOTA ETAL
224
DiSTRIBimOH OF PATIENTS BY CONTACT STATUS
Definition*
Primary treatment: Treatment prescribed at V*
the hrae of diagnosis
. "
Subsequent treatment: Any other treatment 9
taken besides the primary treatment
Contacted : Patient traced at the treatment S
card address and found dead/satisfactorily S
interviewed
5'
Satisfactorily interviewed : Patient found S
living and interviewed
Completed treatment/Lost: As per the DTP S
Manuals
Favourable outcome : Both the sputum '»
specimens found culture negative in those S
satisfactorily interviewed
■
Unfavourable Outcome : Death/culture »
positive
Drug resistance
Isoniazid resistant »
organisms isolated from any of the sputum >
specimens on follow-up
PATIENTS
1227___________
T
I
l
MOT .
CONTACTID
CONTACTED
592
725
J____
SAT.
|
see
SR
’20
SAT.
DEAD
166
ixrv.
336
DE
Sitiifieitrilj
Studtri
Shtrl C««nc
INTV.
SI
see
—
S R
ISO
?
'■
’
|
Results
The distribution of 1,226 out of the 1,227
patients, by primary treatment status (SR or
SCC, completed treatment or lost), is given in
Table 1. Of them, 965 (78.7%) were on SR and
261 (21.3%) on SCC. Further, it is seen from
Annexure 2 that the age-sex distributions of
patients, contacted or not contacted, were
similar, by regimen and treatment status. In
other words, the contacted patients could be
taken to represent all the patients at intake.
Table 2 presents the treatment completion
pattern in the contacted patients, according to
treatment regimen The observed difference
in treatment completion, between SR (205%)
and SCC (69.7%) is significant (p < 0.05), and
is similar to patients at intake.
1
■
?
1
see
120
SR
504
<Cbtnnlh«r>|j
Deaths
As seen from Table 3, of the 502 patients
contacted, 166 (33.1%) were dead at the time
of follow up and the remaining were
satisfactorily interviewed. Of the 76 patients
who completed treatment on SR, 6.6% were
dead compared to 49.3% among those lost on
SR. Of the 150 dead on SR, 145 (96.7%) were
from those lost from treatment.
Deaths among patients completing
treatment on SR was significantly lower than
among those lost on SR. Further, deaths
among SR completed, and among those on
SCC, whether SCC completed or lost, were
similar.
The fate of 498 contacted patients, in terms
of death and bacteriologically favourable
outcome in the remaining is presented in
.. Of the
—:::
— • 5 on sr, 45.7% had
Table 4.
368 rpatients
a favourable outcome. Among the 76 who
completed treatment on SR, 75%, and of the
|(wt group
ornun 38.0%,
aR 0%. had a similar outcome.
lost
Of the 130 patients on SCC, favourable
outcome was observed in 80.8%. Among the
90 who completed treatment on SCC, 86.7%
5
16
I
Overall outcome
:
|
sec
I aUriiiwtd
Material
In all 1,227 consecutive patients, with
adequate address on the treatment card and
satisfying the admission criteria, were
registered for the study (see Figure). Of
them, only 502 (40.9%) could be contacted;
the remaining 725 included, among others,
(i) migrated-305, (ii) house not traced-191,
(iii) false address-20, and (iv) house
demolished-29.
J
had a favourable outcome, compared to
67.5% in those lost on SCC. SCC completed
treatment cases had a significantly better
outcome than 'SCC lost' or 'SR completed <r
lost cases.
Thus the overall favourable outcome
among the 498 contacted patients was 543%,
fifth of
when nearly a 1„_.
—them
----- were treated with
fCC,
Drug resistance
Table 5 shows the bacteriological status
among 332 of the satisfactorily interviewed
patients, whose culture results were available.
Of the 218 patients on SR, 50 were culture
positive. Of them, 35 had drug resistant
organisms. Of the 114 patients on SCC, 9 were
culture ^sitive and 7 of them had drug
resistant organisms. Thus, only 42 remained
as drug resistant patients among the 332
satisfactorily interviewed (12.7%), even when
71.2% of those still positive were drug
resistant.
'
Patients left alive with drug resistant
organisms were not seen to be a major
problem, in the context of the number put on
primary treatment.
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Reasons
SQC ..
Referred to hopital
interviewed is given
Table 8. Of the 217 patients on SR, 42.4
reported still having chest symptorr
compared to 22.1% of the 113 on SCC?at H :ame of interview. Overall, 355% of ti
patrents were still having chest symPto«
Cough alone or in combination with othW
symptoms was present in 79 (36.4%) on sS
compared to 22 (19.5%) on SCC. CouW
constituted the predominant symptom (aboS
»%). Symptoms were significantly high®
among the 'SR lost' than in others.
