|
016 |
SOME EPIDEMIOLOGICAL ASPECTS OF TUBERCULOUS DISEASE
AND INFECTION IN PAEDIATRIC AGE GROUP IN A RURAL COMMUNITY |
GD Gothi, SS Nair & Pyare Lal: Indian Paediatrics
1971, 8, 186-94. |
The prevalence and incidence rates of tuberculous
infection and disease in the community are known in the age group
10 years and above from several surveys carried out so far. The
present paper provides various parameters of tuberculosis in particular
in the pediatric age group. A random sample of 119 villages in 3
taluks of Bangalore district were surveyed 4 times from May 1961
to July 1968 at intervals of 18 months, 3 years and 5 years of the
initial survey. Tuberculin test was done for the entire available
population with 1 TU PPD RT 23 with Tween 80, and 70mm X-ray for
all available persons aged 5 years and above. Two samples of sputum
were obtained from the X-ray abnormals, and examined by smear and
culture.
It was found that prevalence of infection increased
with age from 2.1% at 0-4 year age group to 16.5% at 10-14 year
age group, compared to 47% at 15 years and above age group. Prevalence
of disease in 5-14 year age group was considerably lower than in
age group 15 years or more. Tuberculosis morbidity increased with
the size of tuberculin reaction and it was high among children with
reaction 20mm or more. Incidence of infection increased with age
from 0.9% per year in age group 0-4 years to 2.8% per year among
that of 15 years and above. Incidence of disease also showed the
same phenomenon-, rising from 0.5% in age group 5-9 to 4% per year
in the age group 15 years and above. There were 10 sputum positive
cases in 5-14 years of age in first survey, of them, 8 became negative
and one died. While from among 152 cases in 15 years and above age
group, 48 became negative, 72 died and 32 remained positive. The
fate of cases of pulmonary tuberculosis in 5-14 years age was not
as serious as in 15 years and above age group. The survey had no
means of examining miliary and meningeal tuberculosis.
Children as well as adults with larger reaction
of 20mm or more to tuberculin test had higher mortality. This could
be considered due to tuberculous infection after taking into account
death due to non- tuberculous reasons in both the infected and uninfected
groups. Use of chemoprophylaxis might be considered for those who
give history of contact with open cases and have tuberculin reaction
size 20mm or more.
|
KEYWORDS: CHILDREN, RURAL COMMUNITY, PREVALANCE,
INCIDENCE, INFECTION, DISEASE, TUBERCULIN, INDURATION SIZE, MORTALITY,
CHEMOPROPHYLAXIS. |
021 |
INTERPRETATION OF PHOTOFLUOROGRAMS OF ACTIVE PULMONARY
TB PATIENTS FOUND IN EPIDEMIOLOGICAL SURVEY AND THEIR FIVE YEAR FATE |
GD Gothi, AK Chakraborty & GC Banerjee: Indian
J TB 1974, 21, 90-97. |
In this study the material from Five year
study of Epidemiology of Tuberculosis (1961-68) has been analysed
to find out an improved method of interpretation of chest X-rays
to get accurate estimation of prevalence of suspects
in the community. The population of a random sample of 119 villages
from the three taluks of Bangalore district was surveyed four times
with intervals of 1½ to 2 years by tuberculin testing, 70mm
chest photofluorography and sputum bacteriology. Out of 45,434 persons
X-rayed during the first survey, 590 were read as active pulmonary
tuberculosis on the basis of single picture interpretation by two
independent readers. Of them, 460 being sputum culture negative
were classified as initial suspects and these were reviewed
in this study by the panel of three readers together by the method
of joint reading. The interpretation was done comparing
the serial X-rays of individuals taken at intervals along with other
available examination results and personal data. Out of 460 initial
suspects only 110 (23.9%) were confirmed as suspects,
the remaining were judged as non-tuberculous and/or inactive tuberculous
(62.2%) and normals (13.9%).
Fates on five year follow up were compared between
85 confirmed suspects and 385 initial suspects.
The mortality and sputum positive status were found more among the
former group i.e., 23.5 and 25.5 and 14% and 7.2% respectively.
Radiologically, 48.7% of the confirmed suspects and only 10% of
the initial suspects could be classified as suspects at 5th year
follow up. Incidence of bacillary disease among the confirmed suspects
was also found higher. On the basis of joint reading
and five year follow up study, the limitations of single picture
interpretation resulting in considerable over diagnosis were clearly
seen. The comparative reading of serial X-rays along with other
examination results did help in the better assessment of etiology
and activity status of disease. Of the X-rays read as non-tuberculous
and inactive tuberculous when reviewed by joint reading
method, about 67 more suspects could be added. Even then the estimates
of prevalence of suspects based on single film interpretation
which are widely used in India appear to be about 3 times the actual
prevalence.
|
KEY WORDS: FATE, SUSPECT CASE, X-RAY, JOINT
READING, SINGLE PICTURE, OVER DIAGNOSIS. |
022 |
TUBERCULOSIS IN RURAL SOUTH INDIA: A STUDY OF POSSIBLE
TRENDS AND THE POTENTIAL IMPACT OF ANTI-TUBERCULOSIS PROGRAMMES. |
HT Waaler, GD Gothi, GVJ Baily and SS Nair: Bull
WHO 1974, 51, 263-71. |
This paper estimates the natural trend of tuberculosis
in rural south India and the potential epidemiological impact
of a few selected programmes on this trend, by using the
values of important variables and parameters derived from a longitudinal
epidemiological study conducted in 1961-68 in Bangalore district
by the National Tuberculosis Institute (NTI), Bangalore. The values
are fed into an epidemetric model and the final outputs of computerization
derived are incidence of disease (in both absolute and relative
terms) and cumulative future prevalence of disease.
