|| B : Programme Development
|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 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.
|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.
|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.