W
SR
13-1 66.7%
Stopped on
medical advice
Disatisfaction with
4
treatment
Financial constraints
Migrated
1
Symptoms
disappeared
Not stated
6
45
Total
149
ISJ
295%
21
24
6
9
33
treated. Patients subsequently treated had a
significantly better overall outcome. Of 38
no ^rence was
'
1?Ldeathsandbacteriolo8i“l status
he subse4uen‘ly treated and
untreated group. (The detailed results on
e3."‘ l"a,"’en, Wil‘ b'
Chest symptoms
The presence of chest symptoms among
i
Health status
Health status of these patients I
volunteered, in the form of a self-ratl
perception of better, worse or the same wl
found to be similar. Of the 219 on SR, 92
felt better compared to 95.7% out of the 111
on SCC. Whether on SR or SCC, completed J
S'
Patients P^ceived themselves aj
better (Table not presented).
Subsequent
treatment
Total
171 $
81
252
Treated
Not treated
Total
18
20
38
Not treated
SCC
Changes of occupation from that recorded
at the rime of diagnosis among the employe^
are given m Table 9. There was no change I
employment status in the vast majority c-l
cases, whether they were on SR or SCC 'S
completed or lost (more than 72.3%). Th-.^
Unfavourable
outcome
Favourable
outcome
(Bact. neg.)
Number
%
Total
Dead
Pos.
92
68
56
46
114
24
10
34
25
104
462
30.9
413
148
•'
■
■
-
- ’
■
79
5
1
722
5
4
2
13
7
13
12
6
6
26
65.0
68.4
J SKdtr^entisnotavaihbte
>n
W-
Chwt symptoms mnong nMactarify interviewed patient* rriated to primary treatment
treatment
Totol
Chest symptoms
Present
Absent
Total
Cough with or
without other
symptoms
No.
%
6
7«100x
Col.6/Col.4
No.
1
2
3
4
5 = 100x
Col.4/Col.2
SR
Completed
Lost
Total
70
147
217
49
76
125
21
71
92
30.0
483
42.4
18
61
79
85.7
85.9
85.9
81
32
113
65
SCC
Completed
Lost
Total
16
9
13
9
25
19.8
28.1
22.1
812
100.0
88.0
300#
213
117
355 ’
101
863
Total
23
88
22
H Six excluded-information not available
Number
Treated
SR
TaM»*>
Occupation
Table 7. Fate of lost patients acci'■ording to subsequent treatment it
Primary
treatment
229
PA-raOFSMEARPOSmVB PAUEbTO OF FCIAtONARY TUBERCULOSIS
are excluded
I
>
J
-I
number of unemployed was too small to
draw anyvalid conclusion (not on Table).
Discussion
This study presents the fate of patients
treated with SR or SCC by an urban DTC, five
years after start of treatment. The fate was
observed in terms of survival, bacteriological
conversion and drug resistance at the time of
follow up, as well as socio-economic
problems related to persistence of symptoms,
current occupation, reasons of loss from
treatment and subsequent treatment sought.
The follow-up results of an SCC regimen in
the form of a cohort for such a long duration
are not available so far.
The observations made in the study and
their implications need to be considered in the
following perspectives : (a) while the national
chemotherapy policy’ is to place all the
bacteriologically positive patients on SCC,
only one fifth of them were in fact put on
SCC, (b) while only 21% of the followed up
patients on SR had completed treatment, 70%
of those put on SCC completed treatment
from the same cohort (Table 2). Similar
findings have been reported by NT1, from the
national reports on the performance of
District Tuberculosis Programme* (The study
thus gives the efficiency of the system).
That only 41% of the patients could be
traced out, even after meticulous efforts,
demonstrates the difficulty of carrying out
studies of this nature. However, the age-sex
distributions of the contacted patients
were not different for the patients not traced,
in respect of regimen and treatment status.
This makes the results suitable for
extrapolation.
I
Fate of patients
The fatefc>f smear positive tuberculosis
patients without any chemotherapy shows
that after five years, about half of the patients
would be dead, a third culture negative
(natural cure) and the remaining being
transmitters of the disease. In an operational
study on the potential of treatment efficacy
with SR of 12 months' duration, under
programme conditions, 30% were dead, 59%
became culture negative and the rest
remained as transmitters at the end of five
I
A
jlr
»
230
FATE OF SMEAR POSITIVE PATIENTS OF PULMONARY TUBERCULOSIS
JAGOTAFTal
231
References
< The five year follow up in the study does
Mot reveal much change in respect of
1. National Tuberculosis Institute, Bangalore .
Employment status but looms large,
Tuberculosis in a rural population of south
Primary treatment
Total
^specially
among
those
lost
to
treatment
on
Employment status
India : A five year epidemiological study.
Favourable
response,
over
a
period
of
Bull. Wld. Hlth. Org.; 1974,51,473.
No change
Change
Unemployed Wflve years, was achieved in 45.7% of patients
Completed
2. Baily, G.V.J., Rupert Samuel, G.E., Nagpaul,
148 (100.0)
124 (833)
D.R. : A concurrent comparison of an
2 (1.4) ' ^on SR, irrespective of a patient having been
22 (14.9)
Slost or completed the treatment. It is
unsupervised self-administered daily
Lost
166 (100.0)
regimen and fully supervised twice weekly
120 (723)
■ conceivable that the rate can be raised to
23 (13.9)
23 (13.9)
regimen of chemotherapy in a routine out
80 8% by changing over to the SCC regimen,
Total
314 (100.0)
patient treatment programme, Ind. J. Tuber.;
244 (77.7)
<3-along with a significant decrease in deaths
45 (143)
25 (8.0)
1974,21:152.
