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TUBERCULIN TESTING IN THE COMMUNITY THROUGH GENERAL
HEALTH SERVICES IN PREPARATION FOR TUBERCULOSIS SURVEILLANCE - A STUDY
OF FEASIBILITY |
K Chaudhuri, MS Krishna Murthy, AN Shashidhara, R Channabasavaiah,
TR Sreenivas & AK Chakraborty: Indian J TB 1991, 38, 131-37. |
A study was conducted in 1983-84 by the National
TB Institute (NTI) in the districts of Dharmapuri (Tamil Nadu) &
Ananthapur (Andhra Pradesh). Thirteen health personnel were trained
in census taking, tuberculin testing & reading and data keeping
etc., at the NTI according to the standard methodology. The trainees
were repeatedly assessed and only those who achieved a reasonably
high inter-reader correlation with the standard reader were chosen
for the field work. Field work was carried out by these health workers
and supervised by the team leaders of NTI. Children between 0-9
years were tested with 1 TU RT 23 with Tween 80 in tuberculin testing
centres specially set up in each village and the reactions were
read between 48 & 72 hours after the test. The tuberculin testing/reading
coverage was very high. Of 6702 eligible children, 5904 (97%) were
tuberculin test read.
Individual reading assessment carried out at Ananthapur
and Dharmapuri for the State Field Workers (SFWs) showed that agreement
with Standard Reader (SR) of NTI at three induration levels i.e.,
10+ mm, 14+ mm and 18+ mm were very high. The demarcation line between
infected and uninfected appeared to be about 18 mm. In Ananthapur,
the agreement at 18+ mm was 99% and at Dharmapuri it was 100% for
SFW, and 98.4% for SFW-2. The estimates of prevalence rate of infection
were 9.3% - SFW V/s 9.7% - SR at Anantapur, 5.2% - SFW V/s 5.2%
- SR and 7.2% - SFW.2 V/s 7.2% - SR at Dharmapuri. The study further
showed that it was possible to train general health workers, within
a period of 3 months to attain a high level of efficiency. The general
health services can successfully organise on their own a programme
of tuberculin testing in the community with proper liaison and supervision
by some nodal agency. The training and field supervision responsibilities
may be shouldered initially by NTI or another suitable organisation,
till these nodal agencies come up.
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KEY WORDS: SURVEILLANCE, TUBERCULIN TEST, HEALTH
SERVICES, FEASIBILITY, COMMUNITY. |