29 research outputs found
Influence of initial and repeated motivation on case holding in North Arcot district
Treatment default and premature
discontinuation of treatment continue to be
major c o n s t r a i n t s f o r t h e s u c c e s s f u l
implementation of the National Tuberculosis
programme. In order to assess the influence of
motivation in overcoming this problem and
improving patient compliance, a study was
conducted at three of the major centres,
namely District Tuberculosis Centre, Vellore,
and general hospitals at Gudiattam and
Vaniyambadi in Tamil Nadu. All new smear
positive patients initiated to treatment between
October, 1987 and April; 1989 were admitted to
the study. In all, 278 patients were motivated.
There was an increase in treatment completion
rate among patients who had motivation
initially. This was more evident in patients who
had repeated motivation
Immune response to Mycobacterium tuberculosis culture filtrate antigen in cured spinal tuberculosis patients and their spouses
Humoral and cell mediated immune responses were studied in cured spinal tuberculosis patients and their spouses to
understand immunit to tuberculosis in cured patients. Antibody litre and immune complex levels were measured and lymphocyte
response to Mycobaclerinm tuberculosis culture filtrate antigen was observed in cured spinal tuberculosis patients ( n = 3 0 ) and their
spouses (n =27). A trend towards increased antibody litre was seen in cured patients as compared to their spouses. Significantly
increased circulating immune complex levels, as measured by PEG OD280 (polyethylene glycol optical density 280) were seen in the
contacts compared to cured patients. And a trend towards increased lymphocyte response to Mtuberculosis culture filtrate antigen
was seen with different antigen concentrations (0.1,1 and 10 μg /ml). Moreover, the effect of active-pulmonary-Tuberculosis (AT B)
plasma taken from 1ILA-DR2 positive and DR2 negative patients on lymphocyte response of the cured patients showed no dramatic
immunomodulatory effect in the lymphocyte response when treated with DR2 positive or DR2 negative plasma. The study suggests
that the memory response lo Mtuberculosis is well maintained even after 10-15 years of treatment
Course of action taken by smear negative chest symptomatics: A report from a rural area in South India
Objective: To evaluate adherence to diagnostic algorithm of Revised National Tuberculosis Control Programme (RNTCP)
and course of action taken by smear-negative chest symptomatics (CSs).
Method: Interviewing smear-negative chest symptomatics.
Results: Of the 423 smear-negative CSs interviewed, 85 (20%) were not prescribed antibiotics and only 133 (39%)
received it for more than seven days. Of the 148 patients with persistence of symptoms, 83 (56%) returned for further
investigations and only 39% were X-rayed. Main reasons for not returning were: ‘not aware’ or ‘consulted another health
provider.’
Conclusion: Strict adherence to diagnostic algorithm and proper counselling of patients are important for diagnosing
smear-negative pulmonary tuberculosis (PTB) cases
Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB control programme in South India
Introduction: The demographic transition in India has resulted in an increase in the elderly population. There is limited data on the profile of elderly tuberculosis (TB) patients and their treatment outcomes in India. Objective: To compare the clinical profile, presentation and response to anti-TB treatment among elderly (≥60 yrs) and younger (15–59 yrs) TB patients treated under the Revised National TB Control programme. Methodology: Retrospective cohort analysis of TB patients treated from May 1999 to December 2004 in one Tuberculosis Unit of Tiruvallur district, South India. Results: Records of 865 elderly and 4343 younger TB patients were examined: elderly were more likely to be male (84% vs. 71%), smokers (46% vs.37%), illiterate (63% vs. 45%), identified by active case finding through survey (19% vs. 11%), have pulmonary TB (96% vs. 91%) and initial smear negative disease (46% vs. 36%) compared to younger (for all p<0.001). Among a total of 352 elderly and 1933 younger new smear positive pulmonary TB, the elderly had higher loss to follow-up (15% vs. 11%; p = 0.03) and death rates (9% vs. 4%; p<0.001). Mycobacterium tuberculosis susceptibility to first line anti-TB drugs did not differ (elderly 87% vs. younger 84%) (p = 0.20). Side effects related to anti-TB drugs were reported by a higher proportion of elderly patients (63% vs. 54%) (p = 0.005). Previously treated patients had similar treatment outcomes in both the groups. Conclusion: Elderly TB patients are less likely to have smear positive disease. Newly diagnosed elderly TB patients are more likely to be lost to follow-up or die and report drug side effects. Suitable interventions need to be developed for effective management and better treatment outcomes of TB in the elderly
Care Seeking Behavior of Chest Symptomatics: A Community Based Study Done in South India after the Implementation of the RNTCP
