|
014 |
RESISTANT AND SENSITIVE STRAINS OF MYCOBACTERIUM
TUBERCULOSIS FOUND IN REPEATED SURVEYS AMONG A SOUTH INDIAN RURAL
POPULATION |
Raj Narain, P Chandrasekhar, RA Satyanarayanachar &
Pyare Lal: Bull WHO 1968, 39, 681-99. |
The degree of the risk of infection and disease
in man from drug resistant strains of mycobacterium tuberculosis
is not clear. An increase in the prevalence of primary resistance
indicates the extent of such risk while an increase of secondary
or acquired resistance could be considered as a problem of
the individual patient and may reflect limitations of his treatment.
The present report describes the prevalence of
strains with acquired or primary resistance or of sensitive strains
found in 3 successive surveys in a sizable random sample of village
in a south Indian district. Changes in the status of cases with
such strains from one survey to another and their infectivity among
household contacts are also described. The prevalence of tuberculosis
infection among household contacts of cases with acquired resistance
to isoniazid was significantly higher than those with primary resistance
or with sensitive culture. This was probably due to the longer duration
of sputum positivity of isoniazid resistant strains at the time
of diagnosis. But infectivity as judged by the incidence of new
infection among household contacts was generally less for cases
with acquired or primary resistance than for cases with sensitive
cultures, though the difference observed was not statistically significant.
A large number of culture positive cases especially those with primary
resistance had no radiological evidence of active pulmonary tuberculosis.
The prevalence of primary resistance was high in certain categories
of cases and the differences between cases with primary resistance
and those with acquired resistance were many and large. It was suggested
that this could be due to the primary resistant cultures being those
of atypical mycobacteria, despite positivity in the niacin test.
There was a significant increase in the number of cases with acquired
resistance to isoniazid at the third survey owing to the irregular
treatment and supply of INH alone after the second round. The prevalence
of primary resistance at the three rounds was almost the same.
|
KEY WORDS: DRUG RESISTANCE, M.TUBERCULOSIS,
RURAL POPULATION, INFECTIVITY, SURVEY. |
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.
|
KEYWORDS: FATE, CASE, SUSPECT CASE, MORTALITY,
MIGRATION, RURAL POPULATION, DEMOGRAPHIC CHANGES, SURVEY. |
022 |
TUBERCULOSIS IN RURAL SOUTH INDIA: A STUDY OF POSSIBLE
TRENDS AND THE POTENTIAL IMPACT OF ANTI-TUBERCULOSIS PROGRAMMES. |
HT Waaler, GD Gothi, GVJ Baily and SS Nair: Bull
WHO 1974, 51, 263-71. |
This paper estimates the natural trend of tuberculosis
in rural south India and the potential epidemiological impact
of a few selected programmes on this trend, by using the
values of important variables and parameters derived from a longitudinal
epidemiological study conducted in 1961-68 in Bangalore district
by the National Tuberculosis Institute (NTI), Bangalore. The values
are fed into an epidemetric model and the final outputs of computerization
derived are incidence of disease (in both absolute and relative
terms) and cumulative future prevalence of disease.
(1) An annual average input of new generations
of 3.16% has been derived for a population of 1 million by using
a simplified fertility rate formula. A constant reduction 0f 1%
per year has been assumed until fertility rate has reached 50% of
its starting value. The assumption is that any reduction in fertility
due to current family planning programmes will have a considerable
impact on the size of the population and on the epidemiological
situation. Further demographic assumptions are, excess mortality
applied to groups of active cases and fatality among untreated cases.
(2) The population is subdivided into the following epidemiological
groups: (i) non-infected, (ii) infected for (a)< 5 years,
(b)= 5 years, (iii) protected by BCG, (iv) active cases - (a) non-infectious,
(b) infectious and (v) previous cases. Initially groups (iii) and
(v) are given zero values. The future risk of infection is adjusted
to the force of infection, which is assumed to be reduced to 1/7th
when a case is successfully treated. Morbidity rates include transfers
from infected group to active cases group during 5 year periods.
(3) A spontaneous healing rate of 50% and a cure rate of
80% after chemotherapy are assumed. Protective effect of BCG
is given three values: 30%, 50% and 80%, with uniform annual reduction
of 1% (4) Case detection and treatment (CF/T) is given two
values: 66% and 20%. Coverage for BCG limited to 0-20 years is assumed
to be 66% or 30%.
