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Tuberculosis
and It’s Control in
India and Uttarakhand
What is Tuberculosis?
An infectious disease caused by
Mycobacterium tuberculosis
Who discovered
the Tubercle bacilli?
Robert Koch
Acid
Fast
Bacilli
How TB spreads ?
Inhalation of
droplets
containing AFB in
air
Most common Symptom of
PT
Another Symptom of PT
Rise of
Temperature in
the evening
another Symptom of PT
What are the symptoms of PT?
Cough > 2 weeks
Loss of appetite
Loss of weight
Rise in temp. in the evening
Chest pain
Haemoptosis
India Accounts for Nearly One
Third of the Global TB Burden


India has more cases of
tuberculosis than any
other country in the world
& twice as many cases
as China
Although exact and
current information on TB
incidence and prevalence
is not available, studies
show an incidence rate of
more than 200 per lakh,
among the highest in the
world
China
15%
India
30%
Indonesia
10%
Bangladesh
4%
Russia
1%
South Africa
2%
Phillippines
3%
Pakistan Nigeria
4%
3%
Other
coutries
28%
TB - Disease Burden






> 40% of country’s population is infected
2 million new cases each year
450,000 deaths each year
> 5,000 people develop TB every day
> 1,000 people die every day
TB kills more women than all causes of
maternal mortality put together
All this despite TB being nearly 100% curable
TB is the leading single infectious
cause of death in India
Number of deaths (1000s)
450
400
350
Deaths from infectious
agents in India
300
250
200
150
100
50
0
TB
Measles
HIV
Source: World Health Report, 1999
Tetanus
STD
Tropical Malaria
Dis
How many die in India in
2 minutes due to TB?
Status of TB Control in India








1950s-60s: Important TB research(TRC/NTI)
1962: National TB Programme
1992: Programme Review- only a third of patients
diagnosed and only a third of those treated
successfully
1993: DOTS pilots (RNTCP)
1998: DOTS scale-up begins
2000: > 30% of country covered by DOTS
Beginning of 2002: almost 50% of country covered
by DOTS (460 million population)
2006 – Whole India covered by DOTS
Directly
Observed
Treatment
Short Course
RNTCP :
Revised
National
Tuberculosis
Control
Programme
1.To achieve 85 % Cure Rate
2. To diagnose 70 % of
estimated new Sp. Sm. Pos.
cases after achieving the
above.
Directly Observed Treatment,
Short-course (DOTS)

Political commitment
Diagnosis by
microscopy
 Adequate supply of
SCC drugs



Directly observed
treatment
Accountability
TB Register
How TB is diagnosed ?
By the examination of
Sputum for AFB
X-ray examination
What is the specific method for the
diagnosis of PT?
Advantages of Sputum
Microscopy
Simple
Less expensive
More reliable
Rapid
Take Home Messages
1. Anybody who is having Cough for more than 3
weeks with or without other symptoms should get
their sputum examined at the nearest Health
Facility
2. TB Diagnosis and treatment are available free of
cost in all the govt. hospitals
Fight against
TB
How many sputum samples are
examined for diagnosis?
CATEGORY I
New sp.pos.
 New sp.neg. but
seriously ill
 New extra-pulmonary
but seriously ill

CATEGORY II
Sm. pos. relapse
 Sm.pos. failure
 Sm.pos treatment
after default

CATEGORY-III
New sp.neg. not
seriously ill
 New extra-pulmonary
not seriously ill

Recommended treatment
regimens
TB
Alternative treatment regimens
treatment(if smear + at end of initial phase of Cat I or Cat II,
one more month of initial phase is given)
categor
Continuation Phase
Initial phase
y
I
2 HRZE(2 HRZS)
2 H3R3 Z3 E3 (2 H3R3 Z3 S3 )
6 HE
4 HR
4 H3R3
II
2 SHRZE/1 HRZE
(2 S3H3R3 Z3 E3/1 H3R3 Z3 E3 )
5 HRE
5 H3R3 E3
III
2 HRZ
2 H3R3 Z3
6 HE
4 HR
4 H3R3
Direct observation is recommended for all patients and is
particularly essential when intermittent regimens are
used
How many specimens are examined
follow up
examination?
during
During treatment, when do you examine
the sputum for Cat-I patients ?
Month 2
4
6
During treatment, when do
you examine sputum for Cat-II
patients ?
Month 3
5
8
During treatment, when do
you examine sputum for CatIII Patients?
Month
2
6
What is to be done when the
sp. sm. is pos. at the end of IP
?
IP to be continued
for one more
month.
What is to be done when the patients
default in the CP ?
Action to be taken
within a week of
default.
DOTS triples treatment success
in India
100
84%
80
60
40
25%
20
0
Non-DOTS
DOTS
Anti TB drugs are available
free of cost in all the govt.
hospitals.
Fight against
TB