Marina Rajan Joseph1, Roshan Anna Thomas2, Sanjeev Nair3, Shibu Balakrishnan4, S Jayasankar5. 1. Professor of Community Medicine, M.O.SC. Medical College, Kolenchery, India. Electronic address: marina.rajan@gmail.com. 2. Senior Lecturer Community Medicine, M.O.SC. Medical College, Kolenchery, India. 3. Assistant Professor, Department of Pulmonary Medicine, Govt. Medical College, Trivandrum, India. 4. Medical Consultant RNTCP, Office of The WHO Representative for India, India. 5. State TB Officer, Chest Physician, Directorate of Health Services, Kerala, India.
Abstract
BACKGROUND: Though Directly Observed Treatment Short course (DOTS) is found effective in many controlled trials, few studies have examined its effectiveness under programmatic conditions. DOTS based Revised National TB Control Programme (RNTCP) was initiated in Ernakulam district of Kerala state in June 2000. It now covers all of India. It now seems appropriate to do an evaluation of RNTCP at field level. AIM: This study aims to document impact of DOTS in providing productive life to tuberculosis patients and measure rate of clinical recurrence under program conditions. METHODS: Retrospective cohort study using interview with structured, peer reviewed and validated questionnaire among cohort of new smear positive patients registered in RNTCP from January 2002 to December 2003 and declared cured/Treatment completed. We have contacted 1173 patients (62.2% of the cohort) for the study at their homes by devising a strategy to identify and trace patients from address given in TB registers. RESULTS: Mean age of identified patients is 51.9 years. 82.4% were males. 79% patients report full supervision in the intensive period. After seven years 64.1% are healthy, work and earn; 29.8% report residual respiratory problems; 0.3% of symptomatic patients were diagnosed with smear positive pulmonary tuberculosis. Relapse calculated as worst case scenario for full target population (dead and migrated inclusive) is 9.27%. Age specific mortality is 4-6 times higher than in a comparable general population. CONCLUSIONS: DOTS treatment under program conditions makes a measurable reduction in tuberculosis morbidity. Though high proportion of patients remains productive after DOTS, a significant proportion complains of residual respiratory symptoms. Age specific mortality of Post tuberculosis patients is high compared to general population. Close follow up irrespective of duration of symptoms may help to determine the causes of high residual morbidity and mortality rates.
BACKGROUND: Though Directly Observed Treatment Short course (DOTS) is found effective in many controlled trials, few studies have examined its effectiveness under programmatic conditions. DOTS based Revised National TB Control Programme (RNTCP) was initiated in Ernakulam district of Kerala state in June 2000. It now covers all of India. It now seems appropriate to do an evaluation of RNTCP at field level. AIM: This study aims to document impact of DOTS in providing productive life to tuberculosis patients and measure rate of clinical recurrence under program conditions. METHODS: Retrospective cohort study using interview with structured, peer reviewed and validated questionnaire among cohort of new smear positive patients registered in RNTCP from January 2002 to December 2003 and declared cured/Treatment completed. We have contacted 1173 patients (62.2% of the cohort) for the study at their homes by devising a strategy to identify and trace patients from address given in TB registers. RESULTS: Mean age of identified patients is 51.9 years. 82.4% were males. 79% patients report full supervision in the intensive period. After seven years 64.1% are healthy, work and earn; 29.8% report residual respiratory problems; 0.3% of symptomatic patients were diagnosed with smear positive pulmonary tuberculosis. Relapse calculated as worst case scenario for full target population (dead and migrated inclusive) is 9.27%. Age specific mortality is 4-6 times higher than in a comparable general population. CONCLUSIONS: DOTS treatment under program conditions makes a measurable reduction in tuberculosis morbidity. Though high proportion of patients remains productive after DOTS, a significant proportion complains of residual respiratory symptoms. Age specific mortality of Post tuberculosis patients is high compared to general population. Close follow up irrespective of duration of symptoms may help to determine the causes of high residual morbidity and mortality rates.
Authors: Malvika Verma; Karan Vishwanath; Feyisope Eweje; Niclas Roxhed; Tyler Grant; Macy Castaneda; Christoph Steiger; Hormoz Mazdiyasni; Taylor Bensel; Daniel Minahan; Vance Soares; John A F Salama; Aaron Lopes; Kaitlyn Hess; Cody Cleveland; Daniel J Fulop; Alison Hayward; Joy Collins; Siddartha M Tamang; Tiffany Hua; Chinonyelum Ikeanyi; Gal Zeidman; Elizabeth Mule; Sooraj Boominathan; Ellena Popova; Jonathan B Miller; Andrew M Bellinger; David Collins; Dalia Leibowitz; Shelly Batra; Sandeep Ahuja; Manju Bajiya; Sonali Batra; Rohit Sarin; Upasna Agarwal; Sunil D Khaparde; Neeraj K Gupta; Deepak Gupta; Anuj K Bhatnagar; Kamal K Chopra; Nandini Sharma; Ashwani Khanna; Jayeeta Chowdhury; Robert Stoner; Alexander H Slocum; Michael J Cima; Jennifer Furin; Robert Langer; Giovanni Traverso Journal: Sci Transl Med Date: 2019-03-13 Impact factor: 17.956