India has the most number of tuberculosis cases than any other country in the world. Moreover, 2 million new cases are added to this figure every year. And if these stats do not portray the enormity of the problem enough, the fact that one-third of all TB cases throughout the world are from India should. So, controlling tuberculosis in India is one of the foremost issues in India’s health policies and initiatives.
The National Tuberculosis control programme is one of the most extensive public health programmes in the world. It has been very successful but many challenges still exist. It has helped to treat 1.4 million patients and prevent more than 2 lakh deaths. Health infrastructure developed in India consists of health centre for every 1 lakh people, smaller clinic for every 30,000 people, and a health post has been staffed by paramedical workforce for every 5000 people.
The Revised National Tuberculosis Control Programme started in October 2, 1993. Diagnosis of tuberculosis is mainly by sputum microscopy, but treatment is directly observed, and generalised standards for regimens and system of recording and reporting are employed. For the purpose of diagnosis, physicians get training to ask all patients attending health care facilities whether they have suffered from a cough in the last three weeks or more.
Those that report a cough undergo three sputum-smear examinations within two days. For the acid-fast bacilli, two or three of the smears are positive, anti-tuberculosis treatment is started. If all three smears are found to be negative, the patient would be prescribed with one to two weeks of broad-spectrum antibiotics such as trimethoprim–sulfamethoxazole. If one of the three smears is found to be positive or in case the TB symptoms persist after giving broad-spectrum antibiotics, a chest X-ray is needed, for which a larger health centre would be needed. The patient is evaluated over there.
Although the result has been satisfactory with more than 500 million people covered under the programmes, sustaining it in India will need continued financial support, especially for drugs and contractual supervisors, along with continued and intense monitoring and supervision. The creation and equipping of small laboratories with basic training of many health workers should have long term benefits. The rate of decline in the incidence of tuberculosis will be affected by the proportion of cases resulting from recent transmission, as well as by other factors.
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