(1) An annual average input of new generations
of 3.16% has been derived for a population of 1 million by using
a simplified fertility rate formula. A constant reduction 0f 1%
per year has been assumed until fertility rate has reached 50% of
its starting value. The assumption is that any reduction in fertility
due to current family planning programmes will have a considerable
impact on the size of the population and on the epidemiological
situation. Further demographic assumptions are, excess mortality
applied to groups of active cases and fatality among untreated cases.
(2) The population is subdivided into the following epidemiological
groups: (i) non-infected, (ii) infected for (a)< 5 years,
(b)= 5 years, (iii) protected by BCG, (iv) active cases - (a) non-infectious,
(b) infectious and (v) previous cases. Initially groups (iii) and
(v) are given zero values. The future risk of infection is adjusted
to the force of infection, which is assumed to be reduced to 1/7th
when a case is successfully treated. Morbidity rates include transfers
from infected group to active cases group during 5 year periods.
(3) A spontaneous healing rate of 50% and a cure rate of
80% after chemotherapy are assumed. Protective effect of BCG
is given three values: 30%, 50% and 80%, with uniform annual reduction
of 1% (4) Case detection and treatment (CF/T) is given two
values: 66% and 20%. Coverage for BCG limited to 0-20 years is assumed
to be 66% or 30%.
The computer simulation output for natural trend
shows that the absolute number of new cases increases considerably
while the incidence rate do not warrant firm conclusions about any
long term trend. All programmes considered have considerable potential
impact. The CF/T programmes will reduce the incidence after 25 years
by only 12% compared to reduction of 17% by the BCG programme. In
general, the effect of CF/T will be more immediate and of BCG will
be seen much later. To avoid the drawbacks of incidence as an indicator
of tuberculosis situation, the cumulated future prevalence is taken
as the tuberculosis problem. To adjust for the present significance
of future cases as part of the problem certain discount rate have
been applied. The CF/T programme and the BCG programme with 50%
protection lead to 69% problem reduction, if not discounted. With
increasing discount rates, CF/T has an advantage over BCG. The actual
problem reduction will be higher than that estimated if improvements
in the standard of living are expected during the coming years.
In conclusion, data on the dynamics of tuberculosis
situation in rural south India, obtained by NTI, Bangalore when
fed into a mathematical model, many predictions about the future
tuberculosis situation were made under a wide range of hypothetical
assumptions.
|
KEY WORDS: TREND, MODEL, BCG PROGRAMME, RURAL
POPULATION, IMPACT, CONTROL PROGRAMME. |
025 |
PRECISION OF ESTIMATES OF PREVALENCE OF BACTERIOLOGICALLY
CONFIRMED PULMONARY TUBERCULOSIS IN GENERAL POPULATION |
SS Nair, GD Gothi, N Naganathan, K Padmanabha Rao,
GC Banerjee & R Rajalakshmi: Indian J TB 1976, 23, 152-59. |
This paper reports on a study conducted in the
year 1975 to estimate yield of tuberculosis cases from multiple
sputum specimens, and work out correction factors to be applied
to estimates based on small number of specimens. Eight sputum specimens
were collected within a fortnight from each person with an abnormal
chest X-ray during an epidemiological survey in 77 villages in a
district of south India. Each specimen was examined by Ziehl-Neelsen
technique of microscopy and culture. In all, 3,199 persons were
referred for sputum examination and results of all the eight specimens
were available for 1,652. Of the latter, 64 were culture positive.
The first specimen detected 58% of the culture
positives and the additional positives by later specimens generally
decreased. The contribution from the first specimen was 71% for
cultures showing good growth and 19% for cultures with scanty growth.
Similarly for positives on both culture and microscopy, first specimen
detected 87% whereas the corresponding proportion was 32% for those
positive only on culture. The type of specimen (viz., spot or overnight)
and age or sex of the case did not influence the yield from multiple
examinations. The precision of an estimate of prevalence will depend
on the number of specimens on which it is based and the coverage
obtained in the collection and examination of specimens. Correction
factors to be applied to such estimates based on one or two specimens,
for various levels of coverage have been presented. For example,
an estimate of prevalence based on one sputum specimen with 90%
coverage will have to be nearly doubled to get a more precise estimate.
