COMMUNITY HEALTH NURSING SEMINAR ON

NATIONAL TUBERCULOSIS CONTROL PROGRAMMES

SUBMITTED TO: SUBMITTED BY:

Mrs. Ranjana Chawan Diksha saini
Tutor, SCON 4th Year B.Sc Nursing
DATE: 15 Mar 19
GENERAL OBJECTIVES
By the end of class, group will be able to know about tuberculosis and the
national tuberculosis control programmes run by the government to eradicate
tuberculosis.
SPECIFIC OBJECTIVES
By the end of class group will be able to
 define the concept of TB
 list down the causes of TB
 enlist the clinical manifestations and diagnosis of TB
 list down the drugs used for TB treatment
 define the concept of national TB control programme
 explain the national strategic plan
 explain the revised national tuberculosis programme
Sr. Time Specific Content Teachers Learners AV Evaluation
no objectives activity activity aids

Pulmonary Tuberculosis (TB) is a bacterial

Define the infection caused by a germ
concept of called Mycobacterium tuberculosis. The
tuberculosis. bacteria usually attack the lungs, but they can
also damage other parts of the body.
 Weak immune system.
 Air droplets from a cough or sneeze.

Causes of TB includes:
 HIV infection,
 Low socio economic status,
 Alcoholism, homelessness,
List down the  Crowded living conditions,
causes of  Diseases that weaken the immune
tuberculosis system,
 Migration from a country with a high
number of cases
Latent TB infection doesn’t have any
symptoms, don’t feel sick and cannot infect
others

In the case of an active infection,

 A cough persisting for 2 to 3 weeks
Enlist the  Chest pain
clinical  Blood in the sputum
manifestation  Breathlessness
 Weight loss
 Loss of appetite
 Chills
 Fever
 Sweating in the night time while sleep
 Diagnosis of Tuberculosis

• Lung Sound: Sound of wheezing can be

identified
• Tuberculosis skin test: PPD tuberculin is
injected just below the skin of your
and diagnosis of inside forearm. Within 48 to 72 hours, a
tuberculosis hard raised red bump means you're
likely to have TB infection.
• Chest X-ray: white spots in his lungs.
• Sputum tests: to see if they are resistant to
the effects of medications used to treat
tuberculosis.
• Chest CT scan

• The most commonly used drugs include:

 Isoniazid
 Rifampin
 Pyrazinamide
List down the  Ethambutol
drugs used for • Other drugs that may be used to treat TB
TB treatment include:
 Moxifloxacin
 Streptomycin
INCIDENCES
WORLD:
• TB continues to be one of the most important
public health problems worldwide
• In 2014, an estimated 9.6 million people
developed TB and 1.5 million died from the
disease, 400,000 of whom were HIV positive
• Worldwide the proportion of new cases with
MDR-TB was 3.3% in 2014, whereas those for
previously treated cases was 20.0%
• Of the estimated 9.6 million people who
developed TB in 2014, more than half (58%)
were in South-East Asia and Western Pacific
regions and a further one quarter (28%) were in
African region.
• India, China and Indonesia alone accounted for
23%, 10% and 10% of total cases respectively
• In 2014, an estimated 3.2 million cases were
women.
• An estimated 510,000 women died as a result
of TB, more than 1/3 rd of whom were HIV
positive
• Globally, about 1.1 million new cases and
130,000 deaths occur annually due to TB
among children.

INDIA :
• Accounts for nearly 1/4 th of the global burden
of TB
• Around 2.2 million develop TB in 2013-14.
During the same period, 0.27 million people
 died due to TB
• Everyday about 20,000 people become infected,
5000 develop TB and more than 1000 die due
to the disease
• In simple terms, 2 persons become sputum +ve
for TB and almost 1 person is killed every
minute due to the disease ( WHO 2007)
• The proportion of new cases with MDR-TB was
2.2% in 2014, whereas those for previously
treated cases was 15.0%

Introduction
 The National Tuberculosis Program was
established in 1962 with the main objective
Explain the of reducing the disability and death from TB
national by effective treatment.
tuberculosis  Under the District Tuberculosis Program,
control district TB centers (DTCs) were set up for
programme referral diagnosis, treatment, and
community control of TB.
 Nationally, there are 390 districts with fully
equipped DTCs staffed by a team of
medical and paramedical personnel.
Another 330 TB clinics are mostly located
in big cities, caring for the local populace.
 In addition, 17 tuberculosis training and
demonstration centers provide basic training
to paramedical personnel, including general
practitioners.
 There are a total of about 47,000 beds
available nationwide for TB patients. The
majority of patients are treated at home, thus
 only serious cases or those requiring
surgical treatment are admitted.

