INTRODUCTION TUBERCULOSIS is one of the ancient diseases. Chronic infectious disease. CAUSATIVE ORGANISM-Mycobacterium tuberculosis Mainly affects the lungs-Pulmonary tuberculosis Can also affect intestine ,meninges ,bones & joints,lymph glands,skin & other tissues-Extrapulmonary TB
Burden of the disease TB remains a worldwide public health problem and one the most challenging communicable disease to be controlled and prevented. India 20% Non-HBCs India is the country with highest burden 20% in the world & accounts for nearly China Other 13 HBCs 1/5th of the global burden. 16% 14% Philippines 3% Indonesia 6% Ethiopia 3% Nigeria Pakistan 5% 3% Bangladesh South Africa 4% 5%
The NTP has been in operation since 1962. In 1992, The govt of India, WHO and the World bank reviewed NTP and introduced RNTCP. RNTCP is one of the largest public health programmes in the world. • 85% cure rate through DOTS Phase I(1998-2005) • 97% of the population covered • To decrease the morbidity & mortality due to TB & to cut the transmission Phase II(2006-2011) • DOTS plus (CAT IV drugs) included to treat MDR & XDR TB Phase III(2012-2015) • Early detection & treatment HIV associated TB , MDR & XDR TB cases Evaluation of RNTCP is very much essential to know the outcome of treatment ,statistics of tb detected & treated- mainly HIV associated & drug resistant cases , reasons for interruption , to assess the effectiveness of the program and educating public about the importance of RNTCP.
Aims and objectives To assess the treatment outcomes of RNTCP in Dharwad district in 2010 & 2011. To identify gaps and underlying contributing factors. To explore the reasons for interruption of treatment. To assess the effectiveness of the management.
Materials & methods Place: District Tuberculosis centre(Hubli), Dharwad district, Old Hubli. Duration: 662012 – 572012 Sample Size & Population: Recorded cases registered during the period of 2010 and 2011 in the whole Dharwad district & patient feedback of about 50 patients Type of Study: combination of record based study and observational study Statistics: The data collected from questionnaire was entered and analysis was done in SSPS version 20 statistical software.
Inclusion criteria: All TB cases recorded under RNTCP in Dharwad district during January 2010 to December 2011 for record analysis. Observational study from KIMS, Old Hubli & Dharwad civil hospital. Performance indicators for Dharwad, National, State (Karnataka) data were collected from the website www.tbcindia.org. Incidence, trends of case detection, treatment outcomes, cure rate and success rate,etc was analyzed.Exclusion Criteria: TB patients who have not been registered under DOTS treatment..
DISCUSSION 2010 1st half 2010 2nd half 2011 1st half 2011 2nd half 17.88 17.88 18.07 18.07 lakh lakh lakh lakh Total population 6543 8009 7263 8610 Smear examined 757 743 751 742 Smear positive (11.6%) (9.27%) (10.34%) (8.65%) Treatment 541 544 540 542 (71.47%) (73.21%) (71.9%) (73.05%) The numbers of sputum smears examined are increasing every year suggesting that the efficiency of RNTCP is increasing .
Of the remaining: < 5% on Non DOTS , an average of 6.3% are initial defaulters NSP cases are more common among the economically productive age group, i.e.15-44 yrs, more so in 35-44 age group. It is least common among 0-14 age group ,i.e. around 1%.
70 62.79 63.26 62.75 59.55 60 50 37.25 37.21 40.45 40 36.74 MalePercentage 30 Female 20 10 0 2010 1st half 2010 2nd half 2011 1st half 2011 2nd half Incidence of NSP tuberculosis is more among males than in females in both the years.
Conversion rate 89 88.39 88.5 88 87.5 86.73 87Percentage 86.5 86 85.64 85.55 85.5 85 84.5 84 2010 1st half 2010 2nd half 2011 1 st half 2011 2nd half Sputum conversion rate among NSP should be >90%, but it is less in Dharwad district in both the years.
Success rate 83.00% 81.87 82.00% 81.48 81.00%Percentage 80.00% 79.00% Success rate 78.00% 77.89 78.32 77.00% 76.00% 75.00% 2010 1st half 2010 2nd half 2011 1st half 2011 2nd half Cure rate for NSP should be >85%, this target has not been achieved in both the years in Dharwad district.