The computer simulation output for natural trend
shows that the absolute number of new cases increases considerably
while the incidence rate do not warrant firm conclusions about any
long term trend. All programmes considered have considerable potential
impact. The CF/T programmes will reduce the incidence after 25 years
by only 12% compared to reduction of 17% by the BCG programme. In
general, the effect of CF/T will be more immediate and of BCG will
be seen much later. To avoid the drawbacks of incidence as an indicator
of tuberculosis situation, the cumulated future prevalence is taken
as the tuberculosis problem. To adjust for the present significance
of future cases as part of the problem certain discount rate have
been applied. The CF/T programme and the BCG programme with 50%
protection lead to 69% problem reduction, if not discounted. With
increasing discount rates, CF/T has an advantage over BCG. The actual
problem reduction will be higher than that estimated if improvements
in the standard of living are expected during the coming years.
In conclusion, data on the dynamics of tuberculosis
situation in rural south India, obtained by NTI, Bangalore when
fed into a mathematical model, many predictions about the future
tuberculosis situation were made under a wide range of hypothetical
assumptions.
|
KEY WORDS: TREND, MODEL, BCG PROGRAMME, RURAL
POPULATION, IMPACT, CONTROL PROGRAMME. |
023 |
TUBERCULOSIS IN A RURAL POPULATION OF SOUTH INDIA:
A FIVE YEAR EPIDEMIOLOGICAL STUDY |
National Tuberculosis Institute, Bangalore: Bull
WHO 1974, 51, 473-88. |
A rural population of 65,000 belonging to 119 randomly
selected villages of Bangalore district was repeatedly examined
four times during 1961 to 1968, by tuberculin test, X-ray and sputum
examinations, to study the epidemiology of tuberculosis without
any active anti-tuberculosis measures. The interval between the
first and the fourth examination was 5 years. The coverage of various
examinations at different surveys were very high.
The main findings of the study are: Prevalence
rate of tuberculous infection in the population was about
30% (among females 25% and males 35%). The overall prevalence
rates of infection were fairly constant at all the four surveys,
but a steady decrease in the prevalence of infection was observed
in the age group 0-24 years. Annual incidence rate of infection
on the average was about 1%. During the study period,
the incidence of infection showed a decline from 1.63% to 0.8% for
all ages combined. Prevalence rate of disease ranged from
337 to 406 per 1,00,000 population during the study period,
the highest being at the time of first survey and lowest at the
time of third survey. For the younger age group of 5-34 years, the
rates showed continuous decrease during the study period. Annual
incidence rate of disease ranged from 79 to 132 per 1,00,000
population, highest being between first and second surveys and lowest
between second and third surveys. The incidence rate in younger
age groups below 35 years showed a decline during the study period.
Those with tuberculin test induration of 20mm or more had highest
annual incidence rate of disease. The annual incidence rate
of bacteriologically confirmed disease in the three radiological
groups of population was (i) 185 per 1,00,000 with normal X-rays,
(ii) 958 per 1,00,000 with abnormal shadows judged as inactive
tuberculous are non-tuberculous and (iii) 4,530 per 1,00,000 with
abnormal shadows judged as active or probably active tuberculous
but bacteriologically not confirmed. The third group constituted
1% of the total population and contributed 34% of the total incidence
cases. In each of the above three radiological groups, the incidence
of disease was highest among those with tuberculin test induration
of 20mm or more to 1 TU RT 23 with Tween 80. Those with 20mm or
more tuberculin test induration in the third radiological group
constituted 0.45% of the total population but contributed 27% of
the total incidence cases. Incidence rate for males was nearly double
that of females. More than half of the new male cases were 35 years
of age, whereas more than half the females were below the age of
35 years. Out of 126 cases followed up at three subsequent surveys
over a period of 5 years, 49.2% died, 32.5% got cured and 18.3%
continued to remain sputum positive. Both death and cure rates
were highest during the first one and a half year period.