>1 and reduced search for subsequent
W treatment These are
major socio3. Baily, G.V.J., Gothi, G.D.: The problem of
Drug Resistance under conditions of drug
years’. With SCC of eight months' duration,
> epidemiological gains which could be
among the SR lost cases showed no benefit
chemotherapy.
Proceedings
of TB
at the end of treatment, the respective
3
further
augmented
by
improving
the
while the SR completed treatment cases
Conference 1974, New Delhi, 367.
proportions were observed to be 0%, 89 8%
3
proportion
of
patients
completing
SCC.
To
showed 75% favourable outcome. Thus, SCC
and 10.2%*.
4. Jagota, P., Venkatarama Gupta, E.V.
it be of value, a very high proportion of
Nagaraja Rao, BS., Parimala N., Baily G.V.J.:
was seen to give a definite socioThe above findings represent a situation
patients ('critical level') need to be placed on
epidemiological advantage over SR. It would
The acceptability and efficacy of two
wherein the guidelines given in the DTP
SCC
’
0
to
produce
an
epidemiological
impact.
regimens of short course chemotherapy
also seem that intensive effort is required to ;
manuals7 have been adhered to ('potential').
under conditions of an urban tuberculosis
keep patients on treatment in the evc.ii iitai
However, the outcome of treatment with the
ie event that
Acknowledgments
programme. Ind. J. Tuber.; 1989, 36,18.
SCC cannot be afforded and SR has to be the I
average efficiency with which the NTP
Chaudhuri, K., Jagota, P. Parimala, N. :
treatment alternative.
inc auu.~.^
- o
______ -to Dr. B.T. Uke,
The
authors —
are
grateful
hfa°?SXperformance')' oaring both SR as
Results of treatment with short course
The reasons for loss from treatment were | DirKtor,UNTI, for Ms constant guidance and
well as SCC appears to be different.
chemotherapy regimen used under field
mainly
due
to
referral
to
hospital
or
medical
I
support.
The
authors
are
also
grateful
for
the
FrOm * study on SCC offered by an
conditions
in
district
tuberculosis
advice
given
to
stop
the
treatment
(66.7%
of
1
Computer
assistance
from
the
Statistical
average DTP, the results in respect of death
programme. Ind. J. Tuber., 1993, 40,83.
Oiose on SCC and 29.5% of those on SR). JB Section. For field work, Mrs V.N. Saroja,
those
Sr.
baroja,
or.
sputum negativity and those who remained
6. Japota,
P-,
Chakraborty,
A.K.,
Surprisingly, the patient factors like financial 5 PHN; Mrs A. Korah, Sister Tutor; Mrs E.
Balasangameshwara, V.H.: Case holding in
coo/1 J
end of treatment were 12%,
I Victor, Mr. G. Mohiddin, Mrs V. Lalitha, Mr
or
job
constraints,
distance,
etc.
did
not
have
tuberculosis programme - epidemiological
33 2O5di?%reTCtiVely' ^“mpliance at
much bearing on completion of treatment in I Eshwara, Mr Narahari Rao, Health Visitors
priorities and operational alternatives. NTI
• The findings in the present study,
this study.
| and Mr Mallikarjunaiah, Social Worker of
Bulletin, 1993, 29,1.
after five years, were 12%, 81% and 7%
Among those who had symptoms at the | NTI and Mr Venugopal and Mr
7. i National Tuberculosis Institute, Bangalore :
respectively; probably because of the high
time of the interview, cough was the | Krishnamurthy, Health Visitors of Lady
Introduction to Manual for District
treatment completion rate (70%). It can be
predominant symptom, apparently unrelated
3 Willingdon State TB Demonstration &
Tuberculosis Programme, 1989,1-34.
seen that the favourable outcome improved
to the regimen used during the primary I Training Centre deserve credit. The staff of
among tfM SCC completed treatment patients
8. National Tuberculosis Institute, Bangalore :
treatment.
r
7
I NTI laboratory carried out the bacteriological
Annual reports on performance of
in both the above studies i.e., 86.7% in the
National Tuberculosis Programme for the
It is already known that patients who are 5 investigations : Mrs Pramila Prabhakar and
present study as compared to 905% observed
lost
from
DTPs
pursue
treatment
I Mr S. Prabhakar, Social Investigators are
year 1991.
in the Kolar study5. The results presented
| responsible for the sociological part of the
subsequently from elsewhere. In this study
9. Stefan Grzybowski, Donald A. Enarson : The
here are not very different from those
fate of cases of pulmonary tuberculosis
! field work : Miss K.R. Pramila and Mrs
also, a similar observation was made
observed in other Asian countries (death 10under various treatment programmes, Bull.
However, as seen in Table 7, subsequent
Kamala Rathnaswamy rendered secretarial
bacteriological negativity 60-65% and
I.U AT.; 1978, 53,70.
services and Mr. B.R. Narayana Prasad,
treatment was taken by a significantly higher
remaining positive 25%, over a two year
Chakrab&ty, A.K., Balasangameshwara,
1 Draughtsman prepared the drawings. The
proportion of patients lost on SR (67.9%)
10.
period’.
