|SOME OBSERVATIONS ON THE DRUG COMBINATION OF IN
H+THIACETAZONE UNDER THE CONDITIONS OF DISTRICT TUBERCULOSIS PROGRAMME
|GD Gothi, J O'Rourke & GVJ Baily: Indian J TB
1966, 14, 41-48.
A study was carried out to investigate the applicability
of INH-Thiacetazone (TH) combination with special reference to acceptability
and toxicity in Tumkur district. 150 patients from Tumkur town and
some nearby villages were discovered during a mass Case-finding
programme. Of them, 127 including 43 sputum positives were given
chemotherapy with 300 mgm INH and 150 mgm thiacetazone (TH), in
a single tablet to be taken once a day. All but one patient had
the treatment on an ambulatory basis. Results of treatment in respect
of 103 patients are presented in the paper.
The overall death rate was of the order of 15%.
About twice the number of deaths occurred among the sputum positive
patients than among the negative ones. About 40% of deaths occurred
during the first quarter. In all, 23 patients developed side effects,
in 18 of them thiacetazone had to be withdrawn. Serious side effects
occurred among 5 (4%) patients. These patients did not report to
the treatment centre by themselves and could not have been detected,
if home visits were not made, thus giving an erroneous impression
about side effects with TH. The sputum conversion at the end of
one year was of the order of 50% among all survivors. Among those
who were drug sensitive and examined at one year, conversion rate
was 63%. Favourable radiological response was seen in 74%.
Thus, though cheap and clinically effective, Thioacetazone
in combination with INH was found to produce serious and significant
side effects. Hence, vigilance by the treatment centres were thought
to be necessary when the patients are on this regimen.
|KEY WORDS: TH REGIMEN, ADVERSE REACTIONS, APPLICABILITY,
ACCEPTABILITY, CASE HOLDING.
|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.
|KEY WORDS: TH REGIMEN, DAILY REGIMEN, SUPERVISED
INTERMITTENT REGIMEN, ACCEPTABILITY, EFFICACY, CONTROL PROGRAMME.
|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
|KEY WORDS: BCG VACCINATION, ACCEPTABILITY, RURAL