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i) |
The state health authorities (State
TB Officer) and the district health authorities including Deputy
Commissioner shall be informed in advance about the purpose of the
survey and the time period when it has to be conducted. Their necessary
co-operation will be sought by NTI/ collaborating agency much in
advance of the fieldwork. |
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ii) |
The team will camp at the accommodation arranged
by the district health office/ rented accommodation at district
headquarters for the period of study in that particular district.
The team supervisor shall arrange this accommodation with assistance
from the state health supervisor. |
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iii) |
The supervisors from NTI/any other collaborating
agency shall make a planning visit well in advance of the initiation
of the survey to make necessary arrangements including accommodation,
identification of clusters, hiring of vehicles, storage o f tuberculin,
eliciting necessary support from the local health authorities, etc.
They shall also brief the DHO, DTO and other relevant officials
about the survey during their visit. |
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iv) |
The selection of clusters in each district shall be done by Stastitical
Section of NTI. The list of selected clusters shall be provided to
the Team Supervisor. |
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v) |
To ascertain the location of clusters, the planning
team is to seek help from the District Health Authorities. The District
Health Authorities shall be requested by NTI/collaborating agency
to obtain a district census handbook from the local census office
and also the census map of the district for easy location of the
cluster. |
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vi) |
The planning team shall visit the selected cluster
and contact the village heads or some responsible person of the
village and brief them about the purpose of the survey. The team
shall elicit their cooperation for smooth conduct of the study and
inform them about the date and time of the testing schedule. The
planning sheet (NSS form-1) shall be filled up as per the columns
given (self-explanatory). |
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vii) |
Selection of starting point for registration:
During the planning visit to the cluster, a rough map of the village
and hamlet is to be drawn with the help of the village leaders.
All the lanes of the main village and the hamlets will be numbered
serially and it should be shown on the map. The numbering of lanes
is to be done in a clockwise direction. |
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A two-stage selection of the starting point will be
done using random number table:- |
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In the first stage, it will be decided whether
to start the survey from the main village or the hamlets. |
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In the second stage, the starting lane shall
be selected. |
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The lane number selected shall be indicated
on the planning sheet and the random number table to be maintained
by the Team Supervisor. This information is to be passed on to the
registration and testing team. |
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The first household at the north west end of the selected
lane shall be the starting point for registration. The registration
shall continue into the next higher serially numbered lanes. |
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REGISTRATION
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i) |
The registration team is to commence work from
the first household selected earlier by the planning team. All the
households in that lane are to be numbered serially, with a permanent
marker, the start house being given the No.001. The households are
numbered irrespective of the presence of eligible children for the
survey. In case of more than one household in a single building,
the households shall be numbered as for e.g., 001/A, 001/B, and
so on. The registration team shall move to the adjacent household
and so on till the last household of the lane. Thereafter, it shall
move to the lane with the next higher serial numberand cover the
households similarly. |
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ii) |
Filling of NSS form 2 : The household number
and the lane number will be entered in Column No.1 of NSS form-2
irrespective of the presence or absence of children aged 1-9 years.
In each household, enquiry shall be made about the presence of children
aged 1-9 years from the head of the family or some responsible person.
In case, an eligible child belongs to the household, other details
in the row shall be filled in. The particulars of another eligible
child in the household shall be entered in the subsequent rows and
so on. Nil entry shall be marked in case there is no child in this
age group in the household. Care must be taken to estimate age as
correctly as possible by talking to the parents/guardians relating
with important events in the family and by personal assessment.
In case of doubt verify from available documents. Only the children
in this age group shall be registered and included in the study.
The date of birth eligibility shall be pre-entered at the top of
the form by the Supervisor. For e.g., if a cluster is being surveyed
on 31.10.1999, all children born between 1.11.1989 and 31.10.1998
shall be registered. The name, age, sex, and the Child No. of the
children available for testing is to be entered in the relevant
columns of NSS form 2. |
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The registration team shall enquire about the
residential status of each child in the household. Only permanent
residents (children living in the cluster for more than 6 months)
shall be registered and included in the study. |
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Each available child (permanent resident) shall
be registered in the individual child card (NSS form-3). The child
cards are issued only for the eligible children who are available
at the time of registration or likely to be available in the day.
The remarks column of NSS form 2 would contain information on the
reasons of the absence of any child from the house. |
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iii) |
The enumerator shall fill columns 1 to 8 of
NSS form-3 at the time of registration as per the instructions given
below: |
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iv) |
The registration team is expected to visit adequate
number of households in order to register 85 children. In the event
of non-availability of 85 children in the entire cluster including
hamlets, the registration is to continue in the geographically adjacent
cluster on the same day till the requisite numbers are registered.
On collecting sufficient number of children, one of the members
of the census team shall guide the children to the testing centre
and shall give the registration cards to the tester-secretary. |
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v) |
At the time of registration, parents/guardians
of each child shall be requested to see that the child remains available
on the date of reading.
