|TUBERCULIN SENSITIVITY IN YOUNG CHILDREN (0-4 YEARS
OLD) AS AN INDEX OF TUBERCULOSIS IN THE COMMUNITY.
|NL Bordia, Anton Geser, J Maclary, I Mundt & Kul
Bhushan: Indian J TB 1960, 8, 25-43.
The purpose of this study was to find out whether
the prevalence of infection in young children might be used as an
index of the tuberculosis problem in a population. Tuberculin testing
was done in a random sample of 2,883 children (0-4 years) in Bangalore
city, of those 2,589 (89.8%) actually completed testing. A total
of 4340 children were registered in 59 villages and of these 4090
(94.2%) were tuberculin tested. The villages were from Bangalore,
Kolar and Mandya as these districts were within 100 miles from Bangalore
city. The team went from house to house and made a complete registration
of the children 0-4 years in the selected houses. Information on
socio-economic status, density of population etc., was also collected
before giving tuberculin 1 TU RT 23 with Tween 80.
The results of the study showed that prevalence
of infection in 0-4 years age group of cantonment area was 1.6%
and in the crowded city area 4.1% at 14mm induration level. In the
rural population, the prevalence of tuberculosis infection was 2%.
In the city, a positive correlation between tuberculosis infection
and socio-economic condition was obtained while it was not seen
in rural areas. It was not possible to establish any correlation
between tuberculosis disease and infection either in rural or urban
areas, as the population was not examined for the prevalence of
|KEY WORDS: PREVALENCE, INFECTION, CHILDREN,
RURAL, URBAN, COMMUNITY.
|SIZE & EXTENT OF TB PROBLEM IN URBAN & RURAL
|Raj Narain: Indian J TB 1962, 9, 147-50 & also
in Proceed Natl TB & Chest Dis Workers Conf 1962, 155-68.
The aim of modern Public Health Programmes, is
a reduction in the total amount of disease in the community. The
unit for treatment and cure is not an individual but a sick community.
With this new aim, it becomes essential to know the size and extent
of tuberculosis in the community as it will be helpful not for purposes
of planning only but essentially for the assessment of their effect
on the problem. An attempt is made to review the important features
of the available knowledge about infection, morbidity and mortality
through various surveys. (i) Prevalence of Infection: Tuberculosis
infection is widespread in both urban and rural areas of almost
all parts of the country. Nearly 40% of the population are infected.
To avoid the effect of non- specific allergy and get a more reliable
demarcation, tuberculin reactions of 14mm and more were considered
as positive by National Tuberculosis Institute. (ii) Prevalence
of morbidity: The prevalence of radiologically active tuberculosis
in the population is likely to be 1.5%, Prevalence of bacteriologically
confirmed diseases is 0.4%. Based on single sample of sputum examination,
the prevalence of infectious cases in the country is probably an
under estimate. About two million are infectious at any one point
of time. (iii) Mortality: Deaths from tuberculosis in the
country is not definitely known. The impression of clinicians that
death due to tuberculosis have fallen sharply may not be true. Half
a million deaths will appear an underestimate. About 250 per 1,00,000
persons i.e., one million deaths due to tuberculosis per year seems
to be a reasonable estimate. (iv) Bovine Tuberculosis: Only
a few cases in man caused by the bovine tubercle bacillus have been
reported although 2.75% to 25% of cattle have been found tuberculin
To put in a nut shell, the problem of tuberculosis
in India is a gigantic one and our means of fighting it with the
single tool of BCG, do not even touch the fringe of the problem.
|KEY WORDS: INFECTION, SUSPECT CASE, CASE, MORTALITY,
|SOME ASPECTS OF A TB PREVALENCE SURVEY IN A SOUTH
|Raj Narain, A Geser, MV Jambunathan & M Subramanian:
Bull WHO 1963, 29, 641-64 & Indian J TB 1963, 9, 85-116.
The objective was to establish the prevalence rates
for tuberculosis infection, radiologically active pulmonary tuberculosis
and bacteriologically confirmed diseases for different age and sex
groups. Tumkur District in Mysore State consisting of 2,392 villages,
10 towns of was selected for the study. The district headquarter
town Tumkur was excluded from the survey. Random sample of 62 villages
and 4 town blocks having a population of 34,746 persons constituted
the study population. All the individuals available in the registered
population were given a Mantoux test with 1 TU RT 23 with Tween
80. Longitudinal diameter of induration was read 3-4 days after
the test. At the time of tuberculin test, all persons aged 10 years
and above were offered a single 70mm photofluorogram. For each picture
read as abnormal, a spot specimen of sputum of the individual concerned
was collected at the time of reading the tuberculin test. Age and
sex distribution of infection and disease were studied.
