|DRUG TOXICITIES OBSERVED AMONGST THE PATIENTS TREATED
WITH INH AND THIOACETAZONE UNDER THE CONDITIONS OF DISTRICT TUBERCULOSIS
|GD Gothi, James O'Rourke & GVJ Baily: Proceed
21st Natl TB & Chest Dis Workers Conf, Calcutta 1966, 368-73.
Application of a combined regimen of INH and Thioacetazone
(TH) under conditions of District Tuberculosis Programme having
become a distinct possibility, the study observed its applicability
and toxicity. In all, 127 patients discovered during a mass Case-finding
investigation were treated in their homes with 300 mgm of INH and
150 mgm of thioacetazone in a single tablet once a day. Close supervision
of patients, laboratory or clinical examination to elicit toxic/side
effects were not practicable. During their initial motivation, patients
were asked to report back in the event of occurrence of unpleasant
symptoms. At subsequent drug collection, indirect questioning for
side effects was done. An active search for toxicity was also made
by the home visiting staff when they visited patients' homes for
In all, 23 patients complained of possible side
effects of thioacetazone, of which 5 were major and 18 of minor
nature. Among the 5 patients, two had exfoliative dermatitis and
three had generalised petechial haemorrhages. All were males above
the age of 40 years. All recovered with withdrawal of drugs and
anti histamines. The minor side effects were giddiness and vomiting.
None died of thioacetazone toxicity. It is concluded that TH regimen
can be used for mass application on account of therapeutic efficacy
and low price but consequences of side effects must be borne in
mind while using this drug combination under district programme
|KEY WORDS: CONTROL PROGRAMME, ADVERSE REACTIONS,
TH REGIMEN APPLICABILITY.
|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.
|KEY WORDS: SELF ADMINISTERED REGIMEN, DRUG COLLECTION
LEVEL, DRUG CONSUMPTION, CONTROL PROGRAMME, COMPLIANCE.
|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.
|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.
|LONG TERM SOCIOLOGICAL FOLLOW UP OF SYMPTOM RECURRENCE
AND ACTION TAKEN BY TUBERCULOSIS PATIENTS
|Radha Narayan: Indian J Prev & Soc Med 1978,
Case-finding and treatment activities in the National
Tuberculosis Programme (NTP) are mainly dependent on self reporting
chest symptomatics. It was of main interest to find out that patients
who report to the health institutions due to suffering remain symptom
free later on or there is a recurrence of symptoms among sputum
positive patients during 14 intervening years i.e., from 1961-1974.
The follow up was carried out in 1974, in spite of such a long interval,
information from 20.3% of the patients including dead was collected.
At the time of diagnosis in 1961 at LWC, 91.6%
of patients had symptoms. During the total period from 1961 to the
time of interview 7-16% had recurrence during each of the intervening
years. Recall was possible because majority of them have taken action.
But at the time of interview 29.7% reported to be having symptoms,
of them nearly half had symptoms for more than 6 months. It is likely
that during preceding years also there might have been a higher
percentage of symptoms but the recall was poor. Considering the
total duration of symptoms, 52% had experienced symptoms for more
than 6 months.
|KEY WORDS: SYMPTOMS, RECALL, CONTROL PROGRAMME,
FELT NEED, ACTION TAKING.
|INFLUENCE OF INITIAL MOTIVATION ON TREATMENT OF
|KS Aneja, MA Seetha, Hardan Singh & V Leela: Indian
J TB 1980, 27, 123-29.
The effect of initial motivation on pulmonary tuberculosis
patients in terms of regularity of drug collection and pattern of
default for three months was studied at Lady Willingdon Tuberculosis
Demonstration & Training Centre (LWTDTC), by adopting three
different schedules of motivation (i) motivation as per routine
procedures of District Tuberculosis Programme (ii) issue of simple
brief instructions only and (iii) motivation with reduced contents
and with change in sequence of points. The patients without history
of previous treatment were randomly allocated to these 3 groups.
All the three groups were similar in respect of age and sex composition,
sputum status, extent of disease, duration of symptoms, education
level and the distance that the patient had to travel for collection
of drugs. However, there were more housewives in Group II.