Using these correction factors, revised estimates of prevalence
have been presented for a number of prevalence surveys conducted
in India. It has been estimated that the total number of infectious
cases in India at present may be at least 3 million, as against
2 million according to earlier estimates.
|
KEY WORDS: PREVALENCE, CASE, RURAL POPULATION,
MULTIPLE SPUTUM SPECIMEN, ESTIMATES, SPUTUM EXAMINATION. |
026 |
INCIDENCE OF TUBERCULOSIS AMONG NEWLY INFECTED POPULATION
AND IN RELATION TO THE DURATION OF INFECTED STATUS |
VV Krishnamurthy, SS Nair, GD Gothi & AK Chakraborty:
Indian J TB 1976, 23, 3-7. |
Some of the parameters relating to duration of
infected status and incidence of disease have been measured by analysing
the data collected from the five year study. Between 1961-68, 119
villages in Bangalore district with total average population of
about 62,000 were surveyed at intervals of 1, 3 and 5 years from
the first survey. All persons were tuberculin tested with 1 TU RT
23 and those aged 5 years or more were X-rayed. Sputum of those
persons showing any X-ray abnormality were collected and examined
for AFB. Persons with X-ray abnormality but bacteriologically negative
or with normal X-ray in all the preceding surveys, and who became
culture positive with X-ray abnormality in the current survey were
termed as "New cases". New cases who had shown 10 mm or
more reaction to 1 TU RT 23 at I Survey were considered infected
previously. New cases, tuberculin negative at I survey but who showed
an increase of 16 mm or more between two consecutive surveys were
considered infected midway between the two surveys.
Of the 42 new cases diagnosed from among the newly
infected during 5 years, 81% came from those infected within one
year. Incidence rate of cases among those who were infected within
one year was about 5 times more than those infected earlier than
one year. Incidence of cases steadily decreased with the increase
in the duration of infection. Further, it was found that one fourth
of all newly diagnosed cases came from the newly infected persons.
However, the size of the pool of previously infected persons in
a community being much larger, at least 72% of the new cases came
from the reservoir of previously infected persons. The incidence
of disease among the newly infected was almost the same in the three
age groups i.e., 5-14, 15-34 and 35 years or more. But, the ratio
of the incidence rates for the newly infected and the previously
infected decreased from 13 for the age group 5-14 to 3 for the age
group 35 years and above. In other words, the incidence of disease
among the newly infected in the age group 5-14 was thirteen times
more than for the previously infected in the same age-group whereas
in the age-group 35 years and above, the incidence among newly infected
was only thrice that among the previously infected.
Out of the 160 new cases diagnosed during the three repeat surveys,
21 per cent cases came from among those who were infected on the
average for one year or less. This is almost in conformity with
the hypothesis that one-fourth of all new active cases come from
new infections less than a year old.
|
KEY WORDS: INCIDENCE, INFECTION, CASE, TUBERCULIN
STATUS. |
027 |
RELAPSE AMONG NATURALLY CURED CASES OF PULMONARY
TUBERCULOSIS |
AK Chakraborty & GD Gothi: Indian J TB 1976,
23, 8-13. |
The five year longitudinal epidemiological study
in south India (1961-68) showed that a considerable proportion of
bacteriologically proven cases found in a survey got cured naturally
without the facility of organised treatment in the survey area.
This "natural cure" could be an epidemiologically significant
phenomenon- depending on the stability of such a cure or in other
words, the frequency of relapses among the naturally cured. In all,
108 naturally cured cases of tuberculosis out of a total of 269
cases, from among about 62,000 persons surveyed twice, were followed
up for varying periods of 1 to 3½ years.
It was observed that the average relapse rate was
85.4 per 1000 person years of observation, there being no difference
between the two sexes. Relapse rates were however higher in persons
aged 20 and more compared to those 5-10 years old. Relapses were
not dependent on the bacteriological status at initial diagnosis
i.e., whether positive by culture alone or positive by smear and
culture. The death rate among the naturally cured was 42.7 per 1000
person years and together with relapse constituted the unfavourable
fate after natural cure. It has been calculated that as an input,
adding to the pool of bacillary cases in the community, the ratio
of relapse cases to cases arising afresh from the general population
in a year would roughly be in the order of 1:16. It is concluded
that the naturally cured status could be considered as an epidemiologically
favourable situation, though much less so when compared to the chemotherapeutically
achieved cure.
|
KEY WORDS: RELAPSE, NATURAL CURE, CASE, RURAL
POPULATION, SURVEY. |
028 |
FIVE YEAR INCIDENCE OF TUBERCULOSIS AND CRUDE MORTALITY
IN RELATION TO NON SPECIFIC TUBERCULIN SENSITIVITY |
GD Gothi, SS Nair, AK Chakraborty & KT Ganapathy:
Indian J TB 1976, 23, 58-63. |
The study was undertaken in a sample of 103 villages
of 3 sub-divisions of Bangalore district as a part of the 5 year
study of epidemiology of tuberculosis between 1961-68. The follow
ups were done at 1.5, 3 & 5 years after the first survey.
The entire population was offered tuberculin test with 1 TU RT 23,
a second test with 20 TU RT 23 to those persons who were having
reactions of 0-13 mm to 1 TU. All aged 5 years or more were offered
70mm photofluorograms at each survey. Two specimens of sputum were
collected from persons having abnormal X-ray shadows for examination
of tubercle bacilli. Procedures were uniform at each survey. The
population was divided into three groups on the basis of their tuberculin
reactions: (a) reactors to 1 TU (infected with M.tuberculosis),
b) non-reactors to 1 TU but reactors to 20 TU (infected with atypical
mycobacteria), c) non-reactors to both 1 TU & 20 TU (not infected
with either M.tuberculosis or other mycobacteria). Incidence of
disease and crude mortality were studied separately among these
groups.
