Prevention & Control of Tuberculosis

National TB Control Programme

1. National TB Control Programme:

The NTP is an approach within the national health system to control TB.

2.The Aims of the NTP:

The Aims of the National Tuberculosis Control Programme are;

(i) to decrease the spread of TB infection in the community, thereby expediting the elimination of TB from society,

(ii) to cure the individual patients effectively, restore their capacity for activities of daily living, and to allow them to remain within their family and community enabling them to lead a active productive life.

3. The Goal of the NTP:

The goal of the NTP is to reduce the mortality, morbidity and transmission of tuberculosis, until it is no longer a public health problem.

4. The Activities of the NTP

Promote early diagnosis of people with infectious pulmonary TB by sputum smear examination
Establish a network of microscopy centres, and a system of quality control of sputum smear examination.
Organise and expand DOTS treatment centres within the existing primary health care system.
Provide a continuous drug supply to treatment centres, Maintain a standard system for recording and reporting.
Monitor the results of the treatment and evaluate progress of the programme.
Provide regular training and supervision for all staff involved in the NTP, at different level.
Develop IEC materials and methods to improve community awareness about TB.
Strengthen cooperation between INGOs & NGOs,
Carry out research activities regarding TB.
Develop partnership with other sectors.
General Information On TB

1. What is Tuberculosis?

Tuberculosis is a communicable disease caused by an organism called Mycobacterium tuberculosis. This organism is also called as tubercle bacilli, Usually they affect the lungs.

2. How Does TB spread?

When a person with pulmonary TB coughs, sneezes, laughs, or talks tubercle bacilli are spread into the air in tiny droplets. People who are in close contact can breathe in these droplets and become infected.

3. What is a case of TB?

A patient in whom TB has been bacteriologically confirmed or diagnosed by a clinician.

4. What types of TB are there?

There are two types of TB (according to organ/parts of the body affected)

Pulmonary TB- when tuberculosis occurs in the lungs then it is called as pulmonary TB.

Extra-Pulmonary TB- if TB affects organs other than lungs (such as lymph nodes, bones and joints, genitourinary tract, meninges, pleura, intestines etc.) it is called as Extra Pulmonary TB.

5. What are the symptoms of Pulmonary TB?

Symptoms of pulmonary TB include:

cough more than two weeks
chest pain
low grade fever, especially in the evening
loss of weight
loss of appetite
blood stained sputum

6. Who is vulnerable to TB?

Following individuals are at risk of contracting infection and developing the disease because of their exposure to a patient with TB,

family and close contacts of the patients
the elderly
people with low income
people with poor access to health care
people who inject illicit drugs
people who live or work in certain setting, such as nursing homes, prisons, shelters for the homeless or TB treatment centres
people with HIV infection
people addicted to alcohol
malnourished people
people with poorly controlled Diabetes
people having chronic lung diseases
smokers
people suffering from cancers

7. How is TB detected?

Pulmonary TB can be detected by sputum examination. Chest X-ray also helps in detection of TB of the lungs. At present, bacterial examination of sputum is the best method of diagnosis of pulmonary TB. The smear microscopy is better method of diagnosis than X-ray because it is simple, easy to perform; less expensive and reliable.

8. Impact of HIV/AIDS on TB

HIV infection increases susceptibility to TB. A person with HIV infection is up to 30-50 times more likely to develop active TB than a person with a healthy immune system. Consequences of this epidemic of TB/HIV co-infection on national TB programme are increased caseloads, low TB cure rates, high case fatality rates during treatment, under diagnosis of TB, the potential of high default rates and the accelerated emergence of drug resistant TB. Hence, early detection of TB & HIV, treatment of TB under DOTS, prevention of HIV & care of AIDS cases are vital in the management of the dual epidemics.

Treatment of Tuberculosis

1. How is TB disease treated?

Tuberculosis is a curable disease and treated with the oral drugs sometimes together with injections. TB drugs are available at free of cost in all government health facilities. The total duration of treatment is 6 to 8 months. Treatment should not be discontinued before completion of full course. If treatment is interrupted before completion of full course the drug resistance will develop which is dangerous to patient as well as to the community. Drug resistance TB is difficult to treat.