The findings of the investigations were: Of the
139 patients in Group I, 49.6%, of the 126 in Group II,
46.7% and of the 142 in Group III, 47.2%, had made all
the three collections. On the whole different schedules of motivation
did not significantly affect the behaviour of the patients in making
all the three monthly collections. However, patients in Group
II with simple instructions were more regular and made less number
of defaults. There was also a suggestion that sputum negative patients
required more than mere instructions. The best response in such
cases was in Group III, wherein motivation was neither very elaborate
nor very brief and in which sequence of points was so arranged that
stress on important points was laid early enough to remain within
the recalling memory of the patients.
|KEY WORDS: CONTROL PROGRAMME, TREATMENT COMPLETION,
INITIAL MOTIVATION, SUSPECT CASE, CASE.
|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.
|KEY WORDS: COMPLIANCE, FAMILY MOTIVATION, CONTROL
PROGRAMME, TREATMENT COMPLETION.
|INFLUENCE OF TRAINING VARIATION IN CASE-FINDING
AT PERIPHERAL HEALTH INSTITUTIONS IN DISTRICT TUBERCULOSIS PROGRAMME
|KS Aneja & VV Krishna Murthy: NTI Newsletter
1982, 19, 22-28.
An operational study to understand the influence
of training of Peripheral Health Institution (PHI) Medical Officers
(MOs) at District Tuberculosis Centre (DTC) in comparison to on
the job training in their own PHIs in carrying out case-finding
activity, was carried out in districts of Mysore, Mandya, Bellary
and Hassan of Karnataka State in 1980 81. These districts are now
being referred as I, II, III and IV respectively. From each
district, 20 Microscopy Centres (MCs) were selected. All the selected
MCs of the above four districts after stratified random allocation
were divided into two groups, i.e., A & B. The MOs of Group
A of each district were trained for 2 days in Case-finding activity
at the respective DTCs by District Tuberculosis Officer and District
Health Officer, while the MOs of Group B were given on the
job training as per manual. In all, 108 MOs: 52 in Group A and 56
in Group B were under study. The performance of each PHI was monitored
in terms of number of new Out patient Attendance, selection of chest
symptomatics for sputum examination and number of smear positive
cases detected, for a period of 12 months after the training.
At the end of one year it was observed that there
was a boosting in case detection in districts I and III,
no effect in district II and negative effect in district IV. The
efficiency in districts I and III was higher by methodology A. It
was enhanced from 7.6% pre-training efficiency to 16.7% after training
and in district III, 18% to 65.8%. The enhancement with methodology
B was from 5.5% to 8.1% in district I and from 19.1% to 43.2% in
district III. The average increase by amalgamating all the four
districts was from 8.5% to 17.8% with methodology A and from 9.7%
to 12.3% with methodology B. There was a suggestion of better improvement
through methodology A, which, however, did not attain statistical
In the districts under study, Case-finding was
at a very low ebb. Systematic training by either of the two methodologies,
did improve the activity in I and II i.e., in two of the four districts.
In districts II and IV other variables might also have been at work
e.g., training variables of knowledge, skill and communication abilities
of DTOs who were trainers could have influenced the outcome.
|KEY WORDS: CONTROL PROGRAMME, CASE-FINDING,
TRAINING METHODOLOGY, PHIs.
|SHORT COURSE CHEMOTHERAPY OF TUBERCULOSIS PROCEDURAL
STRATEGIES IN DISTRICT TUBERCULOSIS-PROGRAMME
|P Jagota: NTI Newsletter 1982, 19, 95-102.
In the wake of implementation of Short Course Chemotherapy
(SCC) in the programme, some of the organizational aspects of SCC
as observed in a clinical trial at the Lady Willingdon State TB
Centre (LWSTC), Bangalore vis-a-vis to those recommended in the
programme were evaluated. The efficacy of 3 SCC regimens of 3-5
months duration under clinical trial were studied among 381 patients.
The efforts and the resources employed to achieve the results in
the trial are compared with that of those recommended in the District
TB Programme (DTP).
It is observed that there is a wide gap between
the clinical trial and the programme in organisational
efforts and resources. Although the trials cannot act as a model,
if benefits associated with the SCC are to be availed, extra staff
and transport for home visiting should be provided. The aspects
of the organisation which need strengthening are motivation, timely
defaulter action (preferably on the same day mainly as home visit)
and efficient management of large number of patients attending the
clinic for supervised drug administration, adverse reaction etc.,
before recommending the use of SCC in the DTP.
|KEY WORDS: SCC, CONTROL PROGRAMME, CLINICAL
|ORGANIZATIONAL EFFORT IN A CLINICAL TRIAL AND ITS
RELEVANCE TO APPLICABILITY OF SHORT-COURSE CHEMOTHERAPY IN NATIONAL
|KS Aneja & GE Rupert Samuel: Indian J TB 1982,
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.
|KEY WORDS: SCC, APPLICABILITY, CLINICAL TRIAL,
COMPLIANCE, CONTROL PROGRAMME.
|A STUDY OF TUBERCULOSIS SERVICES AS A COMPONENT
OF PRIMARY HEALTH CARE
|Radha Narayan, A Jones, S Prabhakar & N Srikantaramu:
Indian J TB 1983, 30, 69-73.