The five year incidence of culture positive disease
was the highest among 1 TU reactors and the least among reactors
to 20 TU. In the younger age group (5-14 years) the five year incidence
of culture positive disease among reactors to 20 TU was significantly
lower compared with that among 20 TU non-reactors. The reduction
of incidence of culture positive cases in the former group over
that in the latter was 75% for culture positive cases and 61% for
combined culture positive and negative disease. As regards crude
mortality, the overall rate was significantly lower among 20 TU
reactors compared with non-reactors. Even if the significance of
the finding on crude mortality is debatable, it could be concluded
that non-specific infection provides some protection against development
of tuberculosis, at least in younger age groups.
|
KEY WORDS: INCIDENCE, DISEASE, MORTALITY, NTM,
RURAL POPULATION. |
030 |
ESTIMATION OF PREVALENCE OF BACILLARY TUBERCULOSIS
ON THE BASIS OF CHEST X-RAY AND/OR SYMPTOMATIC SCREENING |
GD Gothi, Radha Narayan, SS Nair, AK Chakraborty &
N Srikantaramu: Indian J Med Res 1976, 64, 1150-59. |
The study was undertaken among 22,957 persons belonging
to 55 randomly selected villages of Nelamangala taluk of Bangalore
district in 1975, to find out precise estimates of prevalence of
bacillary disease. Symptom screening was done by well experienced
social investigators, according to a brief interview schedule. Sputum
was collected from all above the age of 5 years reporting chest
symptoms for seven or more number of days during the previous two
months. Within two weeks after symptom questioning, all were tuberculin
tested and all 5 years and above were X-rayed. Additional sputum
collection was done for those asymptomatics who had abnormal shadows
in their chest X-rays.
The overall prevalence rate of culture confirmed
bacillary cases by symptom and/or X-ray screening was 0.32 percent.
Same prevalence was seen with X-ray alone also. But the overall
prevalence rate based on symptom screening alone was 0.21 percent
which is significantly lower than that of symptom and/or X-ray screening,
or X-ray screening alone. The prevalence rates by age and sex based
on symptom screening were about two-thirds that of rate based on
X-ray and/or symptom screening. Hence to obtain prevalence rate
according to X-ray and/or symptom screening, a correction factor
of 1.52 should be applied to the prevalence rates obtained by symptom
screening alone. This correction factor is fairly good for most
of the age groups. It was also estimated that the cost of surveying
the population by symptom screening alone is about half that of
surveying the population by X-ray screening.
|
KEY WORDS: PREVALENCE, CASE, SYMPTOM SCREENING,
X-RAY EXAMINATION, RURAL COMMUNITY. |
031 |
TUBERCULOSIS IN CHILDREN IN A SLUM COMMUNITY |
GD Gothi, Benjamin Isaac, AK Chakraborty, R Rajalakshmi
& Sukant Singh: Indian J TB 1977, 24, 68-74. |
A study was conducted in a slum area of Bangalore,
to get information on the prevalence of all forms of tuberculosis
in 0-4 year age group, respiratory tuberculosis in 5-14 year age
group and the proportion of respiratory tuberculosis among total
respiratory diseases in 0-14 year age group. Entire population in
a slum area was investigated. Children aged 0-9 years were given
tuberculin test and their nutritional status assessed. All persons
were X-rayed. Sputum specimens were collected from those having
radiological abnormality in chest, chest symptoms of one week or
more in 0-4 years, in addition from those with any kind of sickness,
malnutrition and tuberculin reactors.
In 0-9 year age group, 5.5% were tuberculin positive
(without BCG lesions), in 0-4 years, 1.8% and 5-9 years, 11.3%.
Among the X-rayed children, 47.4% had some kind of sickness, the
proportion being significantly high in 0-4 year age group. The respiratory
sickness is the commonest among children of all ages followed by
malnutrition (21%). Among children with chest symptoms, upper respiratory
infections were 33%. Chest X-ray abnormalities were present in 4.5%
of children and of these 82.5% had non-specific pneumonitis. Of
71 persons with respiratory disease, about 7% were tuberculous.
Out of 1408 children, only 5 had active primary tuberculosis, giving
a prevalence of 0.35%. None in 0-4 year age had sputum positive
disease or extra pulmonary tuberculosis.
It has been highlighted that non-tuberculous chest
diseases are common in pediatric age group and many of these may
be wrongly classified as active tuberculous in practice. It is concluded
that tuberculosis in the pediatric age group in this community is
not a serious public health problem.
|
KEY WORDS: CHILDREN, SLUM COMMUNITY, PREVALENCE,
INFECTION, PEDIATRIC TUBERCULOSIS. |
033 |
USE OF 20 TU RT 23 AND 5 TU BATTEY ANTIGEN FOR ESTIMATION
OF PREVALENCE OF NON-SPECIFIC TUBERCULIN SENSITIVITY |
GD Gothi, AK Chakraborty, MJ Jayalakshmi & KT Ganapathy:
Indian J Med Res 1977, 66, 389-97. |
Estimates of prevalence of non-specific tuberculin
sensitivity in south Indian population are based on studies using
large doses of tuberculin prepared from Mycobacterium tuberculosis.
