A
survey of tuberculosis hospitals in India.-
2004 Oct
Stop TB Department, World Health Organization,
5th floor, A Wing, Nirman Bhavan, New Delhi,
India. singh_a@vsnl.com
SETTING:
Hospitals with beds for tuberculosis (TB)
in India.
OBJECTIVES:
To assess diagnostic and treatment practices
at institutions offering secondary or tertiary
level care for TB patients, and to determine
the resources being used at these institutions.
DESIGN:
Countrywide cross-sectional survey of TB
hospitals using a mailed semi-structured
questionnaire sent to all 105 hospitals
with 100 or more beds and to all State Directorate
Health Services.
RESULTS:
The 94 hospitals that returned the questionnaire
had 15773 TB beds, one third of the total
TB beds in the country. Nearly 1 million
patients sought treatment in the TB hospitals
and one third were diagnosed with TB; the
ratio of smear-positive to smear-negative
patients was 1:2.7. Sixty-four per cent
of hospitals prescribed unobserved rifampicin
in the continuation phase, and 56% of sputum
smear-positive patients were hospitalised.
The annual expenditure for the TB hospitals
was more than the total annual budget for
the TB control programme of the country.
CONCLUSIONS:
In view of the high number of patients seen
and the suboptimal practices observed, urgent
steps should be taken to ensure implementation
of correct diagnostic and treatment policies
in hospitals with TB beds.
PMID: 15527159 [PubMed
- in process]
KNOWLEDGE,
ATTITUDES, AND BEHAVIOR: Care-seeking behavior of
chest symptomatic studied
Tuberculosis Week - July 28, 2003
Tuberculosis specialists in India conducted
a study to "identify the factors
that influence the care-seeking behavior
of chest symptomatic in urban and rural
areas in South India."
Data were collected from interviews of
310 urban residents in Tamil Nadu, Madras,
in South India, and 339 inhabitants of
rural parts of the region.
G. Sudha and colleagues, Indian Council
of Medical Research, Tuberculosis Research
Center, said that 80% of the urban dwellers
they interviewed and 63% of those in rural
areas had sought care (p<0.01). And
most of these didn't delay too long: 93%
sought care within a month of onset of
their symptoms.
"Private health care facilities were
the first and preferred point of contact
for 57% of urban and 48% of rural participants;
the major reasons were proximity to residence
and their perception that good-quality
care would be available there," Sudha
and associates said.
Three factors were cited as main reasons
that symptomatic did not seek care:
they thought their
symptoms were not severe enough (51%)
they couldn't afford
care (46%)
they didn't have
time to seek care due to work pressures
(25%)
Sudha and colleagues reported that "socio-economic
factors such as literacy and family income
significantly influenced care-seeking
behavior."
The researchers summarized: "Our
results indicate that most chest symptomatic
seek care promptly; their initial response
is to go to the nearest private health
care facility, shifting to another if
they are dissatisfied. Fifty percent of
the participants who did not seek care
felt that their symptoms were not severe.
Sudha and coauthors published their study
in Tropical Medicine & International
Health (Factors influencing the care-seeking
behaviour of chest symptomatic: a community-based
study involving rural and urban population
in Tamil Nadu, South India. Trop Med Int
Health, 2003;8(4):336-341).
Additional information can be obtained
by contacting G. Sudha, Indian Council
Med Research, Tuberculosis Research Center,
VR Ramanathan Rd., Spurtank Rd., Madras
600031, Tamil Nadu, India.
The publisher of the journal Tropical
Medicine & International Health can
be contacted at: Blackwell Publishing
Ltd., 9600 Garsington Rd., Oxford OX4
2DG, Oxon, UK.
The information in this article comes
under the major subject areas of Tuberculosis,
Risk Factors, Behavior.
TUBERCULOSIS
RESEARCH CENTRE
Chennai, India
WHO Collaborating
Centre for Tuberculosis Research & Training Research Activities at the Tuberculosis
Research Centre
The Tuberculosis Research
Centre (TRC) is a leading research institution
in the field of tuberculosis. The Centre
is a permanent institute of the Indian Council
of Medical Research (ICMR). It is globally
recognized for its contributions in the
field of tuberculosis. The strength of this
institution lies in its ability to identify
and carefully characterize various populations
of patients with tuberculosis and follow
them up for periods as long as 5-10 years.
This has been possible due to the excellent
teamwork that has been built up over the
last 4 decades. The Centre has on its staff
well-trained clinicians, epidemiologists,
biotechnologists, social workers, health
visitors and bio-statisticians to carry
out these studies.