About 30% of newly detected cases come from population
uninfected at an earlier survey. Both infection and disease showed
a decline in the younger age group. There was no evidence of an
increase in drug resistance among newly diagnosed cases. Incidence
of cases showed a higher natural cure. These findings indicate that
tuberculosis cases are not a uniform entity. There can be different
gradations from the point of view of diagnosis and ability to benefit
from treatment. The differences between male and female patients
with regard to death and cure rates support this view
|
.KEY WORDS: TREND, RURAL POPULATION, PREVALENCE,
INCIDENCE, INFECTION, DISEASE, LONGITUDINAL SURVEY. |
025 |
PRECISION OF ESTIMATES OF PREVALENCE OF BACTERIOLOGICALLY
CONFIRMED PULMONARY TUBERCULOSIS IN GENERAL POPULATION |
SS Nair, GD Gothi, N Naganathan, K Padmanabha Rao,
GC Banerjee & R Rajalakshmi: Indian J TB 1976, 23, 152-59. |
This paper reports on a study conducted in the
year 1975 to estimate yield of tuberculosis cases from multiple
sputum specimens, and work out correction factors to be applied
to estimates based on small number of specimens. Eight sputum specimens
were collected within a fortnight from each person with an abnormal
chest X-ray during an epidemiological survey in 77 villages in a
district of south India. Each specimen was examined by Ziehl-Neelsen
technique of microscopy and culture. In all, 3,199 persons were
referred for sputum examination and results of all the eight specimens
were available for 1,652. Of the latter, 64 were culture positive.
The first specimen detected 58% of the culture
positives and the additional positives by later specimens generally
decreased. The contribution from the first specimen was 71% for
cultures showing good growth and 19% for cultures with scanty growth.
Similarly for positives on both culture and microscopy, first specimen
detected 87% whereas the corresponding proportion was 32% for those
positive only on culture. The type of specimen (viz., spot or overnight)
and age or sex of the case did not influence the yield from multiple
examinations. The precision of an estimate of prevalence will depend
on the number of specimens on which it is based and the coverage
obtained in the collection and examination of specimens. Correction
factors to be applied to such estimates based on one or two specimens,
for various levels of coverage have been presented. For example,
an estimate of prevalence based on one sputum specimen with 90%
coverage will have to be nearly doubled to get a more precise estimate.
Using these correction factors, revised estimates of prevalence
have been presented for a number of prevalence surveys conducted
in India. It has been estimated that the total number of infectious
cases in India at present may be at least 3 million, as against
2 million according to earlier estimates.
|
KEY WORDS: PREVALENCE, CASE, RURAL POPULATION,
MULTIPLE SPUTUM SPECIMEN, ESTIMATES, SPUTUM EXAMINATION. |
027 |
RELAPSE AMONG NATURALLY CURED CASES OF PULMONARY
TUBERCULOSIS |
AK Chakraborty & GD Gothi: Indian J TB 1976,
23, 8-13. |
The five year longitudinal epidemiological study
in south India (1961-68) showed that a considerable proportion of
bacteriologically proven cases found in a survey got cured naturally
without the facility of organised treatment in the survey area.
This "natural cure" could be an epidemiologically significant
phenomenon- depending on the stability of such a cure or in other
words, the frequency of relapses among the naturally cured. In all,
108 naturally cured cases of tuberculosis out of a total of 269
cases, from among about 62,000 persons surveyed twice, were followed
up for varying periods of 1 to 3½ years.
It was observed that the average relapse rate was
85.4 per 1000 person years of observation, there being no difference
between the two sexes. Relapse rates were however higher in persons
aged 20 and more compared to those 5-10 years old. Relapses were
not dependent on the bacteriological status at initial diagnosis
i.e., whether positive by culture alone or positive by smear and
culture. The death rate among the naturally cured was 42.7 per 1000
person years and together with relapse constituted the unfavourable
fate after natural cure. It has been calculated that as an input,
adding to the pool of bacillary cases in the community, the ratio
of relapse cases to cases arising afresh from the general population
in a year would roughly be in the order of 1:16. It is concluded
that the naturally cured status could be considered as an epidemiologically
favourable situation, though much less so when compared to the chemotherapeutically
achieved cure.
|
KEY WORDS: RELAPSE, NATURAL CURE, CASE, RURAL
POPULATION, 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.
|
KEY WORDS: INCIDENCE, DISEASE, MORTALITY, NTM,
RURAL POPULATION. |
029 |
PREVALENCE OF NON-SPECIFIC SENSITIVITY TO TUBERCULIN
IN A SOUTH INDIAN RURAL POPULATION |
AK Chakraborty, KT Ganapathy, SS Nair & Kul Bhushan:
Indian J Med Res 1976, 64, 639-51. |
The data from a tuberculosis prevalence survey
carried out in three taluks of Bangalore district in south India
during 1961-68 were analysed to study (i) the prevalence of non-specific
sensitivity in the community i.e., prevalence of infection with
mycobacteria other than M.tuberculosis, as found by testing the
population with tuberculin RT 23 of a lower strength (1 TU) and
higher strength (20 TU), both with Tween 80 and (ii) additional
boosting if any, resulting from testing with higher dose of tuberculin,
immediately following a test with 1 TU RT 23.
