tuberculosis sensitation for lsgd by dr.mammen p cherian
TRANSCRIPT
DR.MAMMEN P CHERIANMBBS, PGDOR
MEDICAL OFFICER IN CHARGE, PHC NIRANAM
MOTC THIRUVALLA TU
RNTCPTraining for
LSGD MEMBERSCHATHENKERY
24/04/2015
TB Infection
• Chances of getting infected depends on:
1. The duration of exposure2. The frequency of exposure3. The immune status of an
individual
Infection• Entry and establishment of organism in human body• Takes about 6-8 weeks.• Indicated by +ve tuberculin skin test.1. Primary infection – infection occurring for the first time in a susceptible • Individual exposed to M.tb.• Primary complex• Secondary bacillary multiplication that occurs at regional LN• 2.Post primary TB – after a latent period of many months or even years after
primary infection.• Risk of spread of infection:• To 10-15 persons/year for 2-3 years• Risk factors for developing disease:• Strongest risk factor- HIV Co-infection, DM, SMOKING, ALCOHOL ABUSE
India is the highest TB burden country accounting for more than one-fifth of the global incidence
Indonesia6%
Nigeria5%
Other countries20%
Other 13 HBCs16% China
14%
South Africa5%
Bangladesh4%
Ethiopia3%
Pakistan3%
Phillipines3%
India21%
Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing
Global annual incidence = 9.4 millionIndia annual incidence = 1.98 million
India is 17th among 22 High Burden
Countries (in terms of TB incidence rate)
WHO estimates for TB in India (2013)
Incidence of TB disease
2.2 million per annum
(176 per 100,000 pop. per year)
Prevalence of TB disease
2.8 million (230 per 100,000 pop. per year)
Mortality due to TB
270,000 per annum (>900/day)
(22 per 100,000 pop. per year)
Problem of TB in India• Incidence: >1.98 million new TB cases annually
– 0.8 million new infectious cases– 75 NSP cases / 100,000 population / year – Incidence more in north and less in south– Incidence more in urban areas – TB is more common among males
• Prevalence: – WHO estimate (2007) – 3.3 million TB cases
• Deaths: about 2,76,000 deaths due to TB each year– One of the leading infectious cause of death– Nearly 1000 deaths due to TB per day; about 2 deaths every 3 minutes
Problem of TB in India..• Infection: 40% (~400m) infected with tuberculosis bacteria
– Only 10% of them will develop TB disease in lifetime– Co-infection with HIV increases risk of TB disease by 6 to 8 times– Several other factors also increase this risk, e.g. diabetes, smoking, poor
nutrition, etc• HIV : 1. 2.27 million people living with HIV; nearly 1 million co-infected with HIV and TB
2. About 5% of TB patients estimated to be HIV positive3. HIV in TB varies greatly between districts and states (<1% to 14%)4. More in south (except Kerala), north-east and some scattered districts• Estimated Multi-drug resistant TB
1-3% in new cases12-17% in re-treatment cases
• DM, SMOKING
Estimated* Incidence of TB in India(No. of NSP Cases per 100,000 population, per year)
National 75 North Zone 95East Zone 65**West Zone 80South Zone 50**
North
West East
South
* Estimated from ARTI survey
** For programme monitoring purpose estimated cases in East & South zones have been kept at the national level of 75
ARTI survey by NTI 2001-2003
Annual Risk of Tuberculosis Infection(ARTI)
Proportion of population that gets newly infected ( or re-infected ) with tubercle bacilli during the course of one year
ARTI for the country is 1.5%. For Kerala it is 1.0%
203 cases per lakh population is infected each year.
135 cases/L/Year-Kerala
Type of case Occurrence / lakh / year
NSP (Definitive) 75 cases
NSN (Probable) 75 cases
Previously treated
38 cases
EP 15 cases
Total 203 cases
Type of case Occurrence / lakh / year
NSP (Definitive) 50 cases
NSN (Probable) 50 cases
Previously treated
25 cases
EP 10 cases
Total 135 cases
OUR BLOCK
PHC Ned
umpuram
PHC Nira
nam
PHC Kutta
ppuzha
PHC Kad
apra
PHC Kutto
or
CHC Chath
enkery
0
1
2
3
4
5
6
7
NSP 1Q2014NSP 2Q2014NSP 3Q2014NSP 4Q2014
NEW SMEAR POSITIVE CASES
0
1
2
3
4
5
6
1
3
4
1 1
3
2
1 1 1 1 1 1 1 1 1
3
1
5
22
3
1 1 1
4
1 1
2 2
3
1
3
1 1
5
4
1 1 1
3
1
2 2
1
2
4
3
1
2 2
1
2
1
2
5
6
1 1
5
2
1 1
3
1
4
2
1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW SMEAR POSITIVE CASES
PHC Ned
umpuram
PHC Nira
nam
PHC Kutta
ppuzha
PHC Kad
apra
PHC Kutto
or
CHC Chath
enkery
0
0.5
1
1.5
2
2.5
3
3.5
NSN 1Q2014NSN 2Q2014NSN 3Q2014NSN 4Q2014
NEW SMEAR NEGATIVE CASES
PHC Nedum
pura
m
PHC Nirana
m
PHC Kutt
appuz
ha
PHC Kada
pra
PHC Kutt
oor
CHC Chathe
nkery
THQH Mall
appall
y
CHC Chathe
nkery
PMCH Thiruva
lla
PHC Kott
angal
PHC Kav
iyoor
PHC Kun
namthan
am
PHC Anicad
u
PHC Kott
anadu
CHC Kallo
oppar
a
PHC Thelliy
oor
CHC Ezhum
attoor
PHC Kum
bana
du
PHC Puramatt
om
PHC Othe
ra
CHC Kanje
ttuka
ra
PHC Koipur
am
PHC Thottapp
uzha
ssery
0
0.5
1
1.5
2
2.5
3
3.5
4
1
3
2
1
2
3
1 1
4
22
1 1 1 1 1 1 11 1 1
2 2
1 1 1 1
2 2
11 1 1 1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW SMEAR NEGATIVE CASES
PHC Ned
umpuram
PHC Nira
nam
PHC Kutta
ppuzha
PHC Kad
apra
PHC Kutto
or
CHC Chath
enkery
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
NEP 1Q2014NEP 2Q2014NEP 3Q2014NEP 4Q2014
NEW EXTRA PULMONARY CASES
0
1
2
3
4
5
6
7
3
1
2
4
1 1 1
2
1
2
1 1 1 1 1
3
1 1
2
5
1 1 1 1 1 1
4
2
1 1
2
7
1
2
1 1 1 1 1 1
2 2
3
2
1 1
3
2
1 1 1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW EXTRA PULMONARY CASES
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
11 1 1 1 11 1 1 11
1Q2014 2Q2014 3Q2014 4Q2014
PAEDIATRICS TB
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