7
V.H., Jagota, P., Sreenivas, T.R. and
j authors are grateful for their respective roles.
compared to those on SCC (47.4%). In other
The fate of the contacted patients on SR in
Chaudhuri, K.: Short Course Chemotherapy
words, patients felt the need to have
: The authors also acknowledge with gratitude
his study, at the end of five years, was 41%
and efficiency variables in National
subsequent treatment more often when they
< the guidance and suggestions offered by
Tuberculosis Programme : A Model, Ind. J.
dead, 46% sputum negative and 14% still
'
members
of
Technical
Coordination
were
on
SR,
especially
if
they
got
lost
to
positive. The poor results on SR were mainly
Tub.;T992,39,9.
treatment.
This
behaviour
pattern
explains
»
Committee
of
NTI.
due to the patients lost, as the respective
why unfavourable outcome was significantly
amon8 ff*"1 were 49%, 38% and
reduced in the SR lost group cases who had
These results are similar to a nosubsequent treatment compared to those who
intervention situation1. Thus, chemotherapy
did not.
T.H. 9.
________
tmp,oridallnatii
M amctonly interviewed
I
I
Ind. J. Tub., 1994,41,233
Article
hormone prohle of females cases OF PULMONARY
TUBERCULOSIS’
Correlation between smear and culture results oftsatisfactorily interviewed patients
Mrs. S.N. Tripathy* and S.N. Tripathy1
Culture result
Smear
Neg.
Neg.
Pos.
Contaminated
Total
265
20
4
289
——------ \
Summary. The hormone profile (prolactin,
follicular
.timulating hormon*
Pos.
8
39
luteinizing
hormone level.) wa. .tudled in 31
47
Lcterlologically
positive,
Total
273
59
untreated ca»«» of pulmonary tuberculosis
4
336
: having amenorrhoea (including 23 caaes of
secondary amenorrhoea and 5 of
.nenstruation) to find out the reason for these
Annexure ’Oi mostly reversible menstrual irregularity
Age and Sex distribution of patients accoi>rding to primary treatment and contact status
J : conditions met with in cases of P«»®onary
tuberculoeia. The study showed that Uus
Regimen
Age
mostly functional disorder could be ascribed
Intake
Primary
treatment
to hypothalamus in 31%, pituitary in 41% and
(years)
No.
_ _________ Completed
: premature ovarian failure in 25% of ^?Lost
’I while the rest were due to organic lesions in
Males
Females
Males
Females
: the uterine cervix or endometrium.
Not
ContNot
ContNot
Cont
Not
Cont Not 'L
acted
ContCont
acted
cont
acted
cont acted cont- |
acted
acted
actedI
acted ' J Introduction
SR
SCC
Total
5-14
22
1
1
4
2
2
5
4
3
15-24
198
14
10
7
7
29
60
17
25-34
54
232
10
9
6
5
48
97
14
35-54
43
379
18
23
7
10
119
152
18
32
35
59
8
16
24
233
373
61
148
55+
134
6
7
3
Total
965#
49
50
27
5-14
3
1
1
15-24
79
14
14
13
19
3
11
3
25-34
2
96
T9
14
15
16
11
13
4
35-54
4
64
15
16
5
5
13
9
55+
1
19
9
2
1
1
3
2
Total
1
261
57
47
35
41
30
35
10
6
1226#
106
97
62
65
263
408
71
154
1
5
have undertaken a series of studies to
digate
the involvement of the genital
'1 invest
w
,
ysicm in female cases of pulmonary
a ssystem
I tuberculosis since 1980. In our first study , i
| was observed that only 19% of cases had
| normal menstrual cycle while the remaining
menstrual
y 81% had some form or other of
— -J irregularity. In our second study2, while
;■ looking for the2 reasons of menstrual
1 irregularities, we observed
c-------------that organic lesion
1 accounted for the menstrual irregularities in
f 12% of cases and in the rest there was a hypoj function of the ovary. Thus, when these
I patients were put on effective chemotherapy
| and followed up for two years, it was noticed
I that of the 35 cases followed up completely
out of 50 cases put on treatment, 72% had
3 become normal both functionally and
I organically. Only 15% cases continued to
3 have persistent amenorrhoea out of the 20
I amenorrhoric patients successfully followed
|
-• <
up1. The question remained whether the 3
rases who remained amenorrhonc were cases
of premature ovarian failure.
To substantiate the above observations, we
carried out a study on bacteriologically
proved pulmonary tuberculosis cases*. There
was organic involvement in 24% cases. Of the
rest, 84% had functional involvement, namely
hypoestrogenism with no clue as to the site of
involvement in the hypothalamus-pituitaryovarian axis. This study was undertaken in
the Department of Chest & Tuberculosis and
Department of Obstetrics & Gynaecology of
S C.B. Medical College, Cuttack, from April
1992 to January 1993 to provide the answer.