In the present study, comparison of tuberculin test done on 2168
children aged 0-9 years with 20 TU RT 23 and 5 TU Battey antigen,
belonging to rural areas, have been done. The distribution of induration
to 20 TU RT 23 test has been compared to that of 5 TU Battey test,
to see whether estimates of prevalence of non- specific tuberculin
sensitivity based on the former could be compared with those based
on tests with antigen derived from other mycobacteria.
It was seen that distributions of reactions, mean
size of indurations as well as percentages of positive reactors
to either test were not significantly different in the two randomly
selected groups i.e., one tested with Battey antigen and the other
with 20 TU RT 23. The prevalence of non-specific sensitivity in
0-4 years age group based on Battey test was 18.4 per cent and that
with 20 TU test, 16.6 per cent. In the age group 5-9 years corresponding
rates were 54.2 and 60.1 per cent. From these observations, it is
suggested that if other antigens are not available, 20 TU RT 23
could be used for estimation of non-specific sensitivity.
|
KEY WORDS: BATTEY ANTIGEN, PREVALENCE, NON SPECIFIC
INFECTION. |
035 |
NATURAL HISTORY OF TUBERCULOSIS |
GD Gothi, Wander Tuberculosis Association of India
Oration: Delivered at 32nd National Tuberculosis & Chest Diseases
Workers' Conference at Trivandrum, 1977, Indian J TB 1978, 25, Supplementum. |
Concept of the Natural History of Tuberculosis
in individuals and community is derived from a large number of studies
conducted in India and abroad. The entire course of infection to
disease in an individual is divided into five phases which occur
at different times subsequent to infection: Phase I of Primary Infection,
Phase II of Primary Illness, Phase III of generalised dissemination,
Phase IV of localised extra pulmonary tuberculosis and Phase V of
Satellite foci or of adult type of disease. The individuals passing
through any one or all of the first four phases are incapable of
transmission of infection. From the community angle, persons in
Phase V with adult type of disease, being the only source of dissemination
of infection are responsible to perpetuate the cycle of infection.
About 5-8% of the total infected people may develop primary or post
primary disease.
Natural History of Tuberculosis in the community
also known as epidemiology of tuberculosis aims at understanding
the basic laws which govern all the events that take place between
tubercle bacilli and the community under natural conditions without
active interference in the form of organised control measures. At
the start of the principal epidemic wave in a community, the disease
takes high toll of children and young adults. A constant feature
is the high mortality in males at the two extremes of life, infancy
and old age, while in females it is high around 20 years of age.
The generalised clinical forms of tuberculosis at the beginning
of epidemiological wave and localised chronic disease towards the
end of wave are common features. The time span required to attain
low levels of prevalence and incidence of infection and disease
and mortality are related to the degree of opportunities for transmission
of infection and other determinants. The changes in epidemiological
situation with relation to time are classified into three phases.
i) the epidemic phase (ii) transitional phase and (iii) endemic
phase. The epidemic of tuberculosis spans into centuries. The anti-tuberculosis
measures specially drugs in particular, have not only changed the
outlook for individual patient but by reducing infectivity period,
have speeded up the decline of tuberculosis in the community as
seen in Japan and Eskimos in Canada. The epidemic course is determined
by natural causes which could be modified by human interventions,
changes in virulence of agent, susceptibility of host and environmental
factors. Tuberculosis is a social disease also and it is essential
to create a social environment that wards off infection. Since the
tubercle bacilli cannot be extirpated we will have to live with
it in symbiosis but keeping it in its place.
The epidemic course of the disease in a particular
country can be studied through an epidemic model which is nothing
but a mathematical representation of the epidemiological situation
in a community. The model is set up by dividing population in various
epidemiological classes. The inputs required are: (A) Demographic
information, such as (i) division of population into small age groups,
(ii) birth rate, (iii) the age-specific death rates. (B) Epidemiological
indices such as (i) the division of population by age - the epidemiological
classes of: non-infected, infected, inactive lesion, sputum negative
active disease and sputum positive active disease, (ii) age and
specific incidence of infection and morbidity in various classes,
(iii) probability of cure of cases and relapses.
The following information i.e., the tuberculosis
situation viz., future prevalence and incidence of the infection,
the disease and its trend can be predicted without undertaking repeated
surveys. The model could be used for (i) prediction of future tuberculosis
situation, (ii) assessment of tuberculosis programme, by matching
the actual performance against the predicted natural trend or predicted
expectations of the programme, (iii) selection of a suitable anti-tuberculosis
programme for problem reduction from amongst a series of alternative
programmes, keeping cost in mind, (iv) gathering the type of observation
needed for epidemiological studies.
|
KEY WORDS: NATURAL HISTORY, EPIDEMIC PHASE,
EPIDEMETRIC MODEL, INDICATORS. |
036 |
INCIDENCE OF SPUTUM POSITIVE TUBERCULOSIS IN DIFFERENT
EPIDEMIOLOGICAL GROUPS DURING FIVE YEAR FOLLOW UP OF A RURAL POPULATION
IN SOUTH INDIA |
GD Gothi, AK Chakraborty & MJ Jayalakshmi: Indian
J TB 1978, 25, 83-91. |
Out of 56,146 persons without BCG scar examined
at the first survey in 119 villages of Bangalore district (1961-63),
22,468 were subsequently examined 3 times over a period of five
years by tuberculin test, X-ray and sputum at intervals of 1½
years to 2 years. No organized anti-tuberculosis services were provided
in the study area. On the basis of tuberculin status and chest X-ray
interpretations, the population was classified into 6 sub groups
for the study of risk of sputum positive disease viz., Normal X-ray
(N), Inactive Tuberculosis (AB) & Probably Active
Tuberculosis (CD) and each of these into tuberculin positives
and negatives.
