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093 |
CASES OF PULMONARY TUBERCULOSIS AMONG THE OUT-PATIENTS
ATTENDING GENERAL HEALTH INSTITUTIONS IN AN INDIAN CITY |
GD Gothi, D Savic, GVJ Baily & GE Rupert Samuel:
Bull WHO 1970, 43, 35-40. |
A study was undertaken in Bangalore city, Karnataka,
to find out whether people with chest symptoms, including tuberculosis
patients, attend General Health Institutions or report directly
to tuberculosis clinics. The objective was to investigate the proportion
of persons with chest symptoms (cough, fever, pain in chest and
haemoptysis) among out patients attending the general city dispensaries,
and the proportion of pulmonary tuberculosis cases among them. The
findings of this study are based on examination of one day's attendance
at each of the 19 general dispensaries of Bangalore city, consisting
of 2,506 persons aged 10 years or more who had attended the dispensaries
for the relief of any ailment. The investigation consisted of symptom
questioning, examination of spot sputum sample and 70 mm chest photofluorogram.
Sputum specimens were examined by direct smear and culture. Study
intake period of 19 days was spread over three months.
The study showed that of the 2506 out patients,
1170 (47%) had visited dispensaries primarily for relief of chest
symptoms. Of these, 31 (2%) had evidence of active or probably active
pulmonary tuberculosis and 20 (0.8%) were sputum positive cases.
It is concluded that even though there are special tuberculosis
institutions in the city, a fair number of new and old tuberculosis
patients contact general dispensaries. These dispensaries can therefore
contribute considerably to tuberculosis case-finding in the city.
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KEY WORDS: CASE-FINDING, URBAN HEALTH INSTITUTIONS,
SELF REPORTING CHEST SYMPTOMS. |
094 |
COLLECTION AND CONSUMPTION OF SELF ADMINISTERED
ANTI-TUBERCULOSIS DRUGS UNDER PROGRAMME CONDITION |
GD Gothi, D Savic, GVJ Baily, K Padmanabha Rao, SS
Nair & GE Rupert Samuel: Indian J TB 1971, 18, 107-13. |
This investigation was to find out the drug consumption
among tuberculosis patients put on domiciliary self administered
chemotherapy, in terms of proportion of patients that make various
levels of drug collections and proportion among them that consume
drugs at different points of time during the course of treatment.
In all, 816 tuberculosis patients aged 5 years and above residing
in Bangalore city were admitted to the study. They were randomly
divided into 6 groups at the time of inclusion into the study, for
examination of urine samples for the presence of INH and PAS. One
surprise urine sample was collected from each patient at the pre
determined time after the drug collection. The samples of urine
were collected from one group at first month, another at second
month, third at fourth month, fourth at sixth month, fifth at ninth
month and sixth at twelfth month of treatment. Urine samples were
collected within 33 days of drug collection for the month because
the drugs were supplied at a time for the said period. Urine specimens
were examined for the presence of drugs or their metabolites. For
INH, NM test & acetyl INH test and for PAS, ferriechloride and
case test were performed. The drug collection was judged on the
basis of treatment record and its consumption on the basis of results
of urine examination.
Of the total patients included in the study, 54%
made 10 or more drug collections over a period of 15 months. The
initial radiological or bacteriological status or severity of disease
did not influence the drug collection; however smaller proportion
of old persons in both sexes collected the drugs for 10 months or
more. Urine specimens of 71% of patients who had collected drugs
were positive for INH on any one day. Bacteriological quiescence
was obtained among the 82% INH sensitive patients who had made 10
or more collections. The above findings suggest that the patients
who collect drugs also consume with fair amount of regularity and
achieve a high degree of bacteriological quiescence.
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KEY WORDS: SELF ADMINISTERED REGIMEN, DRUG COLLECTION
LEVEL, DRUG CONSUMPTION, CONTROL PROGRAMME, COMPLIANCE. |
095 |
A CONCURRENT COMPARISON OF AN UNSUPERVISED SELF-ADMINISTERED
DAILY REGIMEN AND A FULLY SUPERVISED TWICE WEEKLY REGIMEN OF CHEMOTHERAPY
IN A ROUTINE OUT-PATIENT TREATMENT PROGRAMME |
GVJ Baily, GE Rupert Samuel & DR Nagpaul: Indian
J TB 1974, 21, 152-67. |
The relative merits of a fully supervised twice
weekly regimen of Streptomycin and INH (SHtW) and an unsupervised
daily regimen of INH and Thioacetazone (TH) in routine programme
conditions in an urban area are compared in terms of acceptability
and response to treatment at one year. Of the 474 newly diagnosed
sputum positive cases at Lady Willingdon TB Demonstration &
Training Centre, Bangalore during 1968-69, 134 were allocated to
SHtW regimen and 189 to TH regimen. All others who were unwilling
to take the allocated regimen or were excretors of bacilli resistant
to INH and or SM were analysed as a subsidiary group.