• Paper presented at 48th National Conference on
December. 1993
-?■
■
i-
Material and Methods
A total of 35 bacteriologically positive and
previously untreated cases of pulmonary
tuberculosis, belonging to 19 to 35 years age,
having parity between 0 to 3 were taken into
the study. Apart from detailed history taking
and routine gynaecologic and chest
examination, chest X-ray, endometrial biopsy,
endometrial aspiration cytology, vaginal
cytology and cervical scoring were done. In
all cases, follicular stimulating hormone
(F.S.H.) and luteinizing hormone (L.H.),
prolactin and oestradiol (E2) levels were
estimated by radio-immuno-assay technique.
Out of the 35 cases, 31 were having menstrual
irregularities and hypoestrogenism.
Result^
A very large proportion of the cases (48%)
belonged to 21-30 years age group and were
nulliparous (32%). Secondary amenorrhoea
was the commonest menstrual disorder met
Tuberculosis and Chest Diseases', Bhopal : 9lh-12th
BWSfA .'WT. x
Sa ■■'■■<• vak- - A kOB
‘
-
1
<•:
'MWkwwHfe
-■■■■
atasBiSB---- ------------------------- .
!
3
ir-l
.■I
^■’1
I
1
I
i
:
I
•i
j
i
■!
received trough the questionnaire. llowover, for dhe
hospital bed strength was not availaiblc. Actual analysis
is thus based on the information collected from 25
hospitals Of 68 small hospitals, 13 (19.1%) responded, of
Tuberculosis Hospital Admission System
33 medium hospitals, 9 (27.3%) responded and of 16 large
hospitals. 3 (IS.7%) responded to the quest!-m. aim Out
and National Tuberculosis Programme
of 6 hospitals where bed strength ^WaS not available cither
K. S. ANEJA*. P. JAGOTA** ;
■• ■ from Directory-or from tire : form-lion th-' igh question
naire,% one-hospital^ responded.^. But this was not included
g. e. rupert Samuel***
. as
stated .VCUUV4..
earlier. The
bed was
Ub ■ataivAi
*4»w annual
..................... evrenditure
- --------------- - _
Today majority of the tuberculosis patients can bo • calculated from the total '■bueget. of- . the hospital after
dividing it by ■ the number of
■ treated effectively without admitting them in hospitals.
Facililies available—Ot the 25 hospitals 18 ' ad the pro
Consequently, the WHO Expert Committee on Tubervision of'drugs other than I.NH, PAS,• streptomycin and
culosis (1974), recommended that financial resources andI
thiacetazone. -"’Facilities .'of culture and '? ■•itivity- tests,
t. bo
■ ---manpower available. for tuberculosis control are to)
used* to organise efficient and widespread ambulatory pro- • were available in 4 and for major surgfery in 6 only'. An
analysis of the relationship of tlie category.of the hospitals
grammes rather than to support hospitals. Nevertheless,
to ’the. facilities provided reveals- that all. the 3 large
in the situations stated below, hospitalisation becomes
hospitals had’till the major facilities except, that in one of
essential: (a) Patents requiring -surgery, .(b) medical
emergencies, e.g., severe haemoptysis, spontaneous pneu the 3 where,tlie facility of the culture and sensitivity tests
mothorax, etc., (c) miliary/meningeal tuberculosis, (d) ‘ were not available. Fifteen of the 22 mjedmm and small
hospitals had the facilities of dams, other than INH, PAS,
patients with severe toxaemic symptoms or those having
complications like diabetes mellitus,. thc control of which ■streptomycin and thiacetazone’. but the facilities for cul
requires intensive supervision which is not possible in a - ture and sensitivity tests were provided in 2 hospitals and
domiciliary service, (e) social em urgencies where thc , major surgery in 3 hospitals only; Howe- y.of the 13
small hospitals only 8 had the provision of drugs other
patient has no home or there: is no one in- the home to
than INI-I, PAS, streptomycin and thi’acetaz-ne and. none
look, after him, (f) patients excreting drug resistant bacilli,
had die facility of culture and sensitivity tests or surgery
and (g) diagnostic problems.
(Table 11.
A tuberculosis jJ^sphal therefore, continues to be an
Expenditure- Of the 20 hospitals from,'., .ichinforrnaimportant compone’ht of tuberculosis services within rhe
co-oYdinatcd framework of National Tuberculosis Pro tiorr”o’f’'expenditure was avail ible, f 11 were spending^
i .
gramme. (NTP). Tuberculosis, beds however, cost a good- Rs. 7,000/- or more per bed, and S> less
nation, and their optimal utilisation should be
per'bed- ahnuallw Of thee larer 9 ho':'
were spehd^
deal to the
1
cal aim.
aim. .There ...is therefore,
a need to understand ‘"'ing more than Its:' 5,000If per bed per yen' A •■■ rient the. logical
..
finding however, as tfiaLJvof the 8 Small hospitals, wwe
the existing situation in terms of the facililies provided,
also spending Rs.-7,000/- ^’d^Vvvc“r<i- be ’ 7er year/Tfae
the types of cases admitted, the policies, adopted for admis
average expenditure incurred by Ac 1 r-np'or >ri of
sion and tlie expenses involved in order to give direction
small hospitals was therefore, almost the 3ame as that of
to the discussions for Te-drientaiioh. of hospital admission
medium and large hospitals..
system, vis-a-vis NTP. Thc present i study was an attempt
Types of patients admitted—(I) Tii^ proper utilisation of
in that direction.
