Guide : DR. DATTATRAYA.D.BANT

MD.DNB.PGDHHM.

PROFESSOR & HOD OF P&SM DEPT.

PROJECT BY 1st BATCH ABHINAV KUMAR

ABHISHEK G N

ACHYUTH A SHIVPUR

AJAY S S

AKASH M V

ALOK B B

PRESENTED BY

ABHISHEK G NMBBS III/I

INTRODUCTION

TUBERCULOSIS is one of the ancient diseases.

Chronic infectious disease.

CAUSATIVE ORGANISM-Mycobacterium tuberculosis

Mainly affects the lungs-Pulmonary tuberculosis

Can also affect intestine ,meninges ,bones & joints,lymph glands,skin & other tissues-ExtrapulmonaryTB

Burden of the disease TB remains a worldwide public health problem and

one the most challenging communicable disease to be controlled and prevented.

India is the country with highest burden

in the world & accounts for nearly

1/5th of the global burden.

India20%

China14%

Indonesia6%

Nigeria5%

South Africa5%

Bangladesh4%

Pakistan3%

Ethiopia3%

Philippines3%

Other 13 HBCs16%

Non-HBCs20%

The NTP has been in operation since 1962.

In 1992, The govt of India, WHO and the World bank reviewed NTP and introduced RNTCP. RNTCP is one of the largest public health programmes in the world.

Evaluation of RNTCP is very much essential to know the outcome of treatment ,statistics of tb detected & treated-mainly HIV associated & drug resistant cases , reasons for interruption , to assess the effectiveness of the program

and educating public about the importance of RNTCP.

•85% cure rate through DOTS

•97% of the population coveredPhase I(1998-2005)

•To decrease the morbidity & mortality due to TB & to cut the transmission

•DOTS plus (CAT IV drugs) included to treat MDR & XDR TBPhase II(2006-2011)

•Early detection & treatment HIV associated TB , MDR & XDR TB casesPhase III(2012-2015)

Aims and objectivesTo assess the treatment outcomes of RNTCP in Dharwad

district in 2010 & 2011.

To identify gaps and underlying contributing factors.

To explore the reasons for interruption of treatment.

To assess the effectiveness of the management.

Materials & methodsPlace: District Tuberculosis centre(Hubli), Dharwad

district, Old Hubli.

Duration: 6\6\2012 – 5\7\2012

Sample Size & Population: Recorded cases registered during the period of 2010 and 2011 in the whole Dharwad district & patient feedback of about 50 patients

Type of Study: combination of record based study and observational study

Statistics: The data collected from questionnaire was entered and analysis was done in SSPS version 20 statistical software.

Inclusion criteria:

All TB cases recorded under RNTCP in

Dharwad district during January 2010 to December 2011 for record analysis.

Observational study from KIMS, Old Hubli & Dharwad civil hospital.

Performance indicators for Dharwad, National, State (Karnataka) data were collected from the website www.tbcindia.org.

Incidence, trends of case detection, treatment outcomes, cure rate and success rate,etc was analyzed.

Exclusion Criteria:

TB patients who have not been registered under DOTS treatment..

DISCUSSION2010 1st

half2010 2nd

half2011 1st

half2011 2nd

half

17.88 lakh

17.88 lakh

18.07 lakh

18.07 lakh

6543 8009 7263 8610

757(11.6%)

743(9.27%)

751(10.34%)

742(8.65%)

541(71.47%)

544(73.21%)

540(71.9%)

542(73.05%)

Total population

Smear examined

Smear positive

Treatment

The numbers of sputum smears examined are increasing every year suggesting that the efficiency of RNTCP is increasing .

Of the remaining: < 5% on Non DOTS , an average of 6.3% are initial defaulters

NSP cases are more common among the economically productive age group, i.e.15-44 yrs, more so in 35-44 age group.

It is least common among 0-14 age group ,i.e. around 1%.

0

10

20

30

40

50

60

70

2010 1st half 2010 2nd half 2011 1st half 2011 2nd half

Male

Female

62.75 62.7959.55

36.74

37.25 37.21 40.45

63.26

Per

cen

tage

Incidence of NSP tuberculosis is more among males than in females in both the years.

Conversion rate

84

84.5

85

85.5

86

86.5

87

87.5

88

88.5

89

2010 1st half 2010 2nd half 2011 1 st half 2011 2nd half

85.64

88.39

86.73

85.55

Sputum conversion rate among NSP should be >90%, but it is less in Dharwad district in both the years.