The level of demarcation between infected and uninfected
with 1 TU was 0-9 mm induration size and this negative group tested
with 20 TU dose induration of 8 mm or more was considered positive.
Prevalence of infection with M.tuberculosis in the community were
2.1% in 0-4 years, 7.9% in 5-9 years, 16.5% in 10-14 years, 33.2%
in 15-24 years and overall 14.5% in 0-24 years of age group. Infection
rate with other mycobacteria were 12.9%, 44.9%, 66.2%, 62.4% and
45.7% respectively in the above stated different age groups.
Testing the population with 20 TU RT 23 following
a 1 TU test was found not to boost the tuberculin reactions over
that observed on a single test with 1 TU only.
|
KEY WORDS: NTM, PREVALENCE, INFECTION, BOOSTING,
TUBERCULIN REACTION, RURAL POPULATION. |
036 |
INCIDENCE OF SPUTUM POSITIVE TUBERCULOSIS IN DIFFERENT
EPIDEMIOLOGICAL GROUPS DURING FIVE YEAR FOLLOW UP OF A RURAL POPULATION
IN SOUTH INDIA |
GD Gothi, AK Chakraborty & MJ Jayalakshmi: Indian
J TB 1978, 25, 83-91. |
Out of 56,146 persons without BCG scar examined
at the first survey in 119 villages of Bangalore district (1961-63),
22,468 were subsequently examined 3 times over a period of five
years by tuberculin test, X-ray and sputum at intervals of 1½
years to 2 years. No organized anti-tuberculosis services were provided
in the study area. On the basis of tuberculin status and chest X-ray
interpretations, the population was classified into 6 sub groups
for the study of risk of sputum positive disease viz., Normal X-ray
(N), Inactive Tuberculosis (AB) & Probably Active
Tuberculosis (CD) and each of these into tuberculin positives
and negatives.
The annual incidence of sputum positive disease
observed was 1.45 per thousand among 18,207 eligible persons aged
5 years and more. The incidence of the disease in tuberculin
positive group was 7 times as compared to that among tuberculin
negatives. The incidence rate of bacteriological disease was 0.79
per thousand among X-ray normals (N) of the first survey; it was
3.73 per thousand among persons with inactive tuberculous lesion
and non- tuberculous shadows (AB) and 26.04 per thousand among the
group of persons with active or probably tuberculous shadows (CD).
Of the total incidence cases, 76% were contributed by the tuberculin
positives. The group of active or probably active shadows (CD) contributed
26.6% of the total new cases. The population without any radiological
abnormality (N) contributed 48.2% of the new cases.
|
KEY WORDS: INCIDENCE, SPUTUM POSITIVE CASE,
RURAL POPULATION, EPIDEMIOLOGICAL GROUPS, LONGITUDINAL SURVEY |
037 |
PREVALENCE AND INCIDENCE OF SPUTUM NEGATIVE ACTIVE
PULMONARY TUBERCULOSIS AND FATE OF PULMONARY RADIOLOGICAL ABNORMALITIES
FOUND IN A RURAL POPULATION |
GD Gothi, AK Chakraborty, VV Krishnamurthy & GC
Banerjee: Indian J TB 1978, 25, 122-31. |
A study was carried out mainly to find out the
prevalence and incidence of sputum negative active pulmonary tuberculosis
(suspect cases) among 35,876 persons aged 5 years and above in rural
areas of Bangalore district during 1968-72. Two surveys (I &
II) at an interval of 3 months, succeeded by a follow up examination
of the X-ray abnormals of the earlier surveys, were conducted in
the same villages. Examinations at each survey consisted of tuberculin
test, X-ray and sputum examinations. X-rays were interpreted individually
at the time of each survey by single picture interpretation method
and subsequently by Joint Parallel Reading (JPR) method to
arrive to a diagnosis. In the JPR method X-ray readings and their
comparison was done by a panel of three X-ray readers with full
knowledge of age, sex, result of sputum examination and tuberculin
test of each person with chest abnormality at any of the three surveys.
On a single picture interpretation the overall
prevalence rate of suspect disease was found to be 5.4 per thousand
at I survey and 4.59 per thousand at II survey. There was no significant
difference in the overall age and sex specific prevalence rates
of suspect disease between I & II surveys. Incidence of suspect
disease at the end of 3 months was 2.24 per thousand. By JPR method
the prevalence rates of suspect disease was 3.2 per thousand at
I survey and 3.6 per thousand at II survey. The prevalence rates
by single picture method were overestimated to the extent of 38%
at I survey and 19% at II survey when compared with those found
by JPR method. At I survey prevalence rates on JPR method was significantly
lower than by single picture method. This was not so at II survey.