a tuberculosis hospital is directly reflected , ini the, pro
Study—A questionnaire was designed to elicit the infor
mation on : (1) The average annual expenditure per bed. ' portion of patients .who are admitted, as p- - laid down
specific indications. From- 17 hospitals, ^information re
(2) Facilities available, viz., the provision of drugs iothcr
garding the pattern’of admission according to indication
than streptomycin, 1NH, PAS and thiacetazone, spumm
was available. The discrepancy of adnT'"ion without
culture, sensitivity tests, major surgery, etc. (3) Category
specific indication was more evident; in cases of small and
wise admission as per the specified, indications. (4) dis
medium hospitals, where out of. 14 small and medium bos- .
tribution of admissions from rural and urban areas.
pitals only 3 .were admitting 80%, or more of their patients
(5) The admission policies adopted.
fas per indications:-.and in as many, as 6, ;•.•■•’’ admissions
It was addressed to all the^^vGovernment/Ti.
Institutions in the country,- catering toRenert
general ■public - as4 were less thar. 40% fTable 2).
(2) The analysis of the .ocrccn'.age of > :mi;'ion io pgr' tfie Uirectoiy of Hdspitals in India (1978* For the’
relation to emergencies revealed that in 10 '' the 17 bos* •
purpose of analysis, the hospitals were categorised as
pitals, admission for emergencies was le : than 25%
smallj medium and large^ according to their bed strength.
(Table 3). Further, in 6 of these 10 hospital’, it was even ,
A hospital was considered to be -small if its bed strength
less than 10%. .The discrepancy was again more in small
was 100 'medium one with a range “of^'TOl to 300/and
and medium hospitals.
large' one 'with a bed strength, more than 300./Of thc
(3) Excepting emergencies, in a vast majority of. the
‘123 institutions, • 26 (21.1%) 1'responded' with varying
patients, the sputum, should bo positive for, A^FB at the
degree of completeness of the informa'tion. The bed
time of admission. However, it was only 3 of the 15 hos»
strength for 9 hospitals was not available in the Directory
pitals in which 80% or more of the patient.', were sputum
of Hospitals in ■ 'ia (loc. cit.). Out of these 9 hispitals,
positive on admission, and in 3. they were -.ven less than
4 responded to th© questionnaire, of which thc bed
strength of 3 hospitals was collected from the information' 40%. Thc findings were similar in all Categories of hc-s.
pitals (Table 4).
National Tuberculosis Institute Bangalore
(4) . Number of cases in rural area's is marly 4 times
*
D.T.D., D.P.H., Tuberculosis Specialist- to that of urban areas. There should therefore approxi
M.3.B.S., Senior. Medical Officer i ■
mately be'.a similar ratio_.of tltc admissions in thc hospitals.
In U of the 20 small and .medium hospitals who responded
B.A., Diploma in Sta't.stics, Statistical As.istant
213.
4
’
klRO •' k;:k; ■'
OVELIALISED FACILITIES BY DIFFERENT CATEGORY OF HOSPITALS ' IN RELATION
to Their Annual Expenditure Per Bed
.
■
Facilities available
Category
■' • . .
of
hospital
- . No. of hospitals.
Annual expenditure
per bed (Rupees)
.
few.
<7000
>7000 . NA
.Drugs other than' 1NH<
PAS, streptomycin
Culture and
and thiacecazone
sensitivity’tests
, Annual expenditure
Annual expenditure
. per bed (Rupees)
per bed (Rupees)
<7000 >70J0~NA
” <70'06^7000~i?A
>70J0
Major surgery
Annual expenditure
per bed (Rupees)
<7000 >7000—NA-
_____ None
Annual expenditure
per bed (Rupees)
<7000 >7000 NA
■
■
Small
'
• Medium
H fc
H It-
5
5-
'.515
l
4
4
>
Large
i ■
■2
-
1
2
Total'
9
11
5
6
, r 9
3
■2
—
3
’
i
2
1
2
2
1
2
2
2
1
2
4
'2
.4
l*or one hospital, facilities pro vidcd were not stated; NA=Information not available
■'
Table 2-Seowing .DisnuBtrnoN by
Percentage • -of
. ApALSSTONS AS :i>ER SPECIFIC INDICATIONS
. Category
■
of
hospital ■
Small
Medium '
Large
, Total .
H'
S
fl!'
92
H<
••2
3
6
. ' 3
_
1
- 1
. 1
2
1
• 5
1
2'
.5
-
5
3
13
9
8
25
:■
Table 5—Showing • Distribution 1 by
Percentags pt' adaiissions- as; per..;.;
Wc-o-yw
----- -WdicatiomTiul ..' c£ ' :
<«.. 40^59 ■ 60-79 80 an<j
NA - . .■ .'hospital
' ' ■' . ,----------- .