Various parameters concerning the prevalence of
infection and disease in the community were reported. Prevalence
rate of infection in all ages and both sexes of the population was
found to be 38.3%, radiologically active tuberculosis 1.86% and
0.41% sputum positive disease. The infection and disease increased
with age; of the total diseased, half were in age group 40 years
and more and about 2/3 among males.
|KEY WORDS: SURVEY, PREVALENCE, INFECTION, DISEASE,
CASE, COMMIUNITY, RURAL, URBAN.
|DOES MALNUTRITION AFFECT TUBERCULIN HYPERSENSITIVITY
REACTION IN THE COMMUNITY
|KT Ganapathy, AK Chakraborty: Indian J Pediatrics
1982, 49, 377-82
Distribution of tuberculin test indurations were
studied in relation to nutritional status of 930 rural children
aged 1-4 years and 796 aged 5-9 years. Using Quetlet's Index, it
has been observed that the distribution of indurations were similar
in normal and malnourished children. By following Jelliffe's criteria
of grading nutrition, no correlation was observed between the size
of induration and degree of malnutrition. It is concluded that malnutrition
in the community may not influence the prevalence rates of tuberculin
infection based on such testing.
|KEY WORDS: MALNUTRITION, TUBERCULIN REACTION,
|ROLE OF TUBERCULIN TEST IN SURVEILLANCE OF TUBERCULOSIS
|MS Krishna Murthy, AN Shashidhara, R Channabasavaiah,
RV Kale, & J Chakravarty: Proceed of Indo US Workshop on major
advances in TB Research, Madras, 4-7 Dec 1989, 111-17.
The National Tuberculosis Control Programme is
in operation since 1962, and its quantitative achievement is being
monitored indirectly through records and reports received from District
Tuberculosis Centres. For direct evidence of impact of the programme,
tuberculin surveys are useful in reflecting the recent epidemiological
situations prevailing in the area. Tuberculosis being a disease
of secular nature, a periodic follow up with five years (arbitrary)
interval may be preferred over the continuous follow up, for finding
the trend of tuberculosis situations in an area.
Keeping in view the importance of tuberculin surveys,
National TB Institute (NTI) has evolved a surveillance system which
can be adopted by any state in India. The state teams can be trained
at NTI in registering population, tuberculin testing & reading,
so as to carry out the surveillance in their respective areas. It
is essential to create a central organisation for surveillance of
tuberculosis using the tuberculin test. The centre would be responsible
for technical & administrative support and monitoring. NTI could
provide technical expertise in formulating the surveillance system,
a training methodology and an in service training to the designated
|KEY WORDS: SURVEILLANCE, TUBERCULIN TEST, TREND,
|TUBERCULIN TESTING IN THE COMMUNITY THROUGH GENERAL
HEALTH SERVICES IN PREPARATION FOR TUBERCULOSIS SURVEILLANCE - A STUDY
|K Chaudhuri, MS Krishna Murthy, AN Shashidhara, R Channabasavaiah,
TR Sreenivas & AK Chakraborty: Indian J TB 1991, 38, 131-37.
A study was conducted in 1983-84 by the National
TB Institute (NTI) in the districts of Dharmapuri (Tamil Nadu) &
Ananthapur (Andhra Pradesh). Thirteen health personnel were trained
in census taking, tuberculin testing & reading and data keeping
etc., at the NTI according to the standard methodology. The trainees
were repeatedly assessed and only those who achieved a reasonably
high inter-reader correlation with the standard reader were chosen
for the field work. Field work was carried out by these health workers
and supervised by the team leaders of NTI. Children between 0-9
years were tested with 1 TU RT 23 with Tween 80 in tuberculin testing
centres specially set up in each village and the reactions were
read between 48 & 72 hours after the test. The tuberculin testing/reading
coverage was very high. Of 6702 eligible children, 5904 (97%) were
tuberculin test read.
Individual reading assessment carried out at Ananthapur
and Dharmapuri for the State Field Workers (SFWs) showed that agreement
with Standard Reader (SR) of NTI at three induration levels i.e.,
10+ mm, 14+ mm and 18+ mm were very high. The demarcation line between
infected and uninfected appeared to be about 18 mm. In Ananthapur,
the agreement at 18+ mm was 99% and at Dharmapuri it was 100% for
SFW, and 98.4% for SFW-2. The estimates of prevalence rate of infection
were 9.3% - SFW V/s 9.7% - SR at Anantapur, 5.2% - SFW V/s 5.2%
- SR and 7.2% - SFW.2 V/s 7.2% - SR at Dharmapuri. The study further
showed that it was possible to train general health workers, within
a period of 3 months to attain a high level of efficiency. The general
health services can successfully organise on their own a programme
of tuberculin testing in the community with proper liaison and supervision
by some nodal agency. The training and field supervision responsibilities
may be shouldered initially by NTI or another suitable organisation,
till these nodal agencies come up.
|KEY WORDS: SURVEILLANCE, TUBERCULIN TEST, HEALTH
SERVICES, FEASIBILITY, COMMUNITY.