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PRIMARY LEVEL CARE OF TUBERCULOSIS

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PRIMARY LEVEL CARE OF TUBERCULOSIS

  1. 1. PRESENTERS: •Emmanuel Wekesa •Keagan Kirugo SUPERVISOR •Professor Francis E. Onyango •Dr Boniface O. Osano •Professor Ruth Nduati
  2. 2.  Introduction  Classification  Magnitude of morbidity and mortality  Risk factors  Stop TB strategy
  3. 3.  Causative agent-Mycobacterium genus. Species are varied but mainly Mycobacterium tuberculosis.  It is an obligate aerobe and an acid-fast bacillus.  TB is a re-emerging disease of global concern.  The HIV pandemic has led to a resurgence of TB in both adults and children,  The burden of TB in children depends on the burden of the disease in the adult population.  Children have an increased risk of developing primary progressive TB because of the associated severe immune suppression resulting from their young age and HIV.  Extrapulmonary TB is seen more often in HIV-infected children.
  4. 4.  There is a higher case fatality rate for children who are co-infected with TB and HIV.  It is important to look actively for TB in children with a chronic cough and to provide treatment as early as possible.  The highest reported sero-prevalence was reported in southern africa;10-60%, the lowest prevalence in West Africa.
  5. 5. It is for childhood tuberculosis A. ACCORDING TO SITE  Pulmonary  Extrapulmonary. B. ACCORDING TO SEVERITY, TREATMENT HISTORY AND DRUG RESISTANCE 1Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 34
  6. 6. 1. Non-severe TB 2. Severe TB 3. Retreatment 4. MDR TB •PTB without extensive parenchymal disease •TB lymphadeniti s •TB pleural effusion •PTB with extensive lung disease •Miliary TB •All other forms of extrapulmon ary TB
  7. 7.  Globally2: 2nd to HIV/AIDS as the greatest killer due to a single infectious agent. 2010 2012 Morbidity 8,800,000 8,600,000 Mortality 1,400,000 1,300,000  Amongst those sick in 2012; 530,000 were children of whom 74,000 were HIV negative. 2http://www.who.int/mediacentre/factsheet/fs104/en/ reviewed March 2014
  8. 8.  TB is the leading killer in PLWHIV causing 1/5 of all deaths. Locally3: Kenya is position 15/22 of the high TB burden countries 2012: prevalence 103,159 of which 39% were HIV infected. 3Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 9
  9. 9. A. Major  HIV infection. Most common risk factor locally.  Poorly treated previous TB  Low socioeconomic status B. Minor  Non-modifiable: Age-extremes of age; Sex. M>F  Immunosuppressive states: Malnutrition; Diabetes mellitus; Immunosuppressive agents; Malignancies.  Drugs: Alcoholism; Tobacco smoking  Pulmonary diseases: Silicosis 4Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 3-4
  10. 10. A. BACKGROUND 1991: World Health Assembly recognized TB as a world health problem. 2 targets were set up: i) Detection of 70% of new smear positive cases ii) Cure 85% of the new cases. All these by 2005 1994: DOTS launched. Components i) Govt. commitment ii) Case detection through sputum microscopy iii) Standardized short-course chemotherapy under supervision iv) System of regular drug supply v) Monitoring and evaluation of the programme
  11. 11. 2003: Cure rates of the new sputum positive cases was 83% 2004: Case detection rate 53% 2006: Launching of Stop TB Strategy to run from 2006-2015
  12. 12.  TARGETS i) MDG 66: Combat HIV/AIDS, malaria and other diseases. Target 8: Have halted by 2015 and begun to reverse incidence of malaria and other diseases. ii) Stop TB partnership: By 2015, the global burden of TB will be lowered by 50% relative to 1990 levels  VISION A world free of TB  GOAL To reduce dramatically the global TB burden by 2015 in line with the MDGs and the Stop TB partnership targets and to achieve major progress in the research and development needed for TB 5WHO (2006). The Stop TB Strategy. 6http://www.milleniumproject.org/goals/gti.htm/
  13. 13. PRINCIPAL COMPONENTS 1. PURSUE HIGH-QUALITY DOTS EXPANSION AND ENHANCEMENT a) Political commitment with increased and sustained financing b) Case detection through quality-assured bacteriology c) Standardized treatment with supervision and patient support d) Effective drug supply and management system e) Monitoring and evaluation system and impact measurement
  14. 14. 2. ADDRESS TB/HIV, MDR-TB AND OTHER CHALLENGES 3. CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING 4. ENGAGE ALL CARE PROVIDERS 5. EMPOWER PEOPLE AND COMMUNITIES WITH TB 6. ENABLE AND PROMOTE RESEARCH
  15. 15.  Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition.  http://www.who.int/mediacentre/factsheet/fs104 /en/ reviewed March 2014.  WHO (2006). The Stop TB Strategy.  http://www.milleniumproject.org/goals/gti.htm/
  16. 16.  AHSANTE  MERCI  XIEXIE

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