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002 |
SIZE & EXTENT OF TB PROBLEM IN URBAN & RURAL
INDIA |
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
reactors.
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.
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KEY WORDS: INFECTION, SUSPECT CASE, CASE, MORTALITY,
COMMUNITY. |
003 |
RESURVEY OF 15 VILLAGES FROM THE MADANPALLE ZONE
OF NATIONAL SAMPLE SURVEY ON TUBERCULOSIS |
Raj Narain, MV Jambunathan & M Subramanian: Proceed
Natl TB & Chest Diseases Workers Conf, Bangalore, 1962,
34-47. |
A study was undertaken with the following objectives:
(1) To estimate the proportion of population that would be available
for resurvey after 5 years. (2) To ascertain five years later the
fate of persons with X-ray pathology. (3) To compare the prevalence
of tuberculosis in the villages at an interval of 5 years. Population
of 15 of the 31 villages from the Madanapalle zone, was selected
for this study. About 9,500 persons were registered and 7,200 were
X-rayed at the initial survey. Five years later the same population
was re-examined and nearly 70% were available for X-ray examination.
Sputa were collected from persons with abnormal X-ray shadows interpreted
as such by either of the two readers. Two spot samples were collected
within an interval of 1-3 days and were examined by direct smear
and by culture.
Analysis of the data shadow showed that: (1) There
was no significant difference in the prevalence rates i.e., 3.6
and 4.6 per thousand respectively at two points of time. (2) During
the interval, 30% of active cases had died and 20% were still active
at the end of 5 years. (3) There was almost complete turn over of
the bacillary cases during the 5 years interval.
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KEY WORDS: RESURVEY, COVERAGE, PREVALENCE, MORBIDITY,
MORTALITY. |
016 |
SOME EPIDEMIOLOGICAL ASPECTS OF TUBERCULOUS DISEASE
AND INFECTION IN PAEDIATRIC AGE GROUP IN A RURAL COMMUNITY |
GD Gothi, SS Nair & Pyare Lal: Indian Paediatrics
1971, 8, 186-94. |
The prevalence and incidence rates of tuberculous
infection and disease in the community are known in the age group
10 years and above from several surveys carried out so far. The
present paper provides various parameters of tuberculosis in particular
in the pediatric age group. A random sample of 119 villages in 3
taluks of Bangalore district were surveyed 4 times from May 1961
to July 1968 at intervals of 18 months, 3 years and 5 years of the
initial survey. Tuberculin test was done for the entire available
population with 1 TU PPD RT 23 with Tween 80, and 70mm X-ray for
all available persons aged 5 years and above. Two samples of sputum
were obtained from the X-ray abnormals, and examined by smear and
culture.
It was found that prevalence of infection increased
with age from 2.1% at 0-4 year age group to 16.5% at 10-14 year
age group, compared to 47% at 15 years and above age group. Prevalence
of disease in 5-14 year age group was considerably lower than in
age group 15 years or more. Tuberculosis morbidity increased with
the size of tuberculin reaction and it was high among children with
reaction 20mm or more. Incidence of infection increased with age
from 0.9% per year in age group 0-4 years to 2.8% per year among
that of 15 years and above. Incidence of disease also showed the
same phenomenon-, rising from 0.5% in age group 5-9 to 4% per year
in the age group 15 years and above. There were 10 sputum positive
cases in 5-14 years of age in first survey, of them, 8 became negative
and one died. While from among 152 cases in 15 years and above age
group, 48 became negative, 72 died and 32 remained positive. The
fate of cases of pulmonary tuberculosis in 5-14 years age was not
as serious as in 15 years and above age group. The survey had no
means of examining miliary and meningeal tuberculosis.
Children as well as adults with larger reaction
of 20mm or more to tuberculin test had higher mortality. This could
be considered due to tuberculous infection after taking into account
death due to non- tuberculous reasons in both the infected and uninfected
groups. Use of chemoprophylaxis might be considered for those who
give history of contact with open cases and have tuberculin reaction
size 20mm or more.
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KEYWORDS: CHILDREN, RURAL COMMUNITY, PREVALANCE,
INCIDENCE, INFECTION, DISEASE, TUBERCULIN, INDURATION SIZE, MORTALITY,
CHEMOPROPHYLAXIS. |
019 |
SOME ASPECTS OF CHANGES IN RURAL POPULATION AND
FATE OF TB CASES AFTER AN INTERVAL OF TWELVE YEARS |
MS Krishnamurthy, KR Rangaswamy, AN Shashidhara &
GC Banerjee: NTI Newsletter, 1974, 11, 1-7. |
During second epidemiological survey carried out
in 1972-73, special efforts were made in 21 of 62 villages belonging
to first survey (1961-62) to study the demographic changes and fate
of TB cases after an interval of 12 years.
The findings were: The increase of dejure population
was about 20% over a period of 12 years i.e., an annual increase
of 1.7%. The age structure had altered mainly due to significant
increase in the age group 60 years and above 51% to 64% indicating
aging of population. The loss of original population after 12 years
was 44%, of which 33% was due to migration and 11% due to death.
The overall migration was more among females. The migration rate
was higher in younger age group, being highest in 10-19 years (49%),
next in 0-9 years (38%). Thus, overall migration in 0-19 years was
43%. The death rate was highest in 60 years and above (58%). It
varied from 4-9% in age group 0-39 years. Original population available
after 12 years for re-examination was 56%. Distribution in different
age groups were; 0-9yr = 57%, 10-19yrs = 47%, 20-49yrs = 66%, 50-59yrs
= 44%, 60yrs and more = 28%.