Per

cen

tage

Success rate

75.00%

76.00%

77.00%

78.00%

79.00%

80.00%

81.00%

82.00%

83.00%

2010 1st half 2010 2nd half 2011 1st half 2011 2nd half

Success rate

77.89

81.87

78.32

81.48

Cure rate for NSP should be >85%, this target has not been achieved in both the years in Dharwad district.

Per

cen

tage

Cure rates

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2010 Jan-June 2010 July-Dec 2011 Jan-June 2011July-Dec

Hubli

Dharwad

Kundgol

Kalghatgi

Cure rate is highest in Kalghatgi TU & least in Kundgol TU.Dharwad and Hubli TUs are showing consistent cure rates in both the years

Per

cen

tage

Death rate

0

2

4

6

8

10

12

14

16

2010 1st 2010 2nd 2011 1st 2011 2nd

Hubli

Dharwad

Kundhgol

Kalgatagi

Hubli TU had the highest death rate in 2011.Kalghatagi TU showed the lowest value in 2011.Dharwad TU and Kundgol TU are showing varying trends.

Per

cen

tage

Cure rates

70.00%

72.00%

74.00%

76.00%

78.00%

80.00%

82.00%

84.00%

86.00%

88.00%

2004 2005 2006 2007 2008 2009 2010 2011

DHARWAD

KARNATAKA

INDIA

Dharwad is having cure rate less than state performance.Karnataka has lesser cure rate than national sputum conversion rate.The cure rates have increased in 2011 when compared to 2010 in district and stateand also in the country.

Per

cen

tage

Questionnaire results

Female -32%

Male - 68%

There are more number of TB cases among males than in females, this may be due to more contacts among males during work hours and less personal hygiene among themMales are more exposed to environmental pollutants than females

0

2

4

6

8

10

12

14

16

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-50 years

61-70 years

71-80 years

Female

Male11

5

5

11

11

6

1 1

8

45

Tuberculosis is more among 21-30 years of age , this group contains the people who are working, students and etc where risk of contact transmission from person to person is more.These age groups are to be protected by proper health education about personal hygiene and immunization for prevention of TB.

No

. of

pat

ien

ts

Age in years

32% of cases are found to be unskilled workers & unfortunately the other 34% are students, 16% being housewives & 14% are skilled workers.

78% belongs to low socioeconomic status & remaining 22 % to middle SES.

Vaccination coverage rate is less than 75% in this area.

Among total cases in the age group 0-10 years 50% were found to be vaccinated

Cough and evening rise of temperatures are the chief complaints of the patients approached.

Around 78% of patients have these complaints.

14% of the cases have contact history .

12% of the contacts of the patients have symptoms.

34% dispose sputum in bathroom or basin,16% into the spit box ,26% on open ground and cover with sand & remaining 24% do not use any definitive methods..

20 of 34 male patients & 9 out of 16 female patients are aware that TB is a communicable disease.

About 14% of the cases have h/o similar treatment with anti TB drugs in the past and are now under

CAT II as defaulters.

84% patients are under CAT I, remaining 16% are in CAT II (14% of default & 2% as relapse case).

88% patients are regular in treatment ,

6% interrupted due to side effects of drugs &

6% were unable to follow up.

Importantly 4% i.e, 2 cases have HIV associated TB.

88% patients find that response from RNTCP unit is good , 10% are satisfied & 2% found it unsatisfactory.

All the patients are provided with the drugs on every visit regularly & observed while taking drugs by the DOTS provider.

ConclusionRNTCP program implemented successfully in

Dharwad district according to the guidelines.

Though conversion rates & cure rates are less in district than that of the state& national rates , there is a gradual increase in the performance indicators since then.

The programme is working efficiently acc to the patient feedback.

But there are interruptions in treatment due to side effects & improper follow up .

LIMITATIONS Lack of time

TB cases treated at private hospitals and clinics have not been included in the records.

Some data like Cross-referrals between RNTCP and ICTC was not provided.

Lack of availability of records of MDR & XDR cases.

RecommendationsPeriodic training & monitoring of all lab technicians &

DOTS provider.

Ensure that all the registered patients are started on treatment & regularly followed up.

Early detection & treatment of HIV associated TB & MDR-TB,XDR & TDR TB patients.

All the supervisory staff like DTO, STS need to strengthen their supervisory activities.

Strengthening the evaluation program.