|INTERMITTENT TREATMENT WITH STREPTOMYCIN AND INH
IN RURAL AREA
|V Govindaswamy & D Savic: Proceed Natl TB &
Chest Dis Workers Conf, Ahmedabad, 1965, 113-28.
There is a wide spread prejudice among the staff
of health centres that patients invariably prefer injection and
it was felt by many health workers that streptomycin containing
intermittent regimens would be more acceptable to rural patients.
A study was carried out to find out the acceptability and applicability
of an intermittent supervised drug regimen containing streptomycin
1 gm and INH 650 mgm once a week in a rural area as well as the
regularity with which the rural folk took this treatment. Association
between the observed regularity and factors like age, sex etc.,
was also analysed. 107 rural patients of tuberculosis, diagnosed
at 5 taluk hospitals in Ananthapur district of Andhra Pradesh on
the basis of sputum examination by direct smear and/or X-ray examination
with the help of mobile X-rays, consented to treatment with intermittent
regimen mentioned above. About half of them were new patients and
the rest were old patients who were mostly regular on an earlier
oral regimen. 94 of the above were available for analysis.
The regimen was found quite practicable in the
sense that at no centre the study was interrupted or discontinued
because of the inability of the health centre staff to give injection.
If regularity is expressed as a proportion of patients who at any
given time had taken the optimal amount of treatment (no. of injections),
then 40 patients (42%) were found regular on the intermittent regimen,
36 patients were classified as lost and the remaining had 3 or less
injections due and had not yet had the chance to become lost according
to the definition adopted. Thus, the regularity of those accepting
the regimen was quite low. There was very steep fall in regularity
during the first 10 weeks of treatment, nearly a half of the total
cases became irregular during the first 6 weeks. Beyond 4 months
of treatment, patients who continued to attend centres regularly
for treatment became negligible, thus pointing that injection was
not a key variable in the treatment regularity of tuberculosis.
|KEY WORDS: CASE HOLDING, PHIs, SUPERVISED INTERMITTENT
REGIMEN, TREATMENT, CONTROL PROGRAMME.
|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.
|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.
|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.