Tuberculosis in India
INTRODUCTION
Since
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,
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
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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