The document outlines several national programs in India related to controlling communicable diseases. It discusses programs for acute respiratory infections, diarrhea, tuberculosis, leprosy, malaria and other diseases. For acute respiratory infections, it describes signs of pneumonia in children and treatment guidelines. For diarrhea, it explains the objectives of the control program and composition/use of oral rehydration salts. The tuberculosis program uses the DOTS strategy of supervised treatment and monitoring to achieve cure rates. The leprosy eradication program provides multi-drug therapy and aims to prevent disabilities through integrated care.

1. NATIONAL PROGRAMS RELATED TO
CONTROL OF COMMUNICABLE
DISEASES.
BY
DR.N.S.K.CHAITANYA
www.similima.com 1

2. 1.Acute respiratory infection control program.
2.Diarrheal disease control program.
3.Tuberculosis control program.
4.Leprosy eradication program.
5.Malaria and other arthropod borne disease
control program.
6.National filaria program.
7.National guinea worm control program.
8.AIDS & STD control program.
9.National program of immunization.
www.similima.com 2

3. ACUTE RESPIRATORY INFECTIONS:
One of the Major cause for
Childhood mortality- 20-30% (below 5 yrs of
age)
Children mortality – 15 -30%(total deaths of
children )
www.similima.com 3

4. PREVALENCE:
1. O.P. CASES 22-66%
2. I.P.CASES 12-45%
3. Urban set up
Under age 5 years – suffer upto 3-5 episodes
of ARI in a year.
4. Rural – slightly lower in morbidity than
urban.
www.similima.com 4

5. ARI CONTROL PROGRAM
The guidelines devised by WORLD HEALTH
ORGANISATION for prevention and treatment of
ARI is possible by paramedical workers.
www.similima.com 5

6. www.similima.com 6

7. • WHO protocol puts forward 2 signs as the
‘’ ENTRY CRITERIA’’ for a possible diagnosis of
pneumonia.
Cough.
Difficult breathing.
• Presence of fever is not essential for diagnosis.
www.similima.com 7

8.  Infants under 3 months are categorized as a
seperate group,
 Because in them the gram negative bacteria
predominance as the cause
 Disease is more liable to take a serious
course.
www.similima.com 8

9. Presence of any of the under mentioned signs is
indicative of severe illness:
• Respiratory rate more than 60/minute.
• Chest indrawing in the absence of nose block.
• Infant has stopped accepting feeds.
• Hypothermia.
• Convulsions.
www.similima.com 9

10.  Children aged between 3 months to 5 years:
 The common causative organism is
streptococcus pneumoniae
 Fast breathing is a better predictor of
pneumonia than auscultatory findings.
 Respiratory rate will be
 More than 50/min – in children between
the ages of 3 to 12 months.
 More than 40/min –in children above 1 year
of age.
www.similima.com 10

11. Clinical signs Classification
1)Not able to drink Very Severe Pneumonia
Central cyanosis
are present.
2)Chest indrawing. Severe pneumonia.
No cyanosis
Able to drink.
3)Respiratory rate over Pneumonia.
40/min.
No chest Indrawing.
www.similima.com 11

12. 4)No fast breathing. No pneumonia.
No chest indrawing.
Feeding well.
www.similima.com 12

13. CONTROL OF DIARRHEAL DISEASE PROGRAM.
• Diarrhoea -Major cause of deaths in children.
• Almost ¼ th of the deaths in children is due to
diarrhoea.
CDD program
• Low cost intervention
• Highly effective.
www.similima.com 13

14. OBJECTIVES:
o To train the medical and other health personnel
in standard case managment of diarrhoea.
o Promote standard case management practises
in private practitioners.
o Instruct mothers in home management of
diarrhoea and recognition of signs which signal
immediate medical care.
o Make available oral rehydration salts (ORS)
packets free of cost,at government health
facilities at first later through the public
distribution system.
www.similima.com 14

15. Composition of ORS
CHEMICAL Quantity to be used in grams
Sodium chloride 3.5gm
Sodium citrate 2.9gm
Potassium chloride. 1.5 gm
Glucose 20.0gm
www.similima.com 15

16. o A sachet containing the above contents is
dissolved in 1 liter of water and is kept in clean
utensil.
o 150-200ml of solution is administered each
time a stool is passed.
o In case ORS packet is not available,oral
rehydration therapycan be carried out by by a
home made solution constituted as follows.
www.similima.com 16

17. Weight Household
(gm) measure
Common salt 3.5 3/4th of a teaspoon
Baking soda 2.5 ½ teaspoon
Canesugar 40 8 level teaspoon.
Lemon one (supplies potassium)
www.similima.com 17

18. DO’S :
 Can be given with rice water, dal water,
butter milk,soups,coconut milk.
 Breast feeding should be continued.
 In case of lactose intolerance-milk to diluted
with equal quantity of water.
www.similima.com 18

19. Dont’s :
• Aerated drinks,friut juices,sweetened tea
• Worsen the diarrhoea by their osmotic effect
and should therefore be avoided.
www.similima.com 19

20. REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAM (RNTCP) INCLUDING DIRECTLY
OBSERVED TREATMENT: (1997,March 24)
It’s main goal is
1)To achieve a cure rate of 85% and along with
efforts to detect atleast 70% of smear positive
pulmonary tuberculosis.
2)Involvement of NGO’s,information,education,
communication and improved operational
research.
www.similima.com 20

21. • India
1.5 million cases-every year are put on
treatment.
More than 1000 people die everyday due to
tuberculosis.
www.similima.com 21

