|| B : Programme Development
|POTENTIAL YIELD OF PULMONARY TUBERCULOSIS BY DIRECT
MICROSCOPY OF SPUTUM IN A DISTRICT OF SOUTH INDIA
|GVJ Baily, D Savic, GD Gothi, VB Naidu & SS Nair:
Bull WHO 1967, 37, 875 92 & Indian J TB 1968, 15, 130-46.
In the formulation and evolution of a National
Tuberculosis Programme some assumptions are made which require to
be tested under the normal administrative set up with minimum interference
by the investigating team. The objectives of the study were to understand
some operational aspects of Case-finding in the Peripheral Health
Institutions (PHIs) in an integrated programme. First, what is the
frequency of persons showing symptoms suggestive of pulmonary tuberculosis
among the normal out patients attendance (OPA), how many cases can
be found by direct microscopy of sputum of those symptomatics, what
will be the workload of TB Case-finding at a PHI and, what proportion
of symptomatics will be willing to and will actually attend the
District TB Centre (DTC) when referred there for X-ray examination.
The study was conducted in a district with a population of 1.5 million
having one DTC and 55 PHIs. 15 PHIs were selected on the basis of
stratified random sampling. At each PHI an National Tuberculosis
Institute (NTI) investigator worked for a period of one month. All
new out patients were questioned for symptoms (non- suggestive and
suggestive) and any patient with chest symptoms mainly cough for
more than one week fever, chest pain and haemoptysis was subjected
to a sputum examination and also referred for X-ray examination
at the DTC.
It was found that 381 (2.5%) of the 14881 total
new out patients of all age groups complained of cough for 2
weeks and more. From these chest symptomatics, 11% were new cases
of pulmonary tuberculosis. When the symptomatics were referred for
X-ray examination, although 66% agreed to go for X-ray to DTC but
only 16% (of the total referred) actually went for X-ray. Each PHI
had to examine only one or two sputum specimens per working day.
As the study was conducted in a representative sample of PHIs for
a representative duration of time, the material permits the estimation
of the potential yield of cases in a District TB Programme (DTP)
during a period of time (say one year). It was estimated that about
45% of the total estimated prevalence cases in a district
can be diagnosed in a DTP during a period of one year, if all PHIs
function according to the programme recommendations. The workload
due to tuberculosis Case-finding is small and can be managed with
the existing staff and Case-finding by direct smear examination
of sputum at the PHI has to be relied upon.
|KEY WORDS: CASE-FINDING, CHEST SYMPTOMATICS,
PHI, POTENTIAL, WORK LOAD.
|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.
|KEY WORDS: CASE-FINDING, URBAN HEALTH INSTITUTIONS,
SELF REPORTING CHEST SYMPTOMS.
|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.
|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.
|STUDY OF CAMPS FOR EXAMINING SPUTUM OF CHEST SYMPTOMATICS
ATTENDING OUTPATIENTS OF PERIPHERAL HEALTH INSTITUTIONS
|P Jagota, B Mahadev, BT Uke & KL Vasudeva Rao:
Indian J TB 1989, 36, 27-30.
A study was designed to evaluate the outcome of
holding sputum camps. The chest symptomatics referred by Peripheral
Health Institutions (PHIs) to the camp were compared in terms of
proportion of chest symptomatics registered and number of cases
found with routine Case-finding actually carried out in the PHIs
of an average District Tuberculosis Programme (DTP) and any educative
effect of camp on the PHI staff. The study was carried out in 15
PHIs with wide range of performances in Case-finding. A team consisting
of Medical Officer (MO), Treatment Organiser and Laboratory Technician
of National TB Institute conducted sputum camps by involving the
local staff and MOs of PHIs. The MOs of PHIs registered all the
eligible symptomatics from the daily outpatients for a period of
one month before the due date of the camp. The sputum was collected,
slides prepared and patients advised to come on the camp date. A
total of 528 chest symptomatics who reported at the PHIs during
camp month were registered. Of them, 380 patients' sputum smears
were prepared and 25 were found positive. Of the 528 symptomatics
referred to the camp, only 86 (16.3%) actually turned up and 4 (16%)
were positive. Prior to the sputum camp, 54 smear positive cases
were diagnosed by these centres in 6 months. In the subsequent 6
months, 112 cases were diagnosed.
The study clearly shows that the efficacy of Case-finding
by the sputum camp method is very low in comparison with integrated
Case-finding at PHIs. More than 80% of the cases were missed by
the camp by way of loss due to referral on the camp day. However,
there was significant increase in the total number of cases diagnosed
during 6 months after the camp, in comparison to 6 months prior
to camp, thus, indicating the educative effect of the camp on the
PHI MOs. The integrated sustained Case-finding activity in the PHIs
cannot be substituted with the periodic Case-finding camps or holding
of 'specialised clinics'.
|KEY WORDS: CHEST SYMPTOMATICS, SPUTUM CAMP,
PHIs, CASE-FINDING, REFERRAL.
|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,