During last two decades, the health care delivery
system has undergone several changes. The implementation of the
concept of Primary Health Care and of the Multi Purpose Health
Workers (MPWs) Scheme can be utilised to improve both Case-finding
and case holding activities of the District Tuberculosis Programme.
A study was undertaken by National Tuberculosis Institute (NTI)
to obtain a profile of work of MPWs, observe their work on time
and motion analogy and to ascertain output of tuberculosis services
and other works. The study was carried out in a contiguous area
of 6 PHCs of a district. The work of 16 MPWs was observed by a Social
Investigator of NTI who accompanied them during a day's work; one
month period was selected as reference period. 160 MPWs were asked
to give details of their activities through self administered questionnaire
and records of the six PHCs were studied in terms of output of the
On an average a MPW travelled 15 kms, spent 4 hours
in the village, visited 70 homes; Of them, 25% were locked. The
time spent on different activities during home visits were 34% for
minor ailments, 26% on malaria, 12% on family welfare and 11% on
tuberculosis. Profile of activities carried out on a randomised
day were, 77.5% did not perform any anti tuberculosis activities.
Those who did anti tuberculosis work identified 4 symptomatics,
prepared two smears and followed up 13 patients. The highest performance
was with regard to Family Welfare (68%) and treatment of ailments
(64%). As per the opinion of MPWs tuberculosis was 7th, 8th and
9th rank, malaria was lst and 3rd and family welfare was 1st and
2nd. As per the actual output of work from the PHC records, anti
malaria (70%) and minor treatment had the maximum performance and
family welfare averaged, as only 35 of the eligible couples were
registered. Findings suggest that tuberculosis was given lower priority
in terms of all the three points i.e., actual performance, profile
of work of MPW, actual day's work of MPW and diverse health activities
among rural population. Integration of tuberculosis at periphery
needs more important considerations.
|KEY WORDS: CONTROL PROGRAMME, PRIMARY HEALTH
CARE, HEALTH WORKER, INTEGRATION.
|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
|KEY WORDS: HEALTH WORKER, PRIMARY HEALTH CARE,
CONTROL PROGRAMME, CASE-FINDING, RURAL COMMUNITY.
|A STUDY ON ADVERSE DRUG REACTIONS IN TWO REGIMENS
OF SHORT COURSE CHEMOTHERAPY
|Sudha Xirasagar, P Jagota, N Parimala & K Chaudhuri:
NTI Newsletter 1989, 25, 51-60.
In a study of feasibility of treatment of smear
positive patients with Short Course Chemotherapy (SCC) regimens
under District TB Programme (DTP) conditions in a city, adverse
drug reactions in terms of frequency of episodes, incidence in the
cohort of patients, time of occurrence, major adverse reactions
requiring modification of chemotherapy and or symptomatic treatment,
Patients were allocated to one of the two 8 month
SCC regimens i.e., Regimen 'A' 1 SHRZ/6TH, Regimen 'B' 2SHR/6TH.
Overall incidence of adverse drug reaction in cohort of 265 patients
was 37%, 9% of which were considered as major in nature. 34 episodes
of such reactions resulted in modification of chemotherapy in 15
patients during intensive phase. Though gastro intestinal symptoms
were predominant, cutaneous toxicity was the pre eminent cause of
modification of regimen. No case of exfoliative dermatitis occurred.
A total of 333 episodes of adverse drug reactions of minor nature
occurred; 50% being gastro intestinal symptoms followed by cutaneous
symptoms. More than 70% of all adverse drug reactions of intensive
phase occurred in the first half of the period. There was no significant
difference between the two regimens in the incidence of adverse
drug reactions of either major or minor in nature.
SCC is being implemented in a phased manner in
the DTP. Before introducing SCC in large number of districts, it
would be prudent to find out whether SCC would be acceptable to
both doctor and patient in terms of adverse drug reactions.