22. • DOTS is a systematic strategy which has five
components:
1)Political and administrative commitment.
TB is the leading infectious cause of death among
adults. TB kills more ADULTS. Since TB can be
cured and the epidemic reversed, it warrants the
topmost priority, which it has been accorded by
the Government of India. This priority must be
continued and expanded at the state, district and
local levels.
2)Good quality diagnosis. Good quality microscopy
allows health workers to see the tubercle bacilli
and is essential to identify the infectious patients
who need treatment the most.
www.similima.com 22

23. 3)Good quality drugs. An uninterrupted supply
of good quality anti-TB drugs must be
available. In the RNTCP, a box of medications
for the entire treatment is earmarked for
every patient registered, ensuring the
availability of the full course of treatment the
moment the patient is initiated on treatment.
Hence in DOTS, the treatment can never
interrupt for lack of medicine.
www.similima.com 23

24. 4)Supervised treatment to ensure the right
treatment, given in the right way. The RNTCP
uses the best anti-TB medications available.
But unless treatment is made convenient for
patients, it will fail. This is why the heart of the
DOTS programme is "directly observed
treatment" in which a health worker, or
another trained person who is not a family
member, watches as the patient swallows the
anti-TB medicines in their presence.
www.similima.com 24

25. 5)Systematic monitoring and accountability.
The programme is accountable for the
outcome of every patient treated. This is done
using standard recording and reporting
system, and the technique of ‘cohort analysis’.
The cure rate and other key indicators are
monitored at every level of the health system,
and if any area is not meeting expectations,
supervision is intensified.
www.similima.com 25

26. • Tuberculosis (TB) is an infectious disease
caused by a Bacterium, Mycobacterium
tuberculosis.
• It is spread through the air by a person
suffering from TB.
• A single patient can infect 10 or more people
in a year.
www.similima.com 26

27. www.similima.com 27

28. Algorithm-I For Diagnosis Of Pediatric TB
Pulmonary TB suspect
• Fever and cough > 3 weeks
• Loss of weight /no weight gain
• History of contact with suspected or
diagnosed cases of active TB.
www.similima.com 28

29. SPUTUM
SPUTUM+ve SPUTUM-ve
Case Course of antibiotics for 7-10 days.
Symptoms persist
Do X-ray and Monteux test
Treatment for Mx+xray abnormal All other
Pulmonary TB situation
Refer to pediatrician.
www.similima.com 29

30. ALGORITHM-II:FOR CLINICAL MONITORING.
Patient on therapy
Satisfactory response Non satisfactory response
• Improved symptoms. Review at 2 months.
• No weight loss. 1) Compliance poor.
2) Weight loss.
3)Worsening of symptoms.
Follow up clinically
X-RAY at completion Refer to pediatrician.
of treatment at 6 months. Consider sputum examination.
www.similima.com 30

31. NATIONAL LEPROSY ERADICATION PROGRAM.
Launched – 1955.
Mainly for rural areas having high endemicity.
1969-1970- converted into centrally
sponsored program.
www.similima.com 31

32. 1) 1 District Leprosy Officer-1 district (high
endemicity)
And 1 officer per 2 to 3 districts (moderate
endemicity).
2) For 4-5 lakh population- 1 medical officer,
4 non medical assistants,20 paramedical
workers.
www.similima.com 32

33. • SET (survey,education,training) centers are
present for every population of more than
25000.
• 1 paramedical officer is assigned to each
center which are located in PHC.
www.similima.com 33

34. • 1981-WHO introduced MDT
• Multi drug therapy regimen.
• Supplied free of cost to patients.
• Safe and effective-decreased detection rates
and decreased deformity cases.
Each district – Provided by mobile leprosy
treatment unit for visits to leper’s colonies for
supervision of treatment and periodic surveys.
www.similima.com 34

35. DIAGNOSIS
• Presence of hypopigmented patches with loss
of sensation of heat,cold,pain,light touch.
• Tenderness/thickening of peripheral and
cutaneous nerves on palpation.
• Positive in nasal/skin smear tests.
www.similima.com 35

36. www.similima.com 36

37. PAUCIBACILLARY TYPE includes
• Indeterminate (I)
• Polar Tuberculoid (TT)
• Borderline Tuberculoid (BT)
It is recommended that paucibacillary
cases be examined clinically atleast once a
year of minimum of 2 years after completion
of therapy.
www.similima.com 37

38. Multibacillary leprosy includes
1)Polar Lepromatous (LL)
2)Borderline Lepromatous(BL)
3)Mid Border Line (BB).
It is recommended that the multibacillary cases
should be examined clinically atleast once a
year for a minimum period of 5 years after
completion of therapy.
www.similima.com 38

39. www.similima.com 39

40. • 2. Prevention of Disabilities:
• During the course of disease, even during the
Multi Drug Therapy (MDT), Leprosy cases may
develop complications like lepra reactions,
Ulcers on anesthetic parts, new nerve damage
leading to paralytic deformities and
absorption of fingers / toes.
• These complications are treatable and thus
disabilities can be prevented. In integrated set
up, services for Prevention of Disabilities
(POD) are provided at 3 levels
www.similima.com 40

41. 1. First, at primary level (PHC, CHC, Dispensaries)
reactions and simple ulcers are managed.
2. Difficult cases, grade II disabilities and eye
complications are referred to secondary level i.e.
district hospital or temporary hospitalization
wards.
3. Those cases, which require investigations &
surgery and cases which can not be managed at
secondary level, are referred to tertiary care
centers.
www.similima.com 41

42. Rehabilitation
Physical rehabilitation.
Social rehabilitation.
Vocational rehabilitation.
www.similima.com 42

43. HEALTH EDUCATION.
In India the stigma of leprosy as a punishment of
sins is deeply ingrained in the Indian Psyche.
The notion can be changed when the disease
was completely curable by available medicines
without any residual deformity,if treated at an
early stage.
www.similima.com 43

44. THANK YOU
www.similima.com 44