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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. |
099 |
ACCEPTABILITY OF BCG VACCINATION AMONG RURAL COMMUNITY |
MA Seetha, N Srikantaramu & Hardan Singh: Indian
J Prev & Soc Med 1980, 2, 57-63. |
A study on acceptability of BCG vaccination, through
specialised technicians in a population of 8350 residing in 8 villages
of Channapatna taluk of Bangalore district, was carried out by National
Tuberculosis Institute. Of the 1106 households satisfactorily interviewed,
956 (86.4%) had at least one child eligible for vaccination. For
the purpose of analysis they were classified into three groups.
Group I consisted of 312 (32.6%) households in which all
children were vaccinated, Group II 270 (28.2%) where non-e
of the children were vaccinated and Group III 374 (39.2%)
households where only some of their children were vaccinated. Overall
vaccination coverage was 52.7% with a range of 33.9% to 79.3%.
The reasons for refusing vaccination were studied.
The caste, occupation, education etc., of the household did not
have any influence on the refusals. When analysed according to the
knowledge and opinion about vaccination it was observed that 55.9%
of the children were not vaccinated because of the lack of knowledge
in the group where no child was vaccinated. Even when 42% had favourable
opinion about vaccination, 52% of the households did not vaccinate
any of their children. The refusals were mainly due to (i) absence
from the village on the day of vaccination, (ii) fear of prick.
Among households where there was unfavourable opinion, all had refused
due to fear. The reasons for accepting BCG vaccination were (i)
the vaccination was done in the school and hence there was no option
for the parents to accept or refuse, (ii) parents felt that the
vaccination was good for children, (iii) parents knew that it would
prevent TB.
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KEY WORDS: BCG VACCINATION, ACCEPTABILITY, RURAL
COMMUNITY. |
099 |
ACCEPTABILITY OF BCG VACCINATION AMONG RURAL COMMUNITY |
MA Seetha, N Srikantaramu & Hardan Singh: Indian
J Prev & Soc Med 1980, 2, 57-63. |
A study on acceptability of BCG vaccination, through
specialised technicians in a population of 8350 residing in 8 villages
of Channapatna taluk of Bangalore district, was carried out by National
Tuberculosis Institute. Of the 1106 households satisfactorily interviewed,
956 (86.4%) had at least one child eligible for vaccination. For
the purpose of analysis they were classified into three groups.
Group I consisted of 312 (32.6%) households in which all
children were vaccinated, Group II 270 (28.2%) where non-e
of the children were vaccinated and Group III 374 (39.2%)
households where only some of their children were vaccinated. Overall
vaccination coverage was 52.7% with a range of 33.9% to 79.3%.
The reasons for refusing vaccination were studied.
The caste, occupation, education etc., of the household did not
have any influence on the refusals. When analysed according to the
knowledge and opinion about vaccination it was observed that 55.9%
of the children were not vaccinated because of the lack of knowledge
in the group where no child was vaccinated. Even when 42% had favourable
opinion about vaccination, 52% of the households did not vaccinate
any of their children. The refusals were mainly due to (i) absence
from the village on the day of vaccination, (ii) fear of prick.
Among households where there was unfavourable opinion, all had refused
due to fear. The reasons for accepting BCG vaccination were (i)
the vaccination was done in the school and hence there was no option
for the parents to accept or refuse, (ii) parents felt that the
vaccination was good for children, (iii) parents knew that it would
prevent TB.
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KEY WORDS: BCG VACCINATION, ACCEPTABILITY, RURAL
COMMUNITY. |
101 |
INFLUENCE OF MOTIVATION OF PATIENTS AND THEIR FAMILY
MEMBERS ON THE DRUG COLLECTION BY PATIENTS |
MA Seetha, N Srikantaramu, KS Aneja & Hardan Singh:
Indian J TB 1981, 28, 182-90. |
A controlled study was conducted at Lady Willingdon
Tuberculosis Demonstration and Training Centre (LWTDTC), Bangalore
among 250 patients randomly selected urban patients of pulmonary
tuberculosis of whom 155 were in the 'motivation' group and
95 were in the 'control' group. In the motivation group,
patients were interviewed by National Tuberculosis Institute health
visitor and motivated by LWC staff; a month of drugs (TH) were given.
Within 3 days of initiation of treatment they were motivated along
with their household members during home visit by NTI staff every
month for a period of three months. Control group patients were
motivated at the clinic as per the programme guidelines.
In the motivation group, 59.9% of patients
had made all the three collections during the first three months
compared to 27.8% in the 'control' group. During the remaining
months also the drug collection was 47% and 35.6% respectively.
The drug collection pattern among the patients in the motivation
group was found to be better than among the patients in control
group who did not have the benefit of home visiting. Sputum conversion
was also found accordingly better among the motivation group as
compared to control group.
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KEY WORDS: COMPLIANCE, FAMILY MOTIVATION, CONTROL
PROGRAMME, TREATMENT COMPLETION. |
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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