2. Available effective anti-TB drugs:

Following are the main anti -TB drugs available everywhere, (in all TB treatment Centres)

Isoniazid (INH)
Rifampicin ( RFP)
Pyrazinamid (PZA) Oral Drugs
Ethambutol (EB)
Streptomycin (SM) - Injection

3. What are the adverse effects of anti-TB drugs?

Drugs used in the treatment of tuberculosis may sometimes cause side effects/adverse effects, such as Anorexia, Nausea, Abdominal Pain, Joint Pains, etc. These may cause the patients to stop taking medicines, Most TB patients complete their treatment without any significant adverse effects of drugs. However, a few patients do experience adverse effects. It is therefore important that patients be clinically monitored during treatment so that adverse effects can be detected promptly and managed properly. Health personnel can monitor adverse effects of drugs by teaching patients how to recognize symptoms of common adverse effects.

4. How one can help TB patients understand more about their disease?

Patients are more likely to successfully complete their treatment if they understand about their disease and treatment, Patients are often afraid when they learn of their diagnosis, because they harbor misbelieves such as TB is an incurable disease, Reassure them and provide them with proper and relevant information :

TB is a curable disease and it not a hereditary disease.
TB is caused by an organism/bacillus
TB spreads by air through coughing, sneezing, laughing, talking loudly.
Investigation of TB suspects and treatment of TB cases are I free of cost.
If there is a side effect, inform Health workers as soon as possible.
Talking to an individual patient or patients in groups and distribution of pamphlets and brochures containing basic TB information, should help to improve the patients' knowledge on TB.

Drug Resistance Tuberculosis

1. What is Drug Resistance?

Drug resistant bacilli are the Mycobacterium tuberculosis bacilli, which are resistant to anti-tuberculosis drug and Multi-Drug resistant (MDR) bacilli are the bacilli that are resistant to more than one anti-tuberculosis drugs, specially the two main drugs- Isoniazid and Rifampicin. MDR is currently the most severe form of bacterial resistance.

2. How is MDR TB produced?

As with other forms of drug resistance, the phenomenon of MDR tuberculosis is entirely man-made.

Drug resistant bacilli are the consequences of human error in any of the followings:

Prescription of chemotherapy - wrong combination, inadequate dosages
Management of drug supply - Irregular supply
Case management - Irregular treatment, lack of monitoring & supervision,
Process of drug delivery to the patient - Irregular delivery, lack of supervisory visits

DOTS: The Strategy That Ensures Cure

1. What is DOTS?

DOTS stands for Directly Observed Treatment, Short-course, and it is the proven cost-effective strategy to control TB by giving drugs to patients under direct observation of health workers/treatment supporter DOTS has been found 100% effective to cure TB and to prevent multi-drug resistance. Only DOTS ensures cure of diagnosed TB patients. It can also prevent relapse and death.

2. What are the essential elements of DOTS strategy?

Government commitment to sustain TB control
Sputum smear microscopy to detect the infectious cases among those people attending health care facilities with symptoms of pulmonary TB.
Standardized short course anti TB treatment with direct observation.
Uninterrupted supply of anti-TB drugs and diagnostics, and
Monitoring and accountability,

3. What is the evidence that DOTS works?

In areas where DOTS was implemented, cure rates of up to 95% have been recorded, even in very poor countries. More over DOTS prevents transmission of new infections and the development of multi-drug resistant TB. The DOTS strategy has been ranked by the World Bank as one of the most cost-effective of all health interventions.

4. DOTS success stories in SAARC

The following are some of the success stories in the Sr1ARC region;

Bangladesh adopted the DOTS strategy in 1993. Currently, it is being implemented in over 95% of the country. By 2001, as many as 80% of the patients receiving treatment were cured in areas of the country where the strategy was being used, in 1997, WHO described Bangladesh's TB control programme as a model for the entire world.

Bhutan has achieved complete population coverage; improving the delivery of ambulatory DOTS in the difficult terrain is under way.

Maldives achieved and has maintained global targets since 1995.

Nepal has implemented DOTS successfully and achieved these targets in mid-2002. More than 89% of patients in DOTS sites have been cured compared to less than 50% before the DOTS strategy was adopted.

5. What are the benefits of DOTS?

The benefits for patients themselves are the increasing treatment completion resulting in rapid cure. Furthermore, case management under DOTS strategy can prevent death, sequel & relapse. Moreover, DOTS can reduce community transmission of tubercle bacilli as well as emergence of drug resistance strains.

DOTS can: