|A STUDY OF SOME OPERATIONAL ASPECTS OF TREATMENT
CARDS IN A DISTRICT TUBERCULOSIS PROGRAMME
|MA Seetha, GE Rupert Samuel & VB Naidu: Indian
J TB 1976, 23, 90-97.
The paper presents some aspects of domiciliary
management of tuberculosis patients in a District Tuberculosis Programme
(DTP) viz., the interval between diagnosis and initiation of treatment,
regularity in collection of drugs, role of motivation of patients
for collection of drugs and pattern of defaulter retrieval actions
by health institutions. The treatment cards of 3089 patients of
pulmonary tuberculosis belonging to Bangalore DTP diagnosed during
1964 were analysed. The cohort of 2479 patients was divided into
3 groups according to the place of treatment, viz., (i) those treated
at District Tuberculosis Centre (DTC) where better trained staff
motivated tuberculosis patients & took defaulter actions (ii)
the Urban Peripheral Health Institutions (UPHIs) where motivation
and defaulter actions were taken by specialised staff and (iii)
rural PHIs where non- specialised general health workers along with
general duties did motivation and took defaulter actions.
The study has shown that in the entire district
about 94% of patients were put on treatment within 10 days of diagnosis.
In rural PHIs, among 14.5% of patients the treatment was started
after 10 days of diagnosis. For the 149 initial defaulter patients,
actions were taken only for 39% of the patients, lowest being in
rural PHIs (10.8%). The defaulter actions for 69% were taken in
time, more promptly by DTC staff for DTC & UPHI i.e. 71.5%,
whereas rural PHIs were poor in this respect and only 37.5% of the
actions were taken on time. Sputum positive cases collected drugs
more often than sputum negative and also more patients collected
drugs on due dates at DTC in comparison with PHIs. Both the differences
were statistically significant.
About one third of the lost patients
came from those who made the first default. About 55-63% and 75-82%
of this group defaulted by the second and third collections respectively.
Defaulter actions were not taken by rural PHIs for 66.7 to 72.5%
defaults, while DTC staff had not taken defaulter action for about
20% of defaulters and 67.8% of such actions were prompt in DTC,
whereas it was only 19.3% in rural PHIs.
|KEY WORDS: COHORT ANALYSIS, COMPLIANCE, CONTROL
PROGRAMME, OPERATIONAL FACTORS.