National
Tuberculosis Institute, Bangalore
WHO Collaborating Centre for Tuberculosis
Research & Training
The NTI is designated as
WHO Collaborating
centre for TB research & training
since June 1985. The activities as a collaborating
centre are as follows
To organise training activities in
TB control for medical and paramedical
personnel, in policies and Procedures
consistent with the WHO-recommended
DOTS strategy.
To monitor and supervise the TB Control
programme in the country.
To plan, coordinate and execute TB
research in epidemiology, surveillance
of drug resistance and operations of
control strategies relevant to regional
and national programme delivery.
To augment the dissemination of information
on TB and its control by tapping the
potentials of the existing Library and
Information Dissemination Services.
TB
is a killer, but Pune is fighting it
Pune, August
23: After a long wait on the steps of the
entrance to the Department of Chest and
Respiratory Diseases at Sassoon General
Hospital (SGH), a listless Nathu has been
told at the OPD that he has to be admitted
for treating Multi-Drug Resistant Tuberculosis
(MDR-TB). A daily wage labourer from Bhor
(45 km away from Pune), Nathu has been unable
to work for a year. His wife’s salary
as a house maid and from doing jobs fetches
them Rs 400 a month. Two children aged four
and six miss school most days. And Nathu
has already spent close to Rs 10,000 for
the “right treatment” for curing
TB.
Twenty-two-year-old Ramesh from Parli village
in Beed district (350 km from Pune) hasn’t
been able to attend classes at the Nehru
College for a year. A TB patient, he underwent
the Directly Observed Treatment Short Course
(DOTS) for six months, but he is a likely
patient of MDR-TB. He boards his bus at
9 pm from Parli and reaches Pune at 7 am
the next day to see doctors at Sassoon and
KEM Hospital. There are no facilities for
treating him at Parli and now Ramesh needs
to be admitted.
Nathu and Ramesh are tell tale cases of
TB patients who have to depend on the treatment
facilities in Pune. In Pune district, there
are 5,755 patients receiving Directly Observed
Treatment Short Course (DOTS) at 1,199 DOT
centres and 100 designated microscopy centres
(DMC).
The DOTS programme ensures the patient adheres
to the treatment. “Even if one misses
a dose, he/she is traced and given the dose
the next day,’’says Dr S R Karad,
Pune District TB Control officer. In fact,
DOTS programme has contributed immensely
for the success of the Revised National
Tuberculosis Control Programme (RNTCP) of
the Union health ministry since it keeps
a tab on each and every patient under its
regime.
Today, more and more TB patients are being
identified. Outlining the DOTS methodology,
Karad said before a patient is put on the
anti-TB drug regimen, his/her address is
verified. And if someone misses a dose,
they are called from their homes and referred
to the nearest DOT centre where community
workers and senior supervisors ensure the
patient takes the medicine in their presence.
Normally, the tendency is not to come back
for treatment as patients often start feeling
better after two months. “But our
staff ensures they are back,” says
Karad pointing to Suresh Sarode from Solapur
who is now a “relapse case”
who has had to be admitted at Sassoon.
But treatment and admission pose their own
set of problems for TB patients. For instance,
at the government Sassoon General Hospital,
the department of chest and respiratory
diseases is located bang opposite the morgue
and several proposals to build a compound
wall between them have yet to see the light
of day.
“We have to live with the stench.
Patients cover their faces and look at the
mournful faces around. This is a daily occurrence
for the last 50 years,’’ adds
Karad.
Moreover, if a patient has to be admitted,
he/she has to go to the Pune Chest and General
Hospital at Aundh, which is almost an hour
away from Sassoon which has no ward to isolate
and treat TB patients. So Sassoon’s
patients are being accommodated at the Aundh
hospital.
But aren’t there facilities at Sassoon?
Karad’s reply is a replay of a familiar
story. “There is a proposal to construct
a new building to admit patients and include
the OPD at Sassoon hospital. But nothing
has happened.”
At the Aundh hospital, 120 of the 400 beds
have been reserved for TB patients who,
normally, have to stay on for at least three
months paying a paltry Rs 10 per day. But
despite having segregated the TB ward, the
hospital doesn’t attract “general
patients”, says medical superintendent
Saroj Maheshgauri.
Built originally for “keeping TB patients
in isolation”, the hospital was packed
to capacity during the 70s. Eventually,
the success of the RNTCP saw the number
of patients come down drastically. But the
stigma of being a “TB hospital”
prevents it from being a fully functional
general hospital.
Killer TB
TUBERCULOSIS kills more adults than any
other infectious disease. It is curable,
yet it claims the lives of more than four
lakh people in India every year. Every day
more than 20,000 people become infected
with TB bacillus and about 5,000 develop
the disease. Untreated pulmonary TB cases
spread infection to others in the community
— each infectious patient can infect
10-15 persons a year unless effectively
treated.