It can, therefore, be concluded that adverse reactions may not be
a major constraint for inclusion of SCC under DTP for treating sputum
positive tuberculosis patients provided that additional resources
and man power are allocated to the DTCs to manage patients in the
centre and extend effective guidance to staff working in peripheral
|KEY WORDS: SCC REGIMEN, DAILY REGIMEN, ADVERSE
REACTIONS, CONTROL PROGRAMME, FEASIBILITY.
|A STUDY OF OPERATIONAL FACTORS INFLUENCING THE APPLICABILITY
OF TWO REGIMENS OF SHORT COURSE CHEMOTHERAPY UNDER CONDITIONS OF AN
URBAN TUBERCULOSIS PROGRAMME
|P Jagota, Sudha Xirasagar, N Parimala & K Chaudhuri:
Indian J TB 1989, 36, 213-23.
An operational study of two regimens of Short Course
Chemotherapy (SCC) to assess their efficacy under programme conditions,
applicability and feasibility in District TB Programme (DTP) was
undertaken in an urban TB centre. The two regimens studied were
1SHRZ/7TH and 2SHR/6TH. Their operational efficacy (efficiency)
was found to be 87% and 92% respectively which had already been
reported in an earlier paper. The various factors i.e., initial
willingness, drug default, treatment completion pattern, adverse
drug reactions and initial drug resistance with their potential
harmful effects on the treatment outcome as well as work load and
extra cost these regimens entail for DTP organisation are discussed
in this paper.
Out of a total of 1822 smear positive patients
diagnosed at the Lady Willingdon State TB Centre during intake period
(Feb '84 to March '85), 1126 were residents of Bangalore City. Of
these 695 (61.7%) were unwilling to attend the clinic daily for
2 months, 27 were unfit and one was excluded by mistake. Thus, 403
(38.3%) initially willing patients were classified either as 'core
group' or 'Non core group, according to the history of previous
anti TB treatment (321 and 82 respectively). Of the 695 (77.6%)
unwilling persons, majority were those who pleaded inability to
attend daily for 2 months without specifying any particular reason.
Refusal of SCC due to injections accounted for 12.8% and 9.5% wanted
to take treatment elsewhere. Old age influenced willingness adversely.
Of the 321 patients in the core group, 56 were
excluded due to missing more than 50% of intensive phase doses.
Among the remaining patients, 61 (48%) out of 127 patients on Regimen
A and 48 (34%) out of 138 on Regimen B, did not make a single default
in the intensive phase. Of the total 910 defaults for which actions
were taken, 640 (70%) were retrieved by letter writing,
among the remaining 293 (72%) were retrieved by home visiting.
Main reasons for default elicited during home visits were: going
out of station (52.9%) followed by patients being busy with work
(19.1%). Compensatory phase was availed by 156 of the 265 patients
who missed one or more doses due to default in the treatment. The
pattern of treatment completion of 321 core group patients in the
two regimens were similar i.e., in both the phases 65% for Regimen
A and 63% for Regimen B. Incidence of minor adverse reactions was
28% and major toxic reactions were experienced by 8.4% of patients.
Workload for treating 321 patients was due to supervised administration
of drug 45 patients per day. Letter writing to 3.1 per patients,
home visiting 1.1 per patient and doctor's attention for adverse
reaction 2 occasions per patient. This could be managed with the
existing staff. The cost of Regimen A was Rs.220/ per patient and
for Regimen B, 268/ per patient. Cost to patient for transportation
was Rs.70/ and Rs.113/ for Regimen A and B respectively.The major
disturbing finding of the study was initial low acceptability of
about 40% for SCC. The home visiting which was crucial in increasing
the completion rate in this study is usually not available in most
of the DTCs. Workload, adverse reactions etc. were not of any problem
for implementation of SCC in the programme.
|KEY WORDS: SCC, DAILY REGIMEN, OPERATIONAL FACTORS,
APPLICABILITY, CONTROL PROGRAMME.
|THE FATE OF RESISTANT CASES TREATED WITH THREE DIFFERENT
DRUG REGIMENS OF SHORT COURSE CHEMOTHERAPY UNDER PROGRAMME CONDITIONS
|P Jagota, TR Sreenivas, N Parimala & K Chaudhuri:
Indian J TB 1990, 37, 83-87.