INTRODUCTION: With the creation of the Revised National TB Control Programme (RNTCP), tuberculosis services have become decentralized and more accessible. A 1997 study prior to RNTCP implementation reported that most chest symptomatics accessed first private health care facilities and a general dissatisfaction with government health facilities. The study was repeated post-RNTCP implementation to gain insight into the current care seeking behavior of chest symptomatics. METHODOLOGY: A cross-sectional community-based study carried out between March-August 2008 in 4 sites (2 rural [R] and 2 urban [U]) from the same two districts of Chennai and Madurai, southern India, as in the 1997 study. Six hundred and forty chest symptomatics were identified (R 314; U 326), and detailed interviews were done for 606 (R311; U295). RESULTS: Prevalence of chest symptomatics in the urban and rural areas were 2.7% and 4.9% respectively (p<0.01), and was found to increase with age (Chi-square for trend, p<0.01). Longer delays in seeking care were seen amongst symptomatics above 45 years of age (p 0.01), and those who had taken previous TB treatment (p=0.05). Overall, 50% (222/444) of the chest symptomatics approached a government health care facility first (R 142 (61%); U 80 (38%), p=or  <0.001). This was significantly (p<0.001) more than were observed in the 1997 study, where only 38.4% approached a government facility first. Sixty two (28%) of the 222 made a second visit to a government facility (R26%; U31%), while 17% shifted to a private facility (R14%; U21%). Dissatisfaction with the health care facility was one of the major reasons expressed. CONCLUSIONS: It appears that the RNTCP has had an impact in the community with regard to the availability and accessibility of TB services in government health facilities. However the relatively high levels of subsequent shifting to private health facilities calls for urgent action to make government facilities more patients friendly with quality care facilities in the delivery of RNTCP services
Alcohol Use Disorders (AUD) among Tuberculosis Patients: A Study from Chennai, South India
BACKGROUND: Alcohol Use Disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. Studies from Tuberculosis Research Centre (TRC), Chennai have reported that alcoholism has been one of the major reasons for default and mortality in under the DOTS programme in South India. Hence, it is planned to conduct a study to estimate prevalence of alcohol use and AUDs among TB patients attending the corporation health centres in Chennai, India. METHODOLOGY: This is a cross-sectional cohort study covering 10 corporation zones at Chennai and it included situational assessment followed by screening of TB patients by a WHO developed Alcohol Use Disorders Identification Test AUDIT scale. Four zones were randomly selected and all TB patients treated during July to September 2009 were screened with AUDIT scale for alcohol consumption. RESULTS: Out of 490 patients, 66% were males, 66% were 35 years and above, 57% were married, 58% were from the low monthly income group of <Rs 5000 per month. No females reported alcohol use. Overall, out of 490 TB pts, 29% (141) were found to consume alcohol. Among 141 current drinkers 52% (73) had an AUDIT score of >8. Age (>35 years), education (less educated), income (<Rs 5000 per month), marital status (separated/divorced) and treatment category (Category 2) were statistically significant for TB patients with alcohol use than those TB patients without alcohol use. CONCLUSIONS: AUD among TB patients needs to be addressed urgently and the findings suggest the importance of integrating alcohol treatment into TB care
Differentiation of highly prevalent IS6110 single-copy strains of Mycobacterium tuberculosis from a rural community in South India with an ongoing DOTS programme
We have prospectively analysed the DNA fingerprinting of Mycobacterium tuberculosis strains in a rural community from high prevalence
area in South India with an ongoing DOTS programme. Strains from 451 culture-positive cases, diagnosed during July 1999–December 2000,
were fingerprinted initially by both IS6110 and DR probes followed by polymorphic GC-rich repeat sequences (PGRS) typing only on lowcopy
strains. The results were correlated with selected epidemiological and clinical data. Forty one percent of strains showed single copy of
IS6110, which further got differentiated into 62 DR and 27 PGRS patterns. One predominant DR pattern (5B/2) was found in 20% of the lowcopy
strains and was also involved in clusters. In all, 183 patients out of 451 (40%) were clustered in total 44 clusters when analysed by IS6110
and DR probes. With additional PGRS typing, the number of patients clustered was further reduced to 106 (23%). More number of patients
(131) were clustered in IS6110 single-copy group. The maximum number of clusters was found with two or three patients. Only a small
percentage (16%) of the patients reported direct epidemiological links while remaining patients might have had indirect links or casual
contacts. Thus, a combination of two to three genetic markers is able to differentiate the most endemic strains of M. tuberculosis in areas with a
high incidence of tuberculosis. The epidemiological data do not suggest any major outbreaks or a hot-spot hypothesis of transmission in this
region. Phylogenetic analysis using IS6110, DR and PGRS RFLP (restriction fragment length polymorphism, RFLP) fingerprints showed that
isolates exhibited clonal evolutionary pattern. The predominance of certain genotypes and agreement between the phylogenetic trees
indicated that these strains were closely related and might have evolved or propagated from the common ancestor
Care-seeking pattern with first provider approached (n = 640).
<p>Care-seeking pattern with first provider approached (n = 640).</p