When DPSEEA model is applied on TB

1. TUBERCULOSIS: DPSEEA MODEL
Basanta Chalise
Roll no.- 01
MHPE
IOM

2. OUTLINE OF THE PRESENTATION
• Introduction
• DPSEEA Framework
• Driving forces
• Pressures
• State
• Exposure
• Effects
• Actions
• Conclusion

3. INTRODUCTION
• TB is an infectious disease caused by the
bacillus Mycobacterium tuberculosis. It
typically affects the lungs (pulmonary TB)
but can affect other sites as well
(extrapulmonary TB).
• It is transmitted by droplet infection.

6. DRIVING FORCES
• Rapid population growth
• Industrialization
• Rapid urbanization
• Migration (intra & inter)
• Poverty
• Poor socio economic conditions

7. PRESSURES
• Overcrowding
• HIV/AIDS
• Poor sanitation and housing condition
• Unplanned settlement and urban slum
• Increase number of cases
• Delay diagnosis and inadequate treatment
of cases
• MDR TB

8. STATE
GLOBAL
Tuberculosis (TB) remains one of the world’s
deadliest communicable diseases. In 2013,
an estimated 9.0 million people developed
TB and 1.5 million died from the disease,
360 000 of whom were HIV-positive. TB is
slowly declining each year and it is
estimated that 37 million lives were saved
between 2000 and 2013 through effective
diagnosis and treatment

10. STATE
SEAR
• Of the estimated 9 million people who
developed TB in 2013, more than half
(56%) were in the South-East Asia and
Western Pacific Regions.
• India and China alone accounted for 24%
and 11% of total cases, respectively.

11. STATE
Nepal
• Tuberculosis (TB) is a major public health
problem in Nepal.
• About 45 percent of the total population is
infected with TB, of which 60 percent are
adult. Every year, 45, 000 people develop
active TB, out of them 20,500 have infectious
pulmonary disease.
• Treatment by Directly Observed Treatment
Short course (DOTS) has reduced the
number of deaths; however 5,000 7,000‐
people are still dying per year by TB.

12. EXPOSURE
• Elderly
• People living with HIV/AIDS (PLHIV)
• Prisoners
• Diabetic patients
• Frequent contact with TB patients
• Smokers
• Urban Slums
• Migrants
• Poor/malnourised
• Remote areas
• Minorities

13. EFFECTS
• TB kills millions people every year
• Co-infection with HIV cause increased
mortality
• Multidrug-resistant TB
• Psychological effects - stigma
• High DALY lost
• Increase Poverty (The World Bank estimates
that loss of productivity attributable to TB is 4
to 7 percent of some countries' GDP)

14. ACTIONS: GLOBAL
• Millennium Development Goal (MDG)
framework includes five indicators: TB
incidence, TB mortality, TB prevalence, the
case detection rate for new TB cases and
the treatment success rate for new TB
cases.
• Global Plan to Stop TB 2011−2015 - There
has been encouraging progress towards
2015 targets for TB/HIV interventions.

15. ACTIONS: NATIONAL
National TB Program (NTP) Goal, Strategy
and Target:
• Vision: Tuberculosis free Nepal
• Goal: To reduce mortality, morbidity and
transmission of tuberculosis until it is no
longer a public health problem

16. Objectives:
• To dramatically reduce the National burden
of TB by 2015 in line with the Millennium
Development Goals and the Stop TB
Partnership targets
• Achieve universal access to high quality‐
diagnosis and patient centered treatment‐
• Reduce the human suffering and
socioeconomic burden associated with TB
• Protect poor and vulnerable populations from
TB, TB/HIV and multi drug resistant TB‐ ‐

17. Targets:
• MDG 6, Target 8: ...halted by 2015 and
begun to reverse the incidence.
• Targets linked to the MDGs and endorsed by
the Stop TB Partnership:
– By 2005: detect 100% of new sputum smear‐
positive TB cases and cure at least 85% of these
cases.
– By 2015: reduce prevalence of and death due to
TB by 50% relative to 1990
– By 2050: eliminate TB as a public health problem
(<1 case per million population)

18. Components of the Stop TB strategy
1.Pursue high quality DOTS expansion‐
&enhancement
2.Address TB/HIV, DR TB and other‐
challenges
3.Contribute to health system strengthening
4.Engage all care providers
5.Empower people with TB, and communities
6.Enable and promote research

19. Key activities of NTP are as follows:
• Provide effective chemotherapy to all patients in accordance with
national treatment policies.
• Promote early diagnosis of people with infectious pulmonary TB by
sputum smear examination.
• Establish a network of microscopy centers and a system of quality
control of sputum smear examination.
• Establish treatment centers for every 100,000 population within the
existing primary health care system.
• Provide continuous drugs supply to all treatment centers. This includes
systems for procurement, storage, distribution, monitoring and quality
control of drugs.
• Maintain a standard system for recording and reporting
• Monitor the result of treatment and evaluate progress of the program, by
analyzing periodic treatment outcome in cohorts of patients.
• Provide continuous training and supervision for all staff involved in the
NTP, at each level.
• Pilot and expend health communication project to improve
communication between health workers and TB patients and to promote
community awareness about TB.
• Expansion of income generation and skill development training activities
to needy DRTB patients in all over the country.

20. CONCLUSION
• TB is a infectious disease which is major
public health problem in Nepal.
• Its control depends upon multi-sectoral
coordination and collaboration.
• Poverty alleviation and improved
sanitation along with public health
measure are essential to control TB.

21. REFERENCES:
• Class notes
• Global TB report (2014) – WHO
• Annual Report (070/71) – DoHS
• http://www.who.int/en/