above
NA
of
Per entage of admissions ironi
rural areas
Total
<30
30—49 50—74 75~and NA
1
*
above
Small
Medium
Large
Total
3
Percentage
1
3
1
2
1
: 7
7
2
1
1
1
5
14
. 2
2
13
9
3
.25
•;v
.'.formation not available
NA Information not available
. .- \ •
• to this question, admissioh
Table 3—Showing Distribution BY' Percentage
=
oZ
Admissions for Emergencies
’ pitai^Piie.'>atierits from the rural areas were more than
'===i
^he 3 large hospitals,' in 2, the aSmSCategory
Percentage of admissions for ■
sion from rural areas was less than 50% and in 1 -even
• of .
emergencies
TotaJ
less, than 30%; (Tabk 5).
hospital
<25. . 25-49 50"and
(5) Admission for non-tuberculous conditions was negli
gible' In 17 of the 18. hospitals who responded to this
above
question, 4adm
SVnall
-5
’
'5 •
' 3
Policy
of
admission
—
Oi
the
’
24
hospitals,
who.reported
13
Medium
'5
1 '
on this question, 12 had the policy of admitting the patients
' .3 . . ■
9
Large
1'
strictly by the waiting l.st kept for this purpose and the
2 1
> •
3
Total
10
5 _ ____ 2
8," ‘
other 12 were having varied system of admissions. • All
25
the. 3 reporting large hospitals were admitting their patients
NA=Information not' available:
. recording to their turn on the waiting list.
i 1:-. ■.
. 0
s . r.-
ta ” ■
.'
H ..fe
'tr'
li
■
>
is ; ;
ii
?
■
'
'
'■
-
•
.
•
V.
.
•
,
.
-
’
■
w
J
is
■■
rant
.
Discussion Table 4—Showing,.. Distribution by 1
____ _page ■ op
r'cRCEN
m view of the uniiorm success of the domiciliary treatAdmissions for. Sbutvai Positive -Cases
j ment, the need for hospital admissions has been minimised.
A small porti
Category
tutional care. The admission of such patients will not only
Percentage of admissions of
i
•
• of
lead to better patient acceptance, but will also .create an
•sputum positive cases
___ Total
hospital
■atmosphere of confidence in the community towards NTP.
■<^o 40—59 60—79 JO “and
NA '
/Tuberculosis beds arc very expensive. More than 50%.of
’ ■ ;■ .
, above
tne reporting hbspit.. ■ were incurring. Rs. 7^000/- or more C ■■
Small
, .1
2
aimualiy [;er‘ bed ai ; this proportion bF'the’expenditure
7.
1
■■
Medium
1
3
9 W.^G m\'y^'ncd;. bv • medium-and even by . the small hosI
3
Large
' 1 ■
3 pitals. Further, there was poor
1
poor relationship
relationship between
between the
the j
1
Total
3
3 '
25 1 budget provision and the facilities -provided. Very
” , little ’ t
' 6
: 3
10
___ ;d
specialised facilities were available in the small1 u
hospitals.
Yet, a large proportion of these hospitals were incurring
NA = Information, not available
more than Rs. 7,000/- ner bed annuailv. for
"inn L...,
r-;
..
•*;' J-
II
NOTES AND NEWS
- he routine treatment service. Fifty-five of the tuberculosis-, small
and it is here that there is
small and
and medium
medium hospitals
I
institutions m the country are such Small hospitals, which bulk
bulk of
of the
the resource
resource input
input on
on account of their sheer
nave neither the facility nor the expertise to perform tho numbers. Instead
Instead of
of increasing
increasing the number of beds in
specialised functions. It would be fruitful to probe deeper the form of such small and medium hospitals, it would
into the details of their expenditure and rearrange their
be more relevant to ensure the provision of facilities,
functions within the existing budget by providing more
appropriate staff and adherence to the right type of admis-facilities and appropriate staff. - sion policies in these categories of.hospitals; to derive the
Surpris.ngly, in the hospitals spending between Rs.
optimum benefit-of the resource-input.
5,000/- and Rs. 7,000/- per bed per year, the proportion
Acknowledgment’
of the facilities was also the same as those spending- . The authors''arc grateful to the Head^ of. the tuberculosis/
Rs. 7.000/- and above per bed annually. There is, thus,
hospitals for their response to tKbx questionnaire, to Dr.
a need to rationalise the expenditure vis-a-vis the facilities
G.V.J. Daily, for his valuable suggestions ,and to Miss
provided.
Padmalatha K/ishnan for her secretarial help. ■
T!l£-l!Ld_icati
for----the—hospital
admistidns
are clear
—-—ons-----.......................
References
' - .. and
—gut these_were_adhered to by- one-third of the , Directory of Hospitals in India. 1978, Central Bureau’/
hospitals and in
■" 'an^lier%ane-th'^
-------- — pir'.
of HoMih
Intelligence.
New Delhi.
of Health
Intelligence-,
New I-'-'-.
Delhi.
indications was as low as 40% and less. “
7. major imThe
WHO Expert Committee on Tuberculosis—WHO Tcchn.
balance was again in small and medium hospitals.
Rep. Sef No. 552, 1974; p. 18.,. ..
In normal situation, 25% of the admissions in -tuber
culosis hospital are usually meant for emergency cases In
F- :
one-third of the hospitals, such admissions were less than
10%. Whether the emergency cases did not reach hospitals
in time or they were not admitted, is a i..;_'.
moot question, but
rath international Leprosy.Congremthe utilisation of the hospitals on this account was much
The.