Cure rates 100.00% 90.00% 80.00% 70.00% 60.00% Hubli 50.00% DharwadPercentage 40.00% Kundgol 30.00% Kalghatgi 20.00% 10.00% 0.00% 2010 Jan-June 2010 July-Dec 2011 Jan-June 2011July-Dec Cure rate is highest in Kalghatgi TU & least in Kundgol TU. Dharwad and Hubli TUs are showing consistent cure rates in both the years
Death rate 16 14 12 10 Hubli 8 DharwadPercentage 6 Kundhgol Kalgatagi 4 2 0 2010 1st 2010 2nd 2011 1st 2011 2nd Hubli TU had the highest death rate in 2011. Kalghatagi TU showed the lowest value in 2011. Dharwad TU and Kundgol TU are showing varying trends.
Cure rates 88.00% 86.00% 84.00% 82.00% 80.00% DHARWAD Percentage 78.00% KARNATAKA 76.00% INDIA 74.00% 72.00% 70.00% 2004 2005 2006 2007 2008 2009 2010 2011 Dharwad is having cure rate less than state performance.Karnataka has lesser cure rate than national sputum conversion rate.The cure rates have increased in 2011 when compared to 2010 in district and stateand also in the country.
Questionnaire results Female - 32% Male - 68%There are more number of TB cases among males than in females, thismay be due to more contacts among males during work hours and lesspersonal hygiene among themMales are more exposed to environmental pollutants than females
16 14 5 12 10 Female No. of patients 8 8 6 1 Male 1 11 4 5 6 2 5 4 1 0 1 1 1 0-10 11-20 21-30 31-40 41-50 51-50 61-70 71-80 years years years years years years years years Age in yearsTuberculosis is more among 21-30 years of age , this group contains the peoplewho are working, students and etc where risk of contact transmission from personto person is more.These age groups are to be protected by proper health education about personalhygiene and immunization for prevention of TB.
32% of cases are found to be unskilled workers & unfortunately the other 34% are students, 16% being housewives & 14% are skilled workers. 78% belongs to low socioeconomic status & remaining 22 % to middle SES. Vaccination coverage rate is less than 75% in this area. Among total cases in the age group 0-10 years 50% were found to be vaccinated Cough and evening rise of temperatures are the chief complaints of the patients approached. Around 78% of patients have these complaints.
14% of the cases have contact history . 12% of the contacts of the patients have symptoms. 34% dispose sputum in bathroom or basin,16% into the spit box ,26% on open ground and cover with sand & remaining 24% do not use any definitive methods.. 20 of 34 male patients & 9 out of 16 female patients are aware that TB is a communicable disease.
About 14% of the cases have h/o similar treatment with anti TB drugs in the past and are now under CAT II as defaulters. 84% patients are under CAT I, remaining 16% are in CAT II (14% of default & 2% as relapse case). 88% patients are regular in treatment , 6% interrupted due to side effects of drugs & 6% were unable to follow up.
Importantly 4% i.e, 2 cases have HIV associated TB. 88% patients find that response from RNTCP unit is good , 10% are satisfied & 2% found it unsatisfactory. All the patients are provided with the drugs on every visit regularly & observed while taking drugs by the DOTS provider.
Conclusion RNTCP program implemented successfully in Dharwad district according to the guidelines. Though conversion rates & cure rates are less in district than that of the state& national rates , there is a gradual increase in the performance indicators since then. The programme is working efficiently acc to the patient feedback. But there are interruptions in treatment due to side effects & improper follow up .
LIMITATIONS Lack of time TB cases treated at private hospitals and clinics have not been included in the records. Some data like Cross-referrals between RNTCP and ICTC was not provided. Lack of availability of records of MDR & XDR cases.
Recommendations Periodic training & monitoring of all lab technicians & DOTS provider. Ensure that all the registered patients are started on treatment & regularly followed up. Early detection & treatment of HIV associated TB & MDR-TB,XDR & TDR TB patients. All the supervisory staff like DTO, STS need to strengthen their supervisory activities. Strengthening the evaluation program.