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(i) |
A central place under a shade shall be set
up for tuberculin testing. |
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(ii) |
Written consent : At the testing
center, the procedure for the test, its side effects and the purpose
of the test shall be explained to the parent/guardian. The written
consent for participation in the survey shall be obtained in the
consent form designed by the Ethical Committee. Only in case of
non-availability of either of the parent at the time of survey,
the written consent shall be obtained from any responsible person
of that household. |
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(iii) |
BCG scar examination : The child shall be examined by Tester-Secretary
on the upper third of both the arms for presence/absence of BCG scar
which is a pea-sized (2 to 3mm) hypo-pigmented shiny lesion raised
above the skin and the finding shall be entered in the relevant box. |
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(iv) |
Injection of tuberculin : The child is to be
injected intradermally on the mid volar aspect of the left forearm
by the tuberculin tester, with 1TU of PPD RT23 with Tween 80 using
a disposable 1 ml tuberculin syringe to which a needle of 26½
gauge and half an inch bevel is attached. The procedure should be
in accordance to that outlined in the testing manual. Injection
of each test shall be observed by the tester-secretary and the testing
status shall be marked as mentioned below: |
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(v) |
Testing status : S ( satisfactory): A satisfactory
test should give rise to a hypo-pigmented weal about 5 to 6 mm above
the skin level with pits and clear hair follicles. The tests should
be strictly intradermal and without any leakage of tuberculin. U
(unsatisfactory): The test is given subcutaneously / leakage of
tuberculin / non-formation of the weal as described above. |
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(vi) |
The columns 9 to 12 of NSS-3 shall be filled
by the tester-secretary as per the instructions given below: |
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(vii) |
At the end of the day, all forms and cards shall
be checked once again by the testing team for correctness and completeness
of all entries before leaving the place.
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TUBERCULIN READING
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(i) |
Reading shall normally be done after 3 days
(72 hours) of testing but can be undertaken after 2 days (48 hours)
or 4 days (96 hours) only in case of exigencies. In each cluster,
a minimum of 2 rounds (house to house visits) shall be made in order
to attain at least 80% reading coverage of the registered children
on a single day. |
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(ii) |
On the day of reading before proceeding to the
field, the reader shall collect all the child cards (NSS-3), which
are due for reading in that cluster. The reading team shall go house
to house carrying with them the NSS forms 1 and 3 (filled earlier)
for the tested children. After verifying the identity of the tested
children, the reader is to locate the tested spot and by slowly
palpating the edges of the reactions, the maximum transverse diameter
of the induration is to be measured by a transparent mm scale after
delineating the edges of the induration with a ball pen and dictate
the reaction size to the reader-secretary. It may be noted that
the reading is limited to induration only and transverse diameter
to be measured is relative to the forearm. The induration may vary
from a well-circumscribed density in the skin to a soft ill-defined
swelling. In order to avoid the influence of inter-reader variation
on survey results, the readings in a particular district shall be
performed by the same trained reader. |
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(iii) |
The reader-secretary shall fill columns 13 to
16 of NSS form 3 as per the instructions given below: |
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(iv) |
All the children suspicious of suffering from
tuberculosis shall be issued a referral slip (NSS form 4) with the
advice to consult the medical officer incharge of the nearest Government
Health Centre for further investigations and treatment if required.
DHOs would be requested in advance to issue a circular to PHIs in
this respect. All the cards and forms at the end of the day shall
be re-examined for correctness and completeness. |
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(v) |
The entries made in column 4, 7, 8, 9, 11, 12,
15 and 16 of NSS form 3 shall be transferred to NSS form 5 for duplicate
entries by one of the Field Investigators. The Team Leader shall
crosscheck the transferred entries. These duplicate entries are
a safeguard against loss of data during transit.
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TRANSPORT
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The Team Leader with the support
of local health personnel shall hire a suitable vehicle with a capacity
of 10 for all the days of the field work. On any working day, the
vehicle shall first drop the registration and testing teams, then
the reading team and take the planning team to the planning village
and follow the reverse order on return.
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QUALITY CONTROL
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i) |
The quality control of tuberculin testing shall
be performed by direct observation of the tests given by field workers.
The Supervisors from NTI and other Collaborating Institutions shall
do this observation. The proportion of unsatisfactory tests shall
not be allowed to exceed 2-3%. |
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ii) |
For quality control of reading of the reactions,
5% of the reaction sizes shall be read independently by these Supervisors.
Their readings are to be recorded in a separate sheet for ensuring
internal quality control (NSS form 5). Corrective actions shall
be undertaken as and when required. |
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iii) |
The quality control of data entry shall be undertaken
by scrutiny of the day's work including individual entries in child
cards at the end of each day's work. |
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iv) |
The data shall again be rechecked at NTI and
in case of gross discrepancies from any clusters, appropriate number
of new clusters shall be selected from that district to complete
the required number of clusters from the district. |
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