Tuberculosis in India

  

INTRODUCTION

 

          Since India became free, several measures have been undertaken by the National Government to improve the health of the people.  Prominent among these measures are the National HealthProgrammes, which have been launched by the Central Government for the control / eradication of communicable diseases, improvement of environmental sanitation, racing the standard of nutrition, control of population and improving rural health.  So the National Tuberculosis control programme – launched to control the tuberculosis.


 

          National tuberculosis programme has been in operation since 1962.  This is  a centrally sponsored scheme with 50 percent assistance to the states and 100 percent to union territories from central government.  The implementation of the scheme is the responsibility of the state government.

 

 

Objectives

It has 2 objectives

 

(a) Long term objective

Ø     To reduce tuberculosis in the community

Ø     One case infects less than one new person annually.

Ø     The prevalence of infection in age group below 14 years is brought down to less than 1 %, against about 50% at the present.

 

Short –Term objectives

Ø     To detect maximum number of TB cases among outpatient attending any health institution with symptoms suggestive of tuberculosis and that them effectively.

Ø     To vaccinate new born and infants with BCG.

Ø     To undertake the above objectives in an integrated manner through all the existing health institutions in the country.

 

 

Main Activities, Strategies of NTCP

          Early detection and treatment of TB patent is essential.  The institutions giving priorty to sputum positive cases.

 

1.        BCG vaccination of susceptible population.

2.        Isolation and treatment of cases.

3.        Setting up of training cum demonstration centres

4.        Rehabilitations

5.        Research activities

 


DISTRICT TUBERCULOSIS PROGRAMME

 

          National tuberculosis programme operates through the District tuberculosis programme which is the back bone of NTp.  It was evolved by national tuberculosis institute, Bangalore and was accepted by the government of India for implementation in 1962.  District tuberculosis centre is nucleus of the DTP.  The function of DTC is to plan, organize and implement the DTP, in the entire district, in associated with general health services.

 

          The health institutions available for increase in DTP are – government general hospitals and community health centre, primary health centre, tuberculosis clinicals other than DTC and out patient departments of tuberculosis sanationes and hospitals, other health institutions like dispensaries, health units, hospitals including those managed by the Government health scheme employee state insurance scheme local bodies, religious missions, voluntary organizations and private charitable society.

 


Organization

          A district tuberculosis programme consult of one district tuberculosis centre and on an average 50 peripheral health institutions comparing of PHC, general hospital rural dispensaries etc.

 

          To implement the programme, a specially trained team of key programme personal is posted at each DTC.  The beam consist of

1.     district Tuberculosis officer

1.        Second medical officer

2.        Laboratory technicians

3.        Treatment organizer / Health visitor

 

1.   X-ray technician

1.   Non medical team

1.  leader statistical assistance

1.   Pharmacist

 

Revised National Tuberculosis Control Programme

          The government of India, WHO and world bank together reviewed the NTP in the year 1992.  Based on the findings a revised strategy for NTP was evolved.  The silent features of this strategy are

 

1.     Achievement of at least 85% percent care rate of infections cases through supervised short course chemotherapy involving peripheral health functionaries.

2.     Augmentation of case finding activities through quality sputum microscopy to detect at least 70 percent estimated cases.

3.     Involvement of NGO; information, education and communication and improved operational research

 

 

Objectives

1.     To reduce morbidity and mortality from TB.

2.     To interrupt the chain of transmission of infection.

 

Pilot phased coverage and programme expansion

          The RNTCP was initially implemented in 1993 as a pilot phase in 5 project areas covering a population of 2.35 million.  Success of pilot test lead to the programme extension which provide coverage to a 14 million population in 13 states.

 

Structural Organisation

          Organization of the RNTCP at various level is as under

 

At central level:

          The central TB division, located in the Union ministry of Health and Family Welfare and headed by DDG-TB is responsible for TB control in the entire country.

 

At State Level:

          An STO, trained in RNTCP is responsible for ensuring, the performance of above activities within a state and also regularly coordinating with central TB division.

 

          At district level: A DTC is the nodal point for TB control activities and the DTO, as it in charge, has an overall responsibility for TB control programme within the district.

 

DOTS

          All patients are provided short course chemotherapy free of charge.  During the intensive phase of chemotherapy all the drugs are administered under direct supervision called direct observed therapy short – term.  Dots is a community based tuberculosis treatment and care strategy which combines the benefits of supervised treatment, and the benefits of community, based care and support.  It ensures high cure rates through its three components, appropriate medical treatment, supervision and motivation by a health or non health worker and monitoring of disease status by the health services.  Dots is given by peripheral health staff such as MPWs or through voluntary workers such as teachers, anganwadi workers Agent, expatients, social workers etc.  they are known as Dot ‘Agent’.

          The success of Dots depends on fire components

Ø     Political commitment

Ø     Good quality sputum microscopy

Ø     Direct observed treatment

Ø     Uninterrupted supply of good quality drugs

Ø     Aceatability

          The drugs are supplied in patient – wise boxes containing the full course of treatment and packed in blister packs.  For the intensive phase, each blister pack contains one days medication.  For the continuation phase, each blister pack contains one weeks supply and medication.  The combipack drugs for extension of intensive phase are supplied separately.

 

 

 

CONCLUSION

 

          The National Tuberculosis Control Programme has been accorded high priority by the Government.  With the inclusion of NTP in the 20 point programme, there is expansion of essential activities under the programme.  There has been considerable increase in budget allotment.  The international agencies like WHO, USAID, DANIDA, worlds Bank etc are providing the assistance to RNTCP and NTP.


 

BIBLIOGRAPHY

 

1.    B.T. Basavanthappa

Text Book of Community Health Nursing

2nd Edition, Page No.717-720.

 

2.    K.Park

The Text Book of Preventive and Social Medicine

8th Edition, Page No.334-336.

 

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