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17 May 2012

The cases of TB have increased in Madhya Pradesh. Thus the Government has declared it as a notifiable disease, writes Zafar Alam Khan

Worried with the increasing tuberculosis (TB) cases in Madhya Pradesh, the Union Ministry of Health has listed it as a ‘notifiable’disease in the State and directed to notify it about cases of TB.

The directive has come in the wake of the fact that TB, unlike in the past, is no longer a poor man’s disease. The need for surveillance of cases was also felt after a number of Totally Drug Resistant TB was reported in Mumbai and a large number of TB patients are diagnosed but they are not referred to or notified to the Revised National TB Control Programme (RNTCP).

The Ministry of Health and Family Welfare in its order to the State Government has asked to have complete information on all TB cases for effective control, reduction of TB transmission and address of the problems of emergence of Drug Resistant TB. In January, the TB control division had asked the Union Health Ministry to declare TB a notifiable disease.

Indore District TB officer, Dr Vijay Chhajlani said, "We have received orders from the Union Ministry to notify all the TB cases. A format has been given which will have to be filled by the doctors treating TB patients and submit monthly report." Till now private clinics and doctors were not bound to make and submit record of TB patients, particularly, to the Health Department.

Under the new system, all health officials at the State, district, sub–districts and municipal corporation levels and clinical establishments run or managed by the Government including local authorities, private or NGO sectors and/or individual practitioners in all the districts and towns in the State will have to maintain a track record of TB patients. “With improved notification, RNTCP could improve case management and reduce TB transmission and the spread of drug–resistant TB," said Dr Chhajlani.

The State Health Department estimates suggest that the State has nearly 90,000 TB patients. In the examination report, the Health Department in Indore district has found that an average of 17 patients every month was detected with multi–drug resistant (MDR) TB during April to December 2011.

A private sputum culture testing lab has diagnosed 120 MDR–TB patients among 600 patients during the same period. The situation is also alarming as a nearly 13,500 children in the State are estimated to be infected with TB.

Patients suffering from tuberculosis (TB) can now avail same services from registered private doctors as being offered by the Government centres. The private doctors will give the TB patients medicine provided by the Government free of cost.

A Memorandum of Understanding (MoU) was signed by three doctors with the district TB centre who would provide TB patients with free diagnosis and medicine during the course of treatment. The patient would only have to pay consultation fee to private doctors.

The MoU was signed after a district training programme under Revised National Tuberculosis Control Programme (RNTCP) was organised in the city on Sunday.

Indian Medical Association organised the programme to encourage medical practitioners to refer TB suspects and diagnosed TB patients to RNTCP and to start DOTS centres.

"The idea is to engage private practitioner and reach maximum people," said joint director health Dr BS Ohri."A referral by these registered doctors would be accepted by the Government–run hospital and TB centre who would diagnose patients free," he added.

District TB officer Dr Manoj Verma said, "On an average a TB patient spends about Rs 1,000 a month on medicines excluding expenses on diagnosis."

Under the plan, private medical practitioner’s referral form would be accepted by the Government medical centre and the diagnosis would be conducted free of cost.

However, as per the agreement the private practitioners would not be allowed to conduct or refer any tests of the TB patient to other private diagnostic centres.

The Madhya Pradesh Health Department has mooted a proposal to involve private hospitals to increase the screening of tuberculosis (TB) patients.

If approved, designated microscopy centres DMC LT scheme would be available in designated private hospitals to improve interventions for tuberculosis control and elimination.

Presently, the State has just 743 designated microscopy centres (DMC). The Health Department sources said that the proposal would help achieve TB screening and detection targets for the State.

Under the scheme, any hospital with the required DMC equipment would be eligible to come under the scheme but the laboratory technical (LT) would have to be approved by the Health Department. "The proposal is in its final stages and likely to come into effect within a month," said a senior Health Department official.

The new proposal comes a month after the State’s Health Department signed an Memorandum of Understanding (MoU) with private medical practitioners in the city to provide TB patients with free medicine and diagnosis during their course of treatment.

The patient once registered would avail the same benefits as those visiting a Government hospital and only have to pay the consultation fee to the private doctor.

A review meeting evaluating the performance of Revised National Tuberculosis Control Programme (RNTCP) in the State conceded that renewed stress is needed in few districts.

The review was held with a team from the World Health Organisation (WHO), looking into the State’s progress on TB elimination.

The goal of RNTCP is to cure at least 85& of new smear–positive (NSP) cases of tuberculosis and to detect at least 70& of such patients in the State.

However, the review pointed that in 2011, 52& NSP detection was achieved. “Treatment of NSP patients has increased to 90&, however we are working to increase case detection," said joint director, Health, Dr BS Ohri.

"Clearly, good outcome and high case detection rates are essential. In fact, experience clearly shows that reliably curing patients results in a good publicity. Case detection rates steadily increase as cured patients act as best ambassadors.

Cured patients act as good motivators promoting case detection and patient adherence to treatment," he added.

A tuberculosis patient once registered at private hospitals will avail the same benefits as those visiting a Government hospital and only has to pay the consultation fee to a private doctor.

DOTS plus treatment in Bhopal

Much awaited DOTS plus service used for the diagnosis and treatment of drug resistant TB cases was launched by District Collector Nikunj Shrivastava recently in Bhopal.

Multi–drug–resistant tuberculosis (MDR–TB) is defined as TB that is resistant to Isoniazid (INH) and Rifampicin (RMP), the two most powerful first–line anti–TB drugs widely used to treat TB patients.

“Tuberculosis patients who have developed resistance to the prevailing drugs would be administered DOTS plus treatment in the city," said Shrivastava. The zonal TB centre became the second in the State after Indore which will provide free of cost treatment to the MDR–TB patients.

The Collector administered the first dose to the only confirmed victim of the mildly contagious form of TB in the city. However there are about 250 such suspected cases in the city, informed Bhopal District TB officer Dr Manoj Verma.

"MDR–TB culture is known only after three months and the treatment is started once it is confirmed," said Verma. The cost of MDR–TB drugs ranges from Rs 300 to Rs 700 per day, depending upon the dosage required by the patient. The drugs available for free at the centre have to be taken for about 37–43 weeks without any gap.

The prevalence of TB in India is 216 cases per 1,00,000 population. However, about three per cent of the TB patients can develop MDR–TB, which is transmissible to others, say experts.

The District TB centre has sent 13 samples of suspected MDR–TB to the Bhopal Memorial Hospital and Research Centre (BMHRC) for testing. In India, 10 States are implementing DOTS plus services while another five States would be initiating the services shortly.

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