THE REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
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.
AIMS OF THE REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
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]
Hemoptysis
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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