The Indian National Flag fluttering in the breeze                   This website intends to educate general practitioners and physicians who care for adult Tuberculosis patients, about the RNTCP Programme and its many benefits. It is a  website created by Dr.Anilkumar of the District TB Center, Alappuzha and does not purport to be anything other than an informal introduction to the investigation, diagnosis and treatment of tuberculosis employing the RNTCP programme. We have drawn extensively from the excellent training modules released by the Central TB Division, New Delhi. We have tried to avoid heavy-duty medical verbiage as far as possible, and the style is intentionally conversational and relaxed [ see an irreverent account of the bacillus if you don't believe us !].We do not intend to cover the waterfront in describing the  RNTCP. Broad strokes is very much our motto.

Magnitude of the problem
3 million people die from tuberculosis each year - the majority in developing countries. The annual incidence of all forms of tuberculosis is estimated to be approximately 8 million, of which about 95% occur in developing countries. Tuberculosis kills more adults in India than any other infectious disease. More than 1000 people a day- one every minute- die of TB in our country. In India more than 40% of adults are infected with TB, and approximately 1.5 million cases are put on treatment every year.  It is difficult to wrap our minds around such astronomical figures as 3 million, because our minds cannot really comprehend or grok at numbers more than a few thousand . But do understand that in our country, TB is spiraling out of control and that you can contribute to the eradication of this dreaded disease, which gnaws at the vitals of our nation.

Where do you come in?
Are you a general practitioner who routinely refers patients you suspect of having tuberculosis to specialists, unsure whether you should be handling such "risky" cases? Or perhaps you are that physician who takes in the referred cases and is wondering why you should change the way you treat patients with tuberculosis, especially since what you are currently following seems to be working. We intend to answer these questions and also to tell you where to "plug in" the RNTCP programme to your daily diagnostic algorithm for cough of long duration. It is our wish that we help you integrate RNTCP seamlessly into your daily practice.

In developing countries like India, the fight against tuberculosis can be successfully carried out only within the setting of a National Tuberculosis Programme. This programme is part of the country's general health services. The primary aim of the RNTCP is to achieve a high cure rate of New sputum smear-positive patients, thereby interrupting the chain of transmission. The target cure rate is at least 85%. The only effective means by which 85% cure rate has been shown to be achievable on a programme basis is by application of DOTS [Directly observed treatment, short course chemotherapy] strategy. DOTS is a systematic strategy which has five components.
 Political and administrative commitment
 Good quality diagnosis
 Good quality drugs
 Short course chemotherapy given in a programme of direct observation
 Systematic monitoring and accountability
Some of these components were missing in the earlier programme for the control of tuberculosis in India [The National Tuberculosis Control Programme] and this lead to its failure. It is estimated that only about 30% of the patients completed the daily regimen prescribed under the NTCP. This can potentially lead to the spread of resistant strains of Tuberculosis in the community.

Identification of TB suspects
 The symptoms of Tuberculosis in adult patients include:
 Cough of  3 weeks duration or more [the most common symptom]
 fever, particularly with rise of temperature in the evening
 weight loss, tiredness, night sweats, loss of appetite
 chest pain, shortness of breath etc

Of these, without a doubt, the most common presenting symptom is that of a persistent cough for 3 weeks or more usually with expectoration. All persons who have this symptom should have their sputum examined as soon as possible. Usually 2-3% of adult outpatients in general OPD have cough for 3 weeks or more.
Symptoms of extrapulmonary tuberculosis depends on the organ affected. Patients who are suspected of having extrapulmonary tuberculosis TB, and patients who are contacts of sputum smear-positive cases, should have their sputum examined for AFB if they have any chest symptoms, regardless of the duration of these symptoms.

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