Similarly, incidence rate of 0.2 per thousand of suspect disease
on JPR was about 1/10th of that found by single picture method.
The incidence of bacteriologically positive cases
in 6 months from among suspect cases on JPR was found to be 28%.
Majority (76%) of non-tuberculous or inactive tuberculous shadows
continued to remain as such after 6 months and about a quarter (23%)
became normal. Incidence of bacteriologically positive cases from
this group was minimal. Of 19,640 persons with normal X-rays 134
(0.7%) developed new shadows in 3 months; 103 (0.5%) cleared after
2-12 weeks (fleeting shadows). Mis-interpretation of the latter
as active tuberculous may falsely boost the estimates of suspect
disease to the extent of about 5%.
|
KEY WORDS: SUSPECT CASE, PREVALENCE, INCIDENCE,
RURAL POPULATION, FATE. |
038 |
A COMPARISON OF NEW CASES (INCIDENCE CASES) WHO
HAD COME FROM DIFFERENT EPIDEMIOLOGICAL GROUPS IN THE POPULATION |
VV Krishnamurthy, SS Nair & GD Gothi: Indian
J TB 1978, 25, 144-46. |
In a five year epidemiological survey conducted
by National Tuberculosis Institute (NTI) from 1961 to 1968, the
population was mainly classified into three epidemiological groups
(i) with no radiological abnormalities seen in the lungs (Group
N) (ii) having X-ray shadows of non-tuberculous etiology or tuberculosis
etiology but judged as inactive (Group M) and (iii) with shadows
of tuberculosis etiology judged possibly or definitely active but
negative on culture (Group S). The objective of this paper is to
compare the characteristics of cases coming from the above three
groups (N, M and S) in respect to bacillary disease status (a) at
the time of diagnosis and (b) after a lapse of time (Fate). Out
of the total 172 new cases diagnosed during three follow ups, 70
were diagnosed between I & II surveys, 40 between II and III
and 62 between III-IV surveys. In the two 18 months follow up periods,
45 of the total new cases had come from Group N, 31 cases from Group
M and 34 cases from Group S, corresponding figures for 24 months
follow up (III & IV surveys) were 26, 26 and 10 respectively.
In the 18 months follow up it was observed that
proportion of new cases positive on culture in the three groups
were not significantly different. Comparison of fate of cases coming
from three groups were similar in terms of cure, death and culture
positivity. The findings point out clearly that not only development
of disease but also the fate of cases is independent of pre diagnosis
status of the new cases.
From all the 3 groups, disease developed more rapidly
in some cases than in others. This reveals that tuberculosis cases
are not an uniform entity from the point of view of development
of the disease and cure.
|
KEY WORDS: INCIDENCE, CASE, EPIDEMIOLOGICAL
GROUPS, 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.
|
KEY WORDS: MORTALITY, RURAL POPULATION, LONGITUDINAL
SURVEY. |
040 |
INCIDENCE OF PULMONARY TUBERCULOSIS AND CHANGE IN
BACTERIOLOGICAL STATUS OF CASES AT SHORTER INTERVALS |
GD Gothi, AK Chakraborty, K Parthasarathy & VV
Krishnamurthy: Indian J Med Res 1978, 68, 564-74. |
The incidence rates of sputum positive pulmonary
tuberculosis (cases) from the five year follow ups of a rural population
done by National Tuberculosis Institute were reported on the basis
of studies at intervals of one and a half to two years. Information
on fate of cases was also likewise reported. These parameters appear
to be imprecise since incidence and fate of cases at shorter intervals
were not taken into account. Thus, the information on incidence
of pulmonary tuberculosis in India is meager as compared to that
on prevalence of disease. Therefore, a study mainly to find out
the incidence and fate of cases at shorter intervals of 3-6 months
was undertaken in 87 randomly selected villages of Nelamangala sub-division,
Bangalore district which was one of the 3 sub-divisions where repeated
epidemiological surveys had been conducted between 1961-68. The
sample of villages in the present investigation was other than that
included in the earlier report. Organized Case-finding, anti-tuberculosis
treatment and BCG vaccination neither existed nor could be provided
in the area till the completion of the study. The present study
was conducted between 1968-1972.