About 25% of the patients allocated to SHtW regimen
expressed unwillingness to start treatment on account of unsuitability
of working hours and or distance. Refusal to TH regimen was negligible
(5%). As regards drug acceptability after start of treatment, while
the duration of treatment taken was similar for both the regimens,
the level of drug intake achieved by the SHtW patients was lower
compared with TH patients i.e., 31.3% of the SHtW patients and 56.1%
of TH patients took more than 80% of treatment. If concealed irregularity
among TH patients is taken into consideration, it is likely that
the drug intake among TH patients would be similar to the drug intake
among SHtW patients. The acceptability was therefore almost similar
among SHtW and TH patients. Very low level (28%) of treatment completion
was achieved by SHtW patients. With TH regimen, 46% had made 10
or more monthly collections during 12 months. Among the SHtW patients
there was greater irregularity in the later months which was not
apparent among TH patients. However, the favourable response among
patients on SHtW and on TH regimen was 68% and 60%
respectively. Deaths among SHtW patients were 4%,
13.5% among TH patients, the difference being statistically significant.
The response was directly related to the level of drug collection
or supervised consumption. The large proportion of the patients
who stopped treatment prematurely, continued to remain positive
with drug sensitive organisms, if initially they were so. In the
subsidiary group there were 62 patients who were excretors
of drug resistant organisms. They were treated with drugs to which
their organisms were resistant and nearly 30% of these patients
had negative culture at the end of one year.
It is concluded that (i) SHtW regimen was superior
to TH as it prevented deaths and showed better bacteriological conversion
among patients with level 3 & 4 of treatment and (ii) treatment
organization is the most important factor in obtaining better results
in routine chemotherapy with available drug regimens.
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KEY WORDS: TH REGIMEN, DAILY REGIMEN, SUPERVISED
INTERMITTENT REGIMEN, ACCEPTABILITY, EFFICACY, CONTROL PROGRAMME. |
096 |
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.
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KEY WORDS: COHORT ANALYSIS, COMPLIANCE, CONTROL
PROGRAMME, OPERATIONAL FACTORS. |
098 |
CONTROLLED STUDY OF THE EFFECT OF SPECIFIC TREATMENT
ON BACTERIOLOGICAL STATUS OF "SUSPECT CASES" |
Aneja KS, Gothi GD and GE Rupert Samuel: Indian
J TB 1979, 26, 50-61. |
The effect of specific anti TB drugs on patients
having smear negative radiologically positive pulmonary tuberculosis
(suspect cases), was studied in Lady Willingdon Tuberculosis Demonstration
& Training Centre (LWTDTC), Bangalore during 1975 & 1976.
The main objective was to know the proportion of suspect cases treated
under the programme requiring the specific treatment with anti TB
drugs. A total of 457 suspect cases were randomly allocated to one
of the two regimens; 228 patients were treated with INH + Thioacetazone
(TH) and 229 with calcium gluconate (Placebo) regimens, for one
year. The placebo group allowed a concurrent comparison of status
of suspect cases without any specific treatment. After the intake,
sputum examination by direct smear, culture for M.tuberculosis and
sensitivity for drugs as well as X-ray examinations were carried
out at 0, 2nd, 4th, 6th, 9th and 12th month of treatment.
Among the 228 patients on TH, 103 (45.2%) were
real suspect cases, 83 (36.4%) sputum positive and remaining 42
non- tubercular. Similarly, out of the 229 patients on placebo regimen,
110 (48%) were real suspect cases, 61 (26.5%) sputum positive and
58 non- tubercular. The effect of treatment was measured by observing
the incidence of bacteriologically positive or radiologically active
disease from among the real suspect cases of the two groups.
At the end of the treatment period, 12.6% of TH group and
29.7% of placebo group were broken down, the difference
being statistically significant. Further, an element of self healing
was also observed, as about 40% of patients in placebo group showed
either clearance of lesions or continuing regression which could
be due to self healing or the lesion being non- tubercular in nature.
About 30% of the 457 patients at the start of the study were real
cases of tuberculosis who under the programme were missed and 20%
broke down with bacteriological positive or progress to radiologically
active disease when treatment was not offered. Thus, nearly 50%
of the suspect cases diagnosed in the programme required anti TB
treatment and for those requiring treatment, perhaps TH is not sufficient,
as 12.6% broke down in spite of treatment. It would be appropriate
to treat suspect cases both from the clinical and epidemiological
point of view after taking due precautions to remove non- tubercular
cases by doing repeat sputum examination.
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KEY WORDS: CONTROL STUDY, SUSPECT CASE, TH REGIMEN,
EFFICACY. |
104 |
ORGANIZATIONAL EFFORT IN A CLINICAL TRIAL AND ITS
RELEVANCE TO APPLICABILITY OF SHORT-COURSE CHEMOTHERAPY IN NATIONAL
TUBERCULOSIS PROGRAMME |
KS Aneja & GE Rupert Samuel: Indian J TB 1982,
29, 19-28. |
The high rate of treatment completion and the regularity
of drug intake achieved in clinical trials of Short Course Chemotherapy
(SCC), could possibly be attributed to efficient organizational
set-up, careful selection of cases and all-out effort to control
defaulters. The organizational effort put forth to achieve the regularity
is relevant to the applicability of SCC in the existing set-up of
District Tuberculosis Centres (DTCs) under National Tuberculosis
Programme (NTP). First 300 patients admitted to SCC trial to assess
the efficacy of three drug regimens of 3/5 months duration under
fully supervised conditions, carried out jointly by National Tuberculosis
Research Centre, Madras and National Tuberculosis Institute (NTI),
Bangalore, have been analysed for the purpose.