Out of 88 X-ray suspect cases of earlier survey,
87 could be identified and present status of 72 were known. Of them,
16 were normal, 12 and 4 found to be suspect cases and bacillary
cases respectively and 40 had died. Of the remaining fifteen, 11
migrated and 4 not examined. Out of 14 bacillary cases, 13 could
be identified. Of them, 3 were sputum negatives (2 normal and 1
suspect case) 9 had died and 1 migrated.
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KEYWORDS: FATE, CASE, SUSPECT CASE, MORTALITY,
MIGRATION, RURAL POPULATION, DEMOGRAPHIC CHANGES, SURVEY. |
028 |
FIVE YEAR INCIDENCE OF TUBERCULOSIS AND CRUDE MORTALITY
IN RELATION TO NON SPECIFIC TUBERCULIN SENSITIVITY |
GD Gothi, SS Nair, AK Chakraborty & KT Ganapathy:
Indian J TB 1976, 23, 58-63. |
The study was undertaken in a sample of 103 villages
of 3 sub-divisions of Bangalore district as a part of the 5 year
study of epidemiology of tuberculosis between 1961-68. The follow
ups were done at 1.5, 3 & 5 years after the first survey.
The entire population was offered tuberculin test with 1 TU RT 23,
a second test with 20 TU RT 23 to those persons who were having
reactions of 0-13 mm to 1 TU. All aged 5 years or more were offered
70mm photofluorograms at each survey. Two specimens of sputum were
collected from persons having abnormal X-ray shadows for examination
of tubercle bacilli. Procedures were uniform at each survey. The
population was divided into three groups on the basis of their tuberculin
reactions: (a) reactors to 1 TU (infected with M.tuberculosis),
b) non-reactors to 1 TU but reactors to 20 TU (infected with atypical
mycobacteria), c) non-reactors to both 1 TU & 20 TU (not infected
with either M.tuberculosis or other mycobacteria). Incidence of
disease and crude mortality were studied separately among these
groups.
The five year incidence of culture positive disease
was the highest among 1 TU reactors and the least among reactors
to 20 TU. In the younger age group (5-14 years) the five year incidence
of culture positive disease among reactors to 20 TU was significantly
lower compared with that among 20 TU non-reactors. The reduction
of incidence of culture positive cases in the former group over
that in the latter was 75% for culture positive cases and 61% for
combined culture positive and negative disease. As regards crude
mortality, the overall rate was significantly lower among 20 TU
reactors compared with non-reactors. Even if the significance of
the finding on crude mortality is debatable, it could be concluded
that non-specific infection provides some protection against development
of tuberculosis, at least in younger age groups.
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KEY WORDS: INCIDENCE, DISEASE, MORTALITY, NTM,
RURAL POPULATION. |
039 |
TUBERCULOSIS MORTALITY RATE IN A SOUTH INDIAN RURAL
POPULATION |
AK Chakraborty, GD Gothi, S Dwarakanath & Hardan
Singh: Indian J TB 1978, 25, 181-86. |
Information on cause specific mortality rates due
to tuberculosis in India is inadequate. In the study under report,
these have been estimated based on the data obtained from a five
year epidemiological study of 119 villages of Bangalore district
in south India. For this purpose, the estimated number of excess
deaths due to causes other than tuberculosis among patients of tuberculosis,
have been attributed to the disease.
The annual mortality due to all causes on 5 year
observation could be calculated as 893 per 1,00,000 population (9%)
aged 5 years and above. Agewise as well as overall mortality rates
were not different from survey I & II, II & III & III
& IV. The average rate of the periods is calculated to be 84
per 1,00,000 annually. The death rates were the highest in 55 years
and above age groups, lower in 5-14 years and showed an increasing
trend with age. Compared to the estimates of tuberculous deaths
in India available for 1949 (about 250/1,00,000), the present rates
were lower.
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KEY WORDS: MORTALITY, RURAL POPULATION, LONGITUDINAL
SURVEY. |
047 |
MORTALITY AND CASE FATALITY OF TUBERCULOSIS CASES
DIAGNOSED IN A RURAL POPULATION OF SOUTH INDIA |
VV Krishna Murthy: NTI Newsletter 1982, 19, 8-13. |
Mortality from tuberculosis is an important epidemiological
parameter for defining the problem of tuberculosis in any country.
But due to lack of systematic recording and reporting system, precise
information on cause of death is not available in our country. An
attempt has been made to estimate the case fatality of tuberculosis
cases as well as mortality of cases diagnosed in a longitudinal
study conducted from 1961-68 in Bangalore district. Crude mortality
of cases is defined as the ratio of total deaths observed among
cases to the total number of cases observed, while case fatality
is defined as the ratio of deaths that have occurred due to tuberculosis
to the total number of cases investigated.
The overall observed annual crude mortality was
14.8%, while among culture positive smear positive (C+S+) it was
21%. An upward trend was seen with the increase in the age. The
overall annual crude mortality among culture positive smear negative
(C+S-) cases was 9.5% which is significantly lower than that among
C+S+ cases. The death rates among old and new cases at the end of
18 months were 16.7% and 13.7% respectively. No statistical difference
was found in the crude mortality either among old and new cases
or in relation to the interval of diagnosis. Case fatality due to
tuberculosis was computed by calculating the deaths among non-tuberculosis
population of the same area and during same period and eliminated
from the total deaths observed among tuberculosis cases. The case
fatality of tuberculosis was found to be 13.3%. It was further observed
that out of the total 38 deaths among cases, 89% were due to tuberculosis
and 11% were due to non-tuberculosis causes.
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KEY WORDS: MORTALITY, CASE FATALITY, CASE, RURAL
POPULATION, SURVEY. |
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