Either by clinical iceberg or the lack of people, tuberculosis is not a major public health problem in Sik district. Hence we had an informal session with IK Jamal and MA Alimin regarding this topic.
The prevalence of TB in 2010 was 31 reduced from 45 of the previous year affecting mainly locals. As far as Sik is concerned no major trends are observed in disease epidemiology. Sputum negative cases are rare (three last year) while HIV infection is 5%; seen in the younger age group (20 + years). There was a 2% mortality rate with no MDR, XDR and paediatric TB. The last case of paediatric TB was in 2006. There were no cases of failure, relapse or reinfection last year. An improvement on the whole compared to the previous year.
However the major problem in this seemingly rosy data is the low case detection rate which 68% (not up to the 70% case detection target). The lack of awareness and a focused TB programme is suspect even when resources like medicines are sufficient and funded centrally as well as referrals to the Chest Clinic which operates periodically in Sik Hospital.
The DOTS coverage is 100% although in KK Jeniang the few patients seen there complain of transport issues to the healthcare centre and the prolonged duration of treatment. The side effects of treatment sometimes lead to defaulters. Contact tracing also becomes an issue as at times the index case in a population could not be traced.
TBIS
Refer to Health Infrastructure blogpost by Cassandra.
Contact Tracing
The procedure for contact tracing would to visit the home and workplace of the case and note if they are symptomatic and giving them referrals for a sputum test or CXR. If they fail to comply a warning notice is issued and further similar behavior can result in legal action.
Investigating a TB death
The cause of death would be analysed to ascertain it was a TB mortality. A visit to the individual’s home by the FMS and MA is in order to examine the death certificate and interview the caregivers.
Current Directions
As of now, there is a TB diagnosis and treatment room in the KKs in which each patient’s detailed record is managed as per TBIS as well as drugs are stored according to their doses individualized to the patient. Each patient has a file containing follow-up details, side effects monitoring, notification, treatment course and plan and investigations. A patient’s series of CXRs are also maintained.
The current high prevalence of diabetes has also resulted in TB screening in diabetics as they are prone to be immunocompromised which leads to active TB.
However as with diarrheal diseases, there appears to be no specific programme targeted on TB and mere health education programs carried out by the Health Promotions Unit. The reported low case load is behind this. Although in the Health Plan of Action for 2011, case detection rates and DM TB screening is expected to be made priority and this would work towards better management of this disease.RavivarmaRao
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