The fate of patients with isoniazid (H) resistant
pulmonary tuberculosis, treated with 3 different Short Course Chemotherapy
regimens (Regimen A-1 SHRZ/7TH, Regimen B-2SHR/6TH, Regimen C-2EHR/4H2R2)
was examined in two sequential studies. One hundred H resistant
patients belonging to two groups-one without history of previous
treatment(core group) and second with history of previous treatment
>=15 days (non-core group), were followed up at the end of 12th,
15th and 24th/36th month of chemotherapy. Bacteriological favourable
response among patients in the core group at the end of chemotherapy
with Regimen A, B and C were 65.2% of 23 patients, 50% of l8 patients,
and 57.1% of 18 patients respectively. The response among patients
in the non-core group were 27.3% with Regimen A and 52.6% with Regimen
At the end of 24/36th month of chemotherapy, 62.5%
patients in the core group and 2 out of 7 in the non-core group
on regimen A and 68.7% patients on regimen C in the core group and
5 out of 15 in the core group and 41.7% in the non-core group on
regimen B were culture negative. The relapses were significantly
high in regimen B & C in comparison with regimen A. Thus, of
the total 100 patients, 99.3% were eligible for examination (1 died
during chemotherapy), 67 were examined and of them 37 (62.7%) were
culture negative, 22 positive and 8 were dead. The development of
drug resistance to rifampicin was directly related to the duration
of its use.
|KEY WORDS: SCC, DRUG RESISTANCE, EFFICACY, CONTROL
|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%
|KEY WORDS: CASE-FINDING, CONTROL PROGRAMME,
|IMPACT OF SHORT COURSE CHEMOTHERAPY ON THE OPERATIONAL
EFFICIENCY OF NATIONAL TUBERCULOSIS PROGRAMME
|TR Sreenivas, CV Shyamasundara, K Chaudhuri: Indian
J TB 1992, 39, 107-11.
Five districts in which short course chemotherapy
(SCC) was introduced during 1987-88 (DTP-SCC) and an equal number
of districts without an SCC programme (DTP-SR) but having comparable
new sputum examinations performance (NSE) in 1986 were selected
from the states of Gujarat and Tamilnadu. Data obtained by the monitoring
cell of the National Tuberculosis Institute (NTI) for 15 consecutive
quarters from the lst quarter of 1986 were analysed. It was possible
to study operational variables: NSE, number of pulmonary patients
diagnosed (TBP) and number of bacillary cases detected (BCASE).
While the figures of first six quarters were used to represent pre
SCC performance, those of the last six quarters depicted the post
SCC scenario. However, the trend analysis has been done using the
The growth rates of NSE, TBP and BCASE were 14.1%,
1.7% and 13.0% respectively for DTP-SCC compared with 17.0%, 5.3%
and 29% for DTP-SR. Both the DTCs and PHIs in DTP-SR showed negative
growth in BCASE, inspite of their efforts as evidenced by increase
in NSE and TBP, the introduction of SCC led to an increase in BCASE
for both DTC and PHIs. While the PHIs in DTP-SCC showed increased
efficiency in all the aspects (NSE 24.4%, TBP 19%, BCASE 16.7%),
DTCs showed decreased activity in NSE ( -2.4) and TBP (-6.6%), indicating
improvement at the periphery. Trend analysis corroborated the above
|KEY WORDS: SCC, IMPACT, OPERATIONAL EFFICACY,
|RESULTS OF TREATMENT WITH A SHORT COURSE CHEMOTHERAPY
REGIMEN USED UNDER FIELD CONDITIONS IN DISTRICT TUBERCULOSIS PROGRAMME
|K Chaudhuri, P Jagota & N Parimala: Indian J
TB 1993, 40, 83-89.
The treatment results of an unsupervised Short
Course Chemotherapy (SCC) regimen used under conditions of District
Tuberculosis Programme (DTP) are presented. The District Tuberculosis
Centre (DTC), Kolar and six of its Peripheral Health Institutions
(PHIs) formed the study area. No extra efforts except ensuring of
adequate availability of drugs at the participating centres were
made to obtain patients' compliance. In all, 584 smear positive
tuberculosis patients were diagnosed during the study period but
28.3% of the patients could not be initiated on treatment with the
chosen self administered SCC regimen -2EHRZ/6TH(EH).
Of the 382 put on treatment, only 33.2% completed
over 75% drug collections in both intensive and continuation phases.
The pattern of treatment compliance did not vary with the place
of treatment, i.e. DTC or PHI. Irrespective of treatment compliance,
nearly 72-77% of the patients attained smear negative status at
the end of the period of treatment, there being no difference between
PHI and DTC. However, deaths were higher in the PHI patients. This
could be attributed to a significantly higher proportion of aged
patients taking treatment at PHI than at DTC. Considering death
as an unfavourable outcome, overall favourable response was 65.9%.
Patients with drug sensitive bacilli had a higher rate of culture
negativity (70%), as compared to those with drug resistant bacilli
(48%). It was concluded that unsupervised SCC could give encouraging
results in a DTP setting, provided adequate drug supply was ensured.
|KEY WORDS: SCC, CONTROL PROGRAMME, OPERATIONAL