National

Tuberculosis

Control

Programme

Objectives:-The objectives of NTCP are as follows:

1) To deal with the problem of tuberculosis through integrated health services.

2) To give priority to the reduction of pool of infection, to case detection, treatment of cases and drug distribution.

3) To give BCG vaccination to susceptible.

In 1992 Govt. of India along with WHO & SIDA received the TB situation in the country & came up with following conclusions:

NTP though technically sound, suffered from managerial weakness.

Inadequate funding.

Over reliance on X-ray for diagnosis.

Frequent interrupted supply of drugs.

Low rate of treatment completion.

Objectives:

The objectives of RNTCP are:

Achievement of at least 85% cure rate of

infectious cases of tuberculosis; though

DOTS involving peripheral health

functionaries.

Augmentation of case finding activities

through quality sputum microscopy to

detect at least 70% of estimated cases.

ORGANIZATION:-

The profile of RNTCP in a state is as follows:

State Tuberculosis Office State Tuberculosis Officer

State Tuberculosis Training Director

& Demonstration Centre

District Tuberculosis Centre District Tuberculosis Officer

Tuberculosis Unit Medical Officer- TB Control

Senior Treatment Supervisor

Senior TB laboratory

supervisor

By the end of 1998, only 2% of total population of India was covered by RNTCP. Large scale implementation began in late 1998. The RNTCP has rapidly over the years and since March 2006, it covers the whole country.

DOTS strategy adopted by Revised National TB Control Programme.

DOT THERAPY

Direct Observed Treatment is WHO recommended strategy emphasizes for global T.B. control.

This strategy emphasizes adequate and efficient diagnosis and treatment.

It means short course chemotherapy given under direct observation to at least all identified smear positive T.B. cases.

Globally the DOT strategy has been recognized as the best approach to achieve a decrease in the disease burden and a reduction in the spread of infection.

BENEFITS:-

Dots more than doubles the accuracy of TB diagnosis.

Dots results in success rates upto 95%.

Dots prevent the spread of tuberculosis bacilli, thus reducing the incidence and prevalence of TB.

Dots helps in alleviating poverty by saving lives, reducing the duration of illness and presenting new infectious case.

Contd…

Dots improve the quality of care and overcomes stigma.

Dots prevents treatment failure and the emergence of MDR-TB by ensuring patient adherence and an un interrupted supply of Anti-TB drug.

Dots lends credence to TB control efforts.

Dots provides a model for strengthening health services.

Treatment under DOTS:-The WHO recommended treatment regimen for

DOTS short course chemotherapy. It is divided into two phases the intensive and continuation phase.

In intensive phase(2-3 months), each dose given thrice a week is administered under direct observation.

In the continuation phase(4-5 months), at least one of thrice a week doses is administered under direct observation.

The actual treatment regimen and duration depend on the category of treatment of patient.

Category of Treatment Type of Patient

Regimen

Categry-1New sputum smear positive.Seriously ill sputum smear negativeSeriously ill extrapulmonary

2(HRZES)3

4(HR)3

Category-2

Previously treatedSputum smear +ve relapseSputum smear –ve failureSputum smear+ve treatedAfter default

2(HRZES)3/1(HRZE)3/5(HRE)3

Category-3

New sputum smear –ve not seriously ill extrapulmonaryNot seriously ill.

2(HRZ)3/4(HR)3

ROLE OF NURSE IN CARE OF T.B. PATIENTTuberculosis is a social problem. A T.B.

patient and family are very sensitive and

do not wish their neighbours to know

about the presence of T.B. in the family.

T.B. is a chronic long lasting disease,

hence most of the cases are treated at

home. A nurse must keep in mind the

principles of home visiting and priortising

the case selection and care of the patient

at home.

• Motivate the patient to take regular treatment, when the patient defaults in taking drugs, a visit must be paid and repeated till the patient becomes regular

• In case of newly diagnosed patients, visit the home for initial motivation, instituting procedures designed to care for the patient and to prevent the spread of infection.

• Frequent visit to the patients to ensure the proper disposal of sputum and precautions regarding protection of other members.

Contact Examination:-

• All household contact must be advised for

screening for exposure by the X-ray chest, sputum

test and Mantaux test.

• If the members do not show any infection,

they can be given BCG and those who show early

sign of infection, may be treated by small dose of

Isoniazid(INH) and thiacetazone etc.

BIBLIOGRAPHY:-

1. Park.K, “Parks Text Book of preventive and social medicine”, 22nd edition,Banarsidas bganotPublishers,(M.p.) India, Pp-394-400

2. Gulani K.K , “Community Health Nursing”, 2nd

edition,Kumar Publishing Home,Delhi,Pp-673-683.

3. Swarnkar Keshab , “Community Health Nursing, 2nd

edtion, N.R. Publishers, Pp-612-615.

4. www.tbcindia.com