 Failure of NTCP:
 Managerial weakness,
 lack of supervision
 Poor quality of sputum microscopy
 Multiplicity of treatment regimens
 Poor organizational set-up
 Inadequate funding
 Over dependence on X-ray for
diagnosis
 Frequent interrupted supplies of
drugs
 Low rate of treatment completion
(30% only)

The National TB Programme (NTP) was started

Explain the in 1962 for TB control in India. This programme
concept of was not able to give expected results in India.
RNTCP The NTP was reviewed in 1992.

As a result of the review and pilot studies in

1993, the DOTS strategy was adopted in India
under the Revised National TB control
Programme - RNTCP
The programme was implemented in a phase
manner and by 24th March 2006, the entire
country was covered under the programme.
Goal:
to decrease the mortality and morbidity due
to tuberculosis and cut down the chain of
transmission of infection until TB ceases to be
a public health problem

Objectives:
To achieve and maintain:
 Cure rate of at least 90% among newly
detected smear positive (infectious)
pulmonary TB cases and
 Case detection of at least 85% of the
expected new smear positive PTB cases
in the community.
Strategies:
 Case finding and Diagnostics- Use of
sputum testing as the primary method
of diagnosis
 Patient friendly treatment services and
ensuring a regular, uninterrupted
supply of drugs up to the most
peripheral level-DOTS
 Scale-up of Programmatic
Management of Drug Resistance –TB
 Scale -up of Joint TB-HIV Collaborative
Activities
 Integration with Health Systems
RNTCP Phase I (1998- 2005):
 The goal of TB control Programme is to
decrease mortality and morbidity due to TB
and cut transmission of infection until TB
ceases to be a major public health problem
in India.
 The twin objectives of the Programme were
to achieve and maintain a cure rate of at
least 85 per cent among new sputum
positive (NSP) patients, and to achieve and
maintain case detection of at least 70 per
cent of the estimated NSP cases in the
community.

RNTCP Phase II (2006-2012):

To consolidate, maintain and further improve
the achievements of the phase I
Activities
a) increase access of services to hard-to-
reach areas
b) strengthening the inter sectoral
collaboration
c) scaling up of the state level intermediate
referral laboratories(IRL) capacity
d) implementation of dots-plus for MDR-
TB cases in a phased manner
e) distribution of paediatric drug boxes
f) institutional strengthening at national,
state and district level
g) Introduction of TB-HIV co-ordinator
and communication facilitator.
RNTCP Phase III (2012-2017):
The vision of the Government of India is for a
“TB-free India” with reduction in the burden of
the disease until it is no longer a major public
health problem.
To achieve this vision, the Programme has now
adopted the new objective of aiming to achieve
‘Universal access’ for quality diagnosis and
treatment for all TB patients in the community.
Programme aims to achieve the following
targets:
(i)Early detection and treatment of at least 90
per cent of estimated TB cases in the
community, including HIV-associated TB;
(ii) Initial screening of all re-treatment smear-
positive TB patients for drug-resistant TB and
provision of treatment services for MDR-TB
patients;
(iii) Offer of HIV counselling and testing for
all TB patients and linking HIV-infected TB
patients to HIV care and support;
(iv) Successful treatment of at least 90 per cent
of all new TB patients, and at least 85 per cent
of all previously-treated TB patients; and
(v) Extend RNTCP services to patients
diagnosed and treated in the private sector.
 National Strategic Plan for
2012-17
RNTCP's National Strategic Plan (NSP) 2012-
Discuss about 17 was part of the country’s 12th Five year
national Plan. The theme of the NSP 2012-17 was
strategic plan "Universal Access for quality diagnosis and
treatment for all TB patients in the community"
with a target of "reaching the unreached". The
major focus was early and complete detection
of all TB cases in the community, including
drug resistant TB and HIV-associated TB, with
greater engagement of private sector for
improving care to all TB patients. The NSP was
backed up by Goal’s commitment for
substantial increase in the investment for TB
control, with a four-fold increase in budgetary
allocation.
During the NSP 2012- 17 periods, significant
gains were made in strengthening the support
structures, programme architecture and
implementation environment for TB control.
This includes mandatory notification of all TB
cases, integration of the programme with the
general health services (National Health
Mission), expansion of diagnostics services,
programmatic management of drug resistant TB
(PMDT) service expansion, and single window
service for TB - HIV cases, national drug
resistance surveillance and revision of
partnership guidelines.