To keep up the regularity, 1/3rd of the patients
required home visits-some of them repeatedly. If the actions of
the same intensity of defaulter retrieval in the form of home visiting
are envisaged to be taken in a DTC with the normal working pattern
catering to 500 patients, 250 to 300 home visits will have to be
made in a month. This may not be feasible in the existing set-up
of NTP. A new strategy of defaulter retrieval actions for programme
conditions may have to be devised. Further, selection of drug regimen
which has the maximum potential of being given on self-administered
basis may reduce the work-load to a considerable extent. Drug toxicity,
side effects and the cost of drugs may not be major handicaps. However,
the only way to understand various operational problems is to undertake
scientific operational studies in actual working conditions of NTP.
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KEY WORDS: SCC, APPLICABILITY, CLINICAL TRIAL,
COMPLIANCE, CONTROL PROGRAMME. |
106 |
ACTIVE CASE-FINDING IN TUBERCULOSIS AS A COMPONENT
OF PRIMARY HEALTH CARE |
KS Aneja, P Chandrasekhar, MA Seetha, VC Shanmuganandan
& GE Rupert Samuel: Indian J TB 1984, 31, 65-73. |
Feasibility of introducing limited active case-finding
in tuberculosis involving Multi-purpose Health Workers (HWs)
to supplement the existing methodology of detecting the cases through
chest symptomatics attending Peripheral Health Institutions (PHIs)
on their own, was studied earlier with encouraging results. The
present study was undertaken to understand the existing working
system of HWs and within that the priority areas of input which
may lead to better case yield.
The study revealed that the population available
at any beat schedule of HWs was about 42% of the eligible population
of age 20 years and above. Only 60-75% of the field days were
utilized for routine multi-purpose duties. Of the total area,
25% to 40% remained uncovered. The effective tuberculosis work
was done only on 5% of the beat schedule days and the work
was not uniformly spread throughout the month. Even so, the contribution
by HWs was twice the number of cases diagnosed at PHIs under
study in one year. Had the HWs covered the entire area of their
beat schedule, 80 against 26 cases would have been diagnosed. Moreover,
there is possibility of detecting more cases among the elderly patients
who normally do not attend their area health centres. However, the
success depends upon meticulous supervision and regular flow of
supplies.
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KEY WORDS: HEALTH WORKER, PRIMARY HEALTH CARE,
CONTROL PROGRAMME, CASE-FINDING, RURAL COMMUNITY. |
112 |
IMPROVEMENT IN CASE-FINDING IN DISTRICT TUBERCULOSIS
PROGRAMME BY EXAMINING ADDITIONAL SPUTUM SPECIMENS |
MA Seetha GE Rupert Samuel & N Parimala: Indian
J TB 1990, 37, 139-44. |
A study was conducted to augment Case-finding in
the programme by increasing case yield through repeated sputum examinations
by collecting 2-3 samples on the same day. The study was conducted
in nine Peripheral Health Institutions (PHIs) of Bangalore district.
They were all Microscopy Centres and were drawn on the basis of
random allocation. A Health Visitor (HV), Laboratory Technician
and Laboratory Attendants of National TB Institute (NTI) were posted
at the PHIs during the entire study period. After collection of
first sputum sample from the eligible chest symptomatics, 2nd, 3rd
or 4th samples were collected at an interval of half an hour from
those whose first specimen was negative. Separate smears were prepared
from all the specimens for examination at NTI. The duration of the
study was nine months.
From among 4233 total new outpatients, 458 chest
symptomatics were identified. Of them, 451 gave the first specimen,
416 the second specimen and 379 and 332 the 3rd and 4th specimen
respectively. There were a total of 25 smear positive cases; 18
were detected by the first specimen, 3 were added by second and
the remaining 4 by the 4th specimen. Of the 451 chest symptomatics,
185 were selected by the PHI Medical Officers (MOs) and 266 were
picked up by the NTI HVs from the remaining outpatients. Of the
25 cases detected, 10 came from the chest symptomatics selected
by the MOs and 15 came from those selected by the NTI HV. The study
has shown the feasibility of collecting multiple specimens of sputum
from each symptomatic on the same day. A loss of 60% cases was due
to casual symptom questioning by the MOs. It was further observed
that the intensity of the physical suffering has influenced the
behaviour of patients towards action taking. The sputum positivity
rate was 5.5%
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KEY WORDS: CASE-FINDING, CONTROL PROGRAMME,
SPUTUM EXAMINATION. |
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