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PROBLEMS OF TREATMENT OF TB PATIENTS IN RURAL AREAS |
GD Gothi & GVJ Baily: Indian J TB 1965, 12,
62-68. |
At present most of the districts in India have
a TB clinic at the district headquarters, where TB patients are
diagnosed and treated. Most of the clinics serve the town population
and only a small proportion of the rural population are able to
attend the clinics due to long distances. The wide distribution
of patients in rural areas will necessitate the provision of extensive
anti-tuberculosis services and they should be provided as near to
the patients' home as possible. This cannot be achieved by creating
large number of specialised services (TB clinics) in the district,
as this will not only be beyond the resources but wasteful. As such,
provision of anti-tuberculosis services in rural areas can
be achieved by integration of the primary health centres and dispensaries.
The problems of treatment in rural areas are envisaged as technical,
organizational and personnel. Under the technical problems,
the choice of anti-microbials is considered. The anti-microbials
should be effective, cheap and acceptable to the patients. INH PAS,
INH alone or INH Thiacetazone are considered suitable. Streptomycin
containing drug regimens are difficult for the health services to
deliver them to the patients in rural areas. Even with oral drugs
INH + PAS or INH alone, drug regularity are 26.3% and 24.6%. The
other technical limitation of treatment is the probability of increase
in drug resistance due to the wide application of drug treatment
which might be irregular. This has not been considered as enough
justification for withholding treatment to the vast majority of
patients, as its epidemiological and clinical significance in India
are yet to be fully understood. The District TB Programme provides
a firm organisational structure on the basis of which improvement
can constantly be introduced for smooth functioning, constant supervision,
proper orientation training and demonstration of the programme by
the District TB Centre if necessary.
The organisational problems listed are: irregularity
of drug intake and drug collection; their identification, default
at drug collection, intake and remedial action, maintenance of records,
check up while on treatment and follow up after completion of treatment.
The paper suggests that regular collection could be taken as an
index of regular drug intake. Defaulter actions could retrieve about
30% of the defaulters. Check up during treatment as well as follow
up after treatment were found to be not acceptable to the patients
due to a number of reasons. Training of staff to render services
is also one of the biggest hurdles. The remedial measures are stressing
tuberculosis as a community problem at the undergraduate and post
graduate levels, training of the staff at every level of the programme
and arrangement of seminars and group discussions with the administrators
and medical personnel.
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KEY WORDS: TREATMENT PROBLEMS, SELF ADMINISTERED
REGIMEN, SUPERVISED REGIMEN, RURAL COMMUNITY, CASE HOLDING, CONTROL
PROGRAMME. |