The annual incidence of sputum positive disease
observed was 1.45 per thousand among 18,207 eligible persons aged
5 years and more. The incidence of the disease in tuberculin
positive group was 7 times as compared to that among tuberculin
negatives. The incidence rate of bacteriological disease was 0.79
per thousand among X-ray normals (N) of the first survey; it was
3.73 per thousand among persons with inactive tuberculous lesion
and non- tuberculous shadows (AB) and 26.04 per thousand among the
group of persons with active or probably tuberculous shadows (CD).
Of the total incidence cases, 76% were contributed by the tuberculin
positives. The group of active or probably active shadows (CD) contributed
26.6% of the total new cases. The population without any radiological
abnormality (N) contributed 48.2% of the new cases.
|
KEY WORDS: INCIDENCE, SPUTUM POSITIVE CASE,
RURAL POPULATION, EPIDEMIOLOGICAL GROUPS, LONGITUDINAL SURVEY |
037 |
PREVALENCE AND INCIDENCE OF SPUTUM NEGATIVE ACTIVE
PULMONARY TUBERCULOSIS AND FATE OF PULMONARY RADIOLOGICAL ABNORMALITIES
FOUND IN A RURAL POPULATION |
GD Gothi, AK Chakraborty, VV Krishnamurthy & GC
Banerjee: Indian J TB 1978, 25, 122-31. |
A study was carried out mainly to find out the
prevalence and incidence of sputum negative active pulmonary tuberculosis
(suspect cases) among 35,876 persons aged 5 years and above in rural
areas of Bangalore district during 1968-72. Two surveys (I &
II) at an interval of 3 months, succeeded by a follow up examination
of the X-ray abnormals of the earlier surveys, were conducted in
the same villages. Examinations at each survey consisted of tuberculin
test, X-ray and sputum examinations. X-rays were interpreted individually
at the time of each survey by single picture interpretation method
and subsequently by Joint Parallel Reading (JPR) method to
arrive to a diagnosis. In the JPR method X-ray readings and their
comparison was done by a panel of three X-ray readers with full
knowledge of age, sex, result of sputum examination and tuberculin
test of each person with chest abnormality at any of the three surveys.
On a single picture interpretation the overall
prevalence rate of suspect disease was found to be 5.4 per thousand
at I survey and 4.59 per thousand at II survey. There was no significant
difference in the overall age and sex specific prevalence rates
of suspect disease between I & II surveys. Incidence of suspect
disease at the end of 3 months was 2.24 per thousand. By JPR method
the prevalence rates of suspect disease was 3.2 per thousand at
I survey and 3.6 per thousand at II survey. The prevalence rates
by single picture method were overestimated to the extent of 38%
at I survey and 19% at II survey when compared with those found
by JPR method. At I survey prevalence rates on JPR method was significantly
lower than by single picture method. This was not so at II survey.
Similarly, incidence rate of 0.2 per thousand of suspect disease
on JPR was about 1/10th of that found by single picture method.
The incidence of bacteriologically positive cases
in 6 months from among suspect cases on JPR was found to be 28%.
Majority (76%) of non-tuberculous or inactive tuberculous shadows
continued to remain as such after 6 months and about a quarter (23%)
became normal. Incidence of bacteriologically positive cases from
this group was minimal. Of 19,640 persons with normal X-rays 134
(0.7%) developed new shadows in 3 months; 103 (0.5%) cleared after
2-12 weeks (fleeting shadows). Mis-interpretation of the latter
as active tuberculous may falsely boost the estimates of suspect
disease to the extent of about 5%.
|
KEY WORDS: SUSPECT CASE, PREVALENCE, INCIDENCE,
RURAL POPULATION, FATE. |
038 |
A COMPARISON OF NEW CASES (INCIDENCE CASES) WHO
HAD COME FROM DIFFERENT EPIDEMIOLOGICAL GROUPS IN THE POPULATION |
VV Krishnamurthy, SS Nair & GD Gothi: Indian
J TB 1978, 25, 144-46. |
In a five year epidemiological survey conducted
by National Tuberculosis Institute (NTI) from 1961 to 1968, the
population was mainly classified into three epidemiological groups
(i) with no radiological abnormalities seen in the lungs (Group
N) (ii) having X-ray shadows of non-tuberculous etiology or tuberculosis
etiology but judged as inactive (Group M) and (iii) with shadows
of tuberculosis etiology judged possibly or definitely active but
negative on culture (Group S). The objective of this paper is to
compare the characteristics of cases coming from the above three
groups (N, M and S) in respect to bacillary disease status (a) at
the time of diagnosis and (b) after a lapse of time (Fate). Out
of the total 172 new cases diagnosed during three follow ups, 70
were diagnosed between I & II surveys, 40 between II and III
and 62 between III-IV surveys. In the two 18 months follow up periods,
45 of the total new cases had come from Group N, 31 cases from Group
M and 34 cases from Group S, corresponding figures for 24 months
follow up (III & IV surveys) were 26, 26 and 10 respectively.