The key components of the NSP (2012-2017)

are:
 a. Strengthening and improving the quality
of basic DOTS services.
b. Deploying improved rapid diagnostics
to the field level
c. Expanding efforts to engage all care
providers
d. Expanding diagnosis and treatment of
drug resistant TB cases
e. Improving communication, outreach
and social mobilization.
f. Promoting research for development
and implementation of improved tools
and strategies.
g. Utilizing Information Communication
Technology (ICT) tools for
strengthening TB surveillance

ORGANIZATION

1) State tuberculosis office - state

tuberculosis officer

2) State tuberculosis training and

Explain about demonstration centre –director
the
organisational 3) District tuberculosis centre- district
structure of TB tuberculosis officer
control
programme. 4) Tuberculosis unit –
i. medical officer
ii. Senior treatment supervisor
iii. Senior TB laboratory
supervisor
 DIAGNOSIS OF TB

Sputum examination is the best method to

diagnose TB
i. Pulmonary TB diagnosis can be
confirmed by sputum examination.
Two sputum samples are collected
over one/two consecutive days
Discuss the
process of ii. If the health facility is a DMC, spot
diagnosis of sample is collected immediately and
TB. the patient is given a sputum container
to collect early morning sample &
brought to the lab

iii. Alternatively the patient can be asked

to collect a morning sample and go to
a DMC where a spot sample can be
taken
iv. In case the patient is not able to reach
a DMC, both samples - morning and
spot, can be collected and transported

v. The sputum samples are subjected to

microscopy examination as early as
possible
vi. A patient is diagnosed positive if one
or both the samples is positive for
bacteria
 vii. If the bacteria are not visible in any
sputum sample, the patient is negative
and should be referred to a medical
officer for further evaluation
viii. TB of other organs is diagnosed by a
medical officer
DIRECTLY OBSERVED
TREATMENT- (DOT)

Discuss about Directly observed treatment is one of the

the Directly element of DOTS strategy. An observer
Observed watches and helps the patients to swallow the
Treatment. tablet. Direct observation ensures treatment for
the entire course, with the right drugs, in the
right dose and at the right intervals.

Components of DOTS
a) Political and administrative
commitment
b) Good quality diagnosis, primarily by
sputum smears microscopy.
c) Uninterrupted supply of quality drugs
d) Directly observed treatment (DOT)
e) Systemic monitoring and
accountability

In 2006, STOP TB strategy was announced by

WHO and adopted by RNTCP. The
components are as follows :
a) Pursuing quality DOTS expansion and
enhancement.
b) Addressing TB/HIV and MDR-TB.
c) Contributing to health system
strengthening.
d) Engaging all care providers.
e) Empowering patients and communities.
f) Enabling and promoting research
(diagnosis, treatment, vaccine).

Directly Observed Treatment

Short Course

There are two phases in DOTS treatment

1. Intensive phase
a) Intensive phase is of 2 to 3 months
duration
b) Patient swallow medicine under the
observation of a health worker during
IP
c) Medicines are taken 3 times a week on
alternate days
d) If the sputum is negative for bacteria
after IP, continuation phase is started

2. Continuation Phase
a) This phase is of 4 or 5 months
duration
b) The patient is provided with a weekly
blister pack to take home
 c) The medicines from the blister pack
are taken on alternate days, three
times a week and in the remaining
days, Vitamin tablets are taken
d) The first dose of the weekly blister
pack is taken under direct observation
of the health worker

Dots-plus
Strategy currently under development by who
For the management of MDR-TB cases

Goal
To prevent further development of MDR-TB

Pre-requisite
An effective dots based TB control program

Organisation
a) Designated RNTCP dots-plus sites at
least 1 in each state
b) With ready access to RNTCP accredited
culture and drug susceptibility
testing(DST) laboratory

Management of paediatric
Tuberculosis
a) diagnosis and treatment for the
paediatric
b) Patients issuing drugs for the paediatric
cases in the patient wise boxes(PWB)
c) treatment based on child’s body weight
 6-10kg weight band 11-17kg weight
band
d) children weighing < 6kg will be treated
with loose anti-TB drugs

National framework for joint TB-

HIV collaborative
Activities

a) establishment of co-ordination
mechanisms, joint planning and review
at national, state and district levels
b) service delivery co-ordination
c) involvement of NGOS
d) operational research
e) infection control measures

CONCLUSION
RNTCP has been successful in achieving and
sustaining its stated objectives. The burden due
to TB has been reduced significantly due to
effective implementation of the various
components under the programme with the
cooperation and support off all stakeholders
.Ambitious plans have to be made under
RNTCP (2012-2015) and executing these
requires concerted efforts and support from all
stakeholders with significant enhancement of
budgetary support and community
participation.
 BIBLIOGRAPHY
 K Park , Text book of Preventive and social
medicine 23rd edition ,Page no 390-395
 Basvanthapa (M.sc nursing), PhD Jaypee
brothers; medical publishers(P) Ltd.
2006,First edition
 www.ncbi.nlm.nih.gov
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