1
2th
International Leprosy Congress- will be held
i
less than expected. This underutilisation was again on the
part of small and medium hospitals;
. at Vigyan Bhawan in New Delhi, on February 20-25
1984. x The President of India, Sri ZaiL Singh,• will inApart from the emergencies and admission due to toxicity of the drugs, which form a comparatiyely'snsall group,'
andMmister
- -..............
....... - ..........
.. ot
-- India/..... ...
Smt. » Indira Gandhi will deliverr the\ keynote address.. De? i-..
the patients admitted in the tuberculosis hospitals should
L-t
initially be sputum positive but in 25% of the hospitals. ^,lcd .,n:Or%at,on may be had irom Dr. R. H. Thangaraj.
>
-Leprosy,
Congress,
of all categories,. 60% of the patients were-sputum-negative ,Organising
R d Cr' Secretary,
R.- N 12thn International
...
~.7*'
5
at the time of admission. The bed occupancy in most of
’ NeW ■De,h1’11 001’
Dr. S. S.
5. Verma Memorial
Memoriml Aw
Awmrd
the hospitals was thus uncalled for and Amounted to
rrd / • 1wasteful expenditure.
,
Indian Public Health Association, Delhi ■.Branch',
Routine admissions according to seniority of registration
has invited entries for the .above award, which has been
instituted for
for an
an original
original work
work based
based on
on research
research studies/
studies/
„ lists
R... arc out of place v/ith -vunuH-vvuvctu
in the wait ng
current- concept instituted
yet, half of the hospitals were ad. ar^!e in .the . field of Community:-Medicine by ' scientists
1 :' of case management,
..........X .......................................................................................................................................................................................................................... .
...U-y
below 35 years of . age. '-The award carries scroll, and a
witting their patients strictlyj on . waiting Hist basis and not
on the urgency of the indications for admission. Admis% cash award of Rs.-500/-. Five copies of the entries have
to be sent by 31st Ma'ch. I98J to. Dr. Sarojini Dewan, Pre- 1
sions should be regulated in an effective manner through
ventive’and Social Medicine Department,, Moulana Azad
co-ordination committee consisting of the senior members
of the staff of the hospitals concerned and referring tuber- ’ Medical College, New Delhi-110 002.
culosis centres, offer.ng domiciliary treatment so'as to co
Diploma Course in Physiotherapy aild
Occupations! Therapy .
ordinate domiciliary and hospital services under NTP.
A redeeming feature was that the distribution of services
A 3-year Diploma Course in .Physiotherapy and Occu
pational
rendering to the rural and urban patients was equitable
.
. Therapy
, - has been introduced at the Institute .of
in small and medium hospitals, but the larger hospital^ in
Engineering andI Rural
Technology,
?.
T_ ---c,. The minimum quali
which the facilities were concentrated, catered to lesser
fication.
fi-‘ - for admission is Intermediate in Science with bioproportion of patients from the rural areas
>»ik« a uiiuiiiiuui
mn
.. probably due
....
or equivalent with
minimum ui
of jV/b-ma;Ks
50% marks in me
the
aggregate. Further information may be had,
> to their location in bigger cities.
had. from Dr. V.
■• There are always inherent limitations in such
such, a kind of
■Ki Kansal
Kansal. Head ■1 of the PJivim.AAAnnn-im
Physio-occupation Therapy,
-enquiry based on questionnaire which prevents drawing
IERT’ Allaha6?.d;211 002 U.P.
of firm conclusions but still it.
it does
docs indicate the existing
. Advanced Course Jn Diabetes MeHitus
trend on the utilisation of the tuberculosis beds requiring .. A" L^anced course in Diabetes .Me,i tur -vilf be Md
III
J
■Ir
y,<0J ;
wi -
.
■
.....
-
■
.....
aw;
...
j|lp
'i
1:
(
1 ■
I
1
l^0*1 admis; ' Medical1 Sc.cnees on March 12-17. 1984aS
iSK
with nrof. M.M.S.
'
sion systems within the framework of NTP.
.n.-i/mi ai
Summary
and Conclusion
Tuberculosis hospital
, . is; an important component of
tuberculosis services within the framework of National
Tuberculosis Programme. In order to understand the
situation, information on facilities, provided, the types of
cases admitted, the policies adopted for admission and the
expenses involved was collected through a questionnaire
addressed to various Government Tuberculosis Institutions
in the country catering to general public.
in sb’ •
c The
...^ major discrepancies
■
.
allocation vis-a-vis.
lacilities available and .right type of admissions, relate to
Ahuja as the course director. The last date Tor .application
is. January .31, J984. Detailed information may be had
from the Organising Secretary, Dr. K. Khatarpal,' Depart,
went of Medicine, ARMS, New Delhi-110 029.
West Bengal Chapter of ASI
The 5th Annual Conference of the West Bengal Chapter
of the Association of Surgeons of India will be held at
krishnagar. Nad:a, on February 12, 1984. Dr. H. C.
Majumdar. Organising’ Secretary, has invited ail members
to attend the conference at Rabihdra Bhawan at Krishnagar, Nadia
■
-4:
I
Position: 2693 (2 views)