This study conducted among 30,576 persons has shown
that incidence of cases over a period of three months was 0.99 per
thousand and was not much different from the annual rate of 1.03
per thousand reported on the basis of repeated surveys at longer
intervals. That the three months rates were not a quarter of the
annual rates meant that the procedure of calculating incidence rates
on the basis of surveys done at varying intervals after adjusting
for the interval had to be used with great caution. The study of
fate of cases showed that cases converted or reverted even at shorter
intervals and this appeared to be going on continually in the community.
However, incidence of cases and cure and death from among the existing
as well as the fresh cases kept on balancing each other so that
the prevalence rates of cases studied at shorter or at longer intervals
did not show variations.
|
KEY WORDS: INCIDENCE, FATE, CASE, RURAL POPULATION,
SURVEY, SHORTER INTERVALS |
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. |
057 |
INCIDENCE OF TUBERCULOSIS INFECTION IN A SOUTH INDIAN
VILLAGE WITH A SINGLE SPUTUM POSITIVE CASE: AN EPIDEMIOLOGICAL CASE
STUDY |
MS Krishna Murthy, R Channabasavaiah, AV Nagaraj &
P Chandrasekhar: Indian J TB 1991, 38, 123-30. |
During a longitudinal survey, carried out in 119
randomly selected villages of Bangalore district for studying the
time trend of tuberculosis, the average infectivity of a case over
a period of one and a half years was found to be six. In 1986 i.e.,
25 years after the start of I survey, 61 persons belonging to one
village called Nunnur who were found newly infected between I &
II surveys, were interviewed. Further, a general study of the layout
of the houses and public facilities in the village was made. However,
in Nunnur, there was just a single bacteriological case (index case)
identified at the I survey. This index case was resident of household
numbered 80 in the main village. This case study investigates the
background of the observed high infectivity. The incidence rate
of infection in Nunnur was 9.5% in 1½ years which is higher
than the overall average rate of 4% as well as rate for 30 other
single case villages i.e., 3.5%. The investigation reveals that
at least 21 persons., found newly infected at II survey, had varying
levels of contact with the index case. The remaining 40 infected
persons could not be linked, either directly or indirectly, to any
other known bacteriological case including the index case in the
village. All the persons identified as infected at II survey were
distributed throughout the village, beyond the likely zone of infection
of the index case.
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KEY WORDS: SINGLE CASE STUDY, INFECTIVITY, INCIDENCE,
INFECTION, RURAL POPULATION. |
061 |
WANING OF BCG SCAR AND ITS IMPLICATIONS |
R Channabasavaiah, V Murali Mohan, HV Suryanarayana,
MS Krishna Murthy, & AN Shashidhara: Indian J TB 1993, 40,
137-44. |
It has been postulated that BCG scar disappears
in a good number of children and some of the vaccinated children
will get included in the non- vaccinated group and cause difficulty
in interpreting the results of tuberculin test. It was decided to
analyse information on BCG scar status in the younger population
of a rural community in 3 taluks of Bangalore district with an objective
to find out whether disappearance of BCG scar is dependent on the
age of the child, size of post-vaccination induration at initial
survey and tuberculin sensitivity status of children in whom BCG
scar has disappeared, in comparison with children in whom the BCG
scar has not disappeared. In all, 1095 children aged 0 to 14 years
were found with BCG scar in 119 randomly selected villages during
an epidemiological survey done in 1961 at the time of intake. Following
two groups of children were studied for disappearance of the scar.
Of them, a) 796 children who had BCG scar at the first survey, and
whose BCG scar status was available at 4th survey, b) 299 who showed
no BCG scar at first survey but were found with BCG scar at 2nd
survey and whose BCG scar status was available at 4th survey.
Of the BCG scars recorded at intake, 26.4% and
32.5% disappeared subsequently during three and a half and five
year periods respectively. The waning of BCG scars was independent
of age of the child and tuberculin sensitivity status at intake.
Tuberculin sensitivity status in children in whom scar had disappeared
was the same as that found in children in whom scar had persisted
at intake and after five years. The misclassification of children,
in whom scars have disappeared, as unvaccinated leads to a difficulty
in interpreting the results of tuberculin test done for the purpose
of computation of the Annual Risk of Infection. Further,
the extent of misclassification increases in proportion with the
increase in BCG coverage of the population. This finding justifies
the practice of identifying the demarcation level on the basis of
the distribution of tuberculin induration sizes for classifying
the infected persons in a population in each survey.
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KEY WORDS: BCG SCAR, WANING, RURAL POPULATION,
RISK OF INFECTION. |
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