In the 18 months follow up it was observed that
proportion of new cases positive on culture in the three groups
were not significantly different. Comparison of fate of cases coming
from three groups were similar in terms of cure, death and culture
positivity. The findings point out clearly that not only development
of disease but also the fate of cases is independent of pre diagnosis
status of the new cases.
From all the 3 groups, disease developed more rapidly
in some cases than in others. This reveals that tuberculosis cases
are not an uniform entity from the point of view of development
of the disease and cure.
|
KEY WORDS: INCIDENCE, CASE, EPIDEMIOLOGICAL
GROUPS, RURAL POPULATION. |
039 |
TUBERCULOSIS MORTALITY RATE IN A SOUTH INDIAN RURAL
POPULATION |
AK Chakraborty, GD Gothi, S Dwarakanath & Hardan
Singh: Indian J TB 1978, 25, 181-86. |
Information on cause specific mortality rates due
to tuberculosis in India is inadequate. In the study under report,
these have been estimated based on the data obtained from a five
year epidemiological study of 119 villages of Bangalore district
in south India. For this purpose, the estimated number of excess
deaths due to causes other than tuberculosis among patients of tuberculosis,
have been attributed to the disease.
The annual mortality due to all causes on 5 year
observation could be calculated as 893 per 1,00,000 population (9%)
aged 5 years and above. Agewise as well as overall mortality rates
were not different from survey I & II, II & III & III
& IV. The average rate of the periods is calculated to be 84
per 1,00,000 annually. The death rates were the highest in 55 years
and above age groups, lower in 5-14 years and showed an increasing
trend with age. Compared to the estimates of tuberculous deaths
in India available for 1949 (about 250/1,00,000), the present rates
were lower.
|
KEY WORDS: MORTALITY, RURAL POPULATION, LONGITUDINAL
SURVEY. |
040 |
INCIDENCE OF PULMONARY TUBERCULOSIS AND CHANGE IN
BACTERIOLOGICAL STATUS OF CASES AT SHORTER INTERVALS |
GD Gothi, AK Chakraborty, K Parthasarathy & VV
Krishnamurthy: Indian J Med Res 1978, 68, 564-74. |
The incidence rates of sputum positive pulmonary
tuberculosis (cases) from the five year follow ups of a rural population
done by National Tuberculosis Institute were reported on the basis
of studies at intervals of one and a half to two years. Information
on fate of cases was also likewise reported. These parameters appear
to be imprecise since incidence and fate of cases at shorter intervals
were not taken into account. Thus, the information on incidence
of pulmonary tuberculosis in India is meager as compared to that
on prevalence of disease. Therefore, a study mainly to find out
the incidence and fate of cases at shorter intervals of 3-6 months
was undertaken in 87 randomly selected villages of Nelamangala sub-division,
Bangalore district which was one of the 3 sub-divisions where repeated
epidemiological surveys had been conducted between 1961-68. The
sample of villages in the present investigation was other than that
included in the earlier report. Organized Case-finding, anti-tuberculosis
treatment and BCG vaccination neither existed nor could be provided
in the area till the completion of the study. The present study
was conducted between 1968-1972.
This study conducted among 30,576 persons has shown
that incidence of cases over a period of three months was 0.99 per
thousand and was not much different from the annual rate of 1.03
per thousand reported on the basis of repeated surveys at longer
intervals. That the three months rates were not a quarter of the
annual rates meant that the procedure of calculating incidence rates
on the basis of surveys done at varying intervals after adjusting
for the interval had to be used with great caution. The study of
fate of cases showed that cases converted or reverted even at shorter
intervals and this appeared to be going on continually in the community.
However, incidence of cases and cure and death from among the existing
as well as the fresh cases kept on balancing each other so that
the prevalence rates of cases studied at shorter or at longer intervals
did not show variations.
|
KEY WORDS: INCIDENCE, FATE, CASE, RURAL POPULATION,
SURVEY, SHORTER INTERVALS |
041 |
CHEST DISEASES AND TUBERCULOSIS IN A SLUM COMMUNITY
AND PROBLEMS IN ESTIMATING THEIR PREVALENCE |
AK Chakraborty, GD Gothi, Benjamin Issac, KR Rangaswamy,
MS Krishnamurthy & R Rajalakshmi: Indian J Public Health 1979,
23, 88-99.
|
The entire population of a slum area of Bangalore
city, comprising of 3313 persons was registered, questioned for
symptoms and offered chest X-ray at a centre located in the slum
itself. Those, who had any chest symptom and/or X-ray abnormality,
were offered detailed examinations, viz., clinical examinations,
repeated examinations of sputum for tubercle bacilli, and further
chest X-rays. Of the total 2855 persons X-rayed and/or questioned,
1039 needed detailed examinations and about a fifth of the latter
required referral to a consultant panel for diagnosis of chest diseases.
Further, about 60% of those referred to consultants needed special
investigations. Thus, the study of prevalence of chest diseases
in the community needed considerable facilities and were operationally
difficult. It is envisaged that similar problems will also be faced
if peripheral dispensaries are to make proper diagnosis of chest
diseases, due to the need for referral of large number of patients
and provision of complicated diagnostic facilities at the referral
hospitals. The study seeks to quantify the problem of chest diseases
and tuberculosis in the slum community.
