Profile of Multi Drug Resistant Tuberculosis patients: A Study at Drug Resistant Tuberculosis Centre in Kumaun Region, Uttarakhand

Background: Drug Resistant Tuberculosis (DR-TB) has frequently been encountered in India, and its presence has been known virtually from the time anti-TB drugs were introduced for the treatment of Tuberculosis. Multi Drug Resistant Tuberculosis (MDR-TB) is a man-made phenomenon and has become a formidable challenge to effective Tuberculosis control in India. Objectives: To study the Socio-demographic and Clinical profile of Multi Drug Resistant Tuberculosis (MDR-TB) patients presenting to Drug Resistant Tuberculosis (DR-TB) Centre at Govt. Medical College, Haldwani in the Kumaun region, Uttarakhand. Methodology:  This study is a Record based study, where in service data available at Drug Resistant Tuberculosis (DR-TB) Centre at Govt. Medical College, Haldwani in the Kumaun region, Uttarakhand, was accessed and analyzed. Inclusion criteria included all patients with diagnosis of Multi Drug Resistant Tuberculosis (MDR-TB) presenting to the centre from 1st April 2015 to 31st December 2015. Results: The present study showed that younger age group particularly males were more affected with MDR-TB. Under-nutrition was quite prevalent among the MDR-TB patients. 56.7% cases were addicted to alcohol and 54.3% cases were addicted to smoking. 85.8% patients took treatment for TB and 44.1% not completed their treatment. Relapse of previous anti-tuberculosis treatment was found to be the major contributor in MDR-TB suspect cases. Prevalence of XDR-TB was also found to be low. Conclusion: The findings of the study emphasize the importance of studying the socio-demographic factors and baseline clinical characteristics in different MDR-TB patient categories to timely modify and strengthen the national programs

Is the Revised National Tuberculosis Control Programme achieving early initiation of treatment post two decades of its operation?: A cross-sectional study from Uttarakhand, India

Background: Early case finding and prompt initiation of treatment of pulmonary Tuberculosis (PTB) is the most effective strategy to achieve successful TB control. In order to achieve early initiation of treatment, the Revised National TB Control Programme (RNTCP) since its launch in 1997 has been using advocacy, communication and social mobilization (ACSM) strategy targeted at health care providers (HCP) and other stake holders by large scale utilization of electronic and print media. Objective: To study whether RNTCP is really achieving early initiation of TB treatment among infectious PTB patients. Methods: A cross- sectional study among new smear positive PTB patients at Haldwani block of Nainital district of Uttarakhand State of North India. Data was analyzed using the software Epi Info version 7.2.0.1. Results: Of the 85 infectious PTB patients included in the study, the median time consumed between onset of cough and contact with the first HCP, between first HCP contact to confirmation of diagnosis, and between confirmation of diagnosis to initiation of treatment were 6 days, 43 days and 6 days respectively. Overall, median time consumed between onset of cough to initiation of treatment was 61 days. HCPs working in the public health settings fared no better than those in the private health sector in this regard. Conclusions: Although majority patients sought medical care timely, a considerably unacceptable long time was consumed by HCPs in initiation of treatment of PTB

A study on incidence of adverse drug reactions of current multidrug resistant pulmonary tuberculosis treatment regimen at a tertiary care centre in kumaon region of Uttarakhand

Background: Treatment of multidrug resistant pulmonary tuberculosis (MDR-PTB) is challenging because of multiple anti-TB drugs, long treatment duration and various adverse drug reactions (ADRs). The aim of this study was to find the incidence of ADRs related to various anti-TB drugs. Methods: This was a prospective observational study done from 1st January 2019 to 30th June 2020, in the Department of Respiratory Medicine at Government Medical College, Haldwani, Uttarakhand. Results: A total of 163 MDR-PTB patients were reviewed, of which 136 (83.44%) patients experienced >1 ADRs, during intensive phase of treatment. Total 398 ADR episodes were observed, maximum ADRs (134, 33.7%) were related to Gastrointestinal system. Incidence of ADRs was more (96.97%) in 46-60 yrs. of age group, in patients living in rural area (82 of 92, 89%), in married patients (88.07%), in smokers (91.4%), in alcoholics (90.6%), in patients having co-morbidities and in patients who had anemia (88.24%). The most common ADR was joint pain in 36 (26.5%) of 136 patients. Conclusion: Strict follow-up with laboratory investigations, providing assurance and exercise plan to the patients is crucial. Healthcare providers should be trained regarding identification and management of ADRs