The prevalence of sickness in the population at
any point of time were 49.5%. Sickness related to the respiratory
system was 13.3%. It increased with age and was highest (42.6%)
in those aged 55 years and above. Among 2855 persons X-rayed, 145(5.1%)
had any radiological abnormality in chest. It is seen that respiratory
systems symptoms were commonest in all the age groups. A total of
172 patients were diagnosed to have respiratory system abnormalities
with or without X-ray lesions. Of them, 75% had non- tuberculous
etiology, 7.6% had active pulmonary tuberculosis and the remaining
17.4% had inactive tuberculosis. Prevalence of sputum positive cases
was 0.26% and prevalence of total active pulmonary tuberculosis
was 0.44%. The problem of arriving at final diagnosis was dependent
on application of complicated special investigation tools to a large
community. In view of the low coverage (47.4%) for the special investigations,
prevalence of different chest diseases in the community could not
be investigated.
It is concluded that in the community under study,
the size of the problem of non- tuberculous diseases of the chest
and operational problems in their diagnosis were considerable.
|
KEY WORDS: PREVALENCE, URBAN, SLUM COMMUNITY,
CHEST DISEASES, CASE. |
042 |
EFFECT ON TUBERCULIN ALLERGY OF TUBERCULIN TESTS
GIVEN 18 MONTHS EARLIER |
Raj Narain, GD Gothi, KT Ganapathy & CV Shyama
Sunder: Indian J Med Res 1979, 69, 886-92. |
Enhancing effect of tuberculin allergy as a result
of repeat tests with 1 TU RT 23 on groups tested with I TU, 20 TU
and placebo was studied by random allocation among population not
vaccinated with BCG in 8 villages. In all, 2357 persons were tested
with 1 TU and 759 with normal saline at first round. Based on testing
at three rounds the study population could be divided into eight
different groups and were labelled with alphabets 'a' to 'h' having
been tested once, twice or thrice. The groups 'a', 'c', 'e' &
g' were tested at 2 months, round two with 1 TU RT 23 and
remaining half were not tested. However, all available persons in
the 8 groups were retested at the third round, 18 months after the
initial test. Thus, eight groups cannot be treated as independent
samples but representative of the whole population.
The study did not show enhancing effect due to
previous tuberculin test with 1 TU alone among groups tested once,
twice or thrice after an interval of 18 months. Part of population
was tested with 20 TU at round one; boosting effect was seen at
2 months when test was repeated. However, it was not seen after
18 months but when exactly the boosting effect disappeared was not
known. Thus, there was no increase in reaction even among those
who were tested with a higher dose of 20 TU earlier after 18 months.
The groups provided the largest number for comparison between tested
and the control groups. It is inferred from the study that boosting
with high dose or repeat tests with the same dose does not persist
after 18 months. Hence, for classifying positive tuberculin reactors,
no correction is required to the same individuals/population after
an interval of 18 months or more, as no boosting effect after 18
months has been observed, on the basis of this analysis.
|
KEY WORDS: TUBERCULIN TEST, TUBERCULIN ALLERGY,
BOOSTING. |
043 |
PREVALENCE OF INFECTION AMONG UNVACCINATED CHILDREN
FOR TUBERCULOSIS SURVEILLANCE |
AK Chakraborty, KT Ganapathy & GD Gothi: Indian
J TB 1980, 72, 7-12. |
A survey was carried out among 12,535 children
in the age group 0-9 years of 90 villages in Doddballapur sub-division
of Bangalore district to study the possible variation in the prevalence
of tuberculous infection among the unvaccinated children in a village
depending upon the varying prevalence of BCG scars in the same population.
In each village, all the children in the age group of 0-9 years
were registered and examined for the presence or absence of the
BCG scar. Of the 12,535 children, 6269 (50%) who did not have BCG
scars were eligible for tuberculin test, while 6045 were actually
tested. Each child without BCG scar was tuberculin tested with 1
TU RT 23 with tween 80 and the reaction read between 72 and 96 hours.
Two proportions were calculated in each village viz., a) the proportion
with BCG scars and b) that of infected children among those without
scar and the villages were distributed by these two proportions.
On the basis of distribution of tuberculin reactions,
10 and 12 mm induration was the demarcation between positive and
negative reactors. Prevalence of infection among 0-9 years was 4.9%,
2.6% among 0-4 years and 8.9% among 5-9 years. Distribution of villages
according to two variables i.e., prevalence of BCG scars and prevalence
of infection among unvaccinated children did not show any correlation
with the prevalence of infection among the unvaccinated in the same
villages.
It is seen from the study that exclusions of various
proportions of children with BCG scars did not have any correlation
with the prevalence of infection among the unvaccinated in the same
villages.
In non-e of the villages any association was seen
between these two. In view of this finding, it is felt that the
simple method of periodic tuberculin testing of the population in
younger age groups could be developed into a method of tuberculosis
surveillance even in areas where direct mass BCG vaccination is
given. This would appear to be the cheapest, practicable and technically
appropriate method of studying the overall tuberculosis situation.
|
KEY WORDS: PREVALENCE, INFECTION, BCG SCAR,
SURVEILLANCE. |
|
|