1. Guide : DR. DATTATRAYA.D.BANT
MD.DNB.PGDHHM.
PROFESSOR & HOD OF P&SM DEPT.
PROJECT BY 1st BATCH
ABHINAV KUMAR
ABHISHEK G N
ACHYUTH A SHIVPUR
AJAY S S
AKASH M V
ALOK B B

2. PRESENTED BY
ABHISHEK G N
MBBS III/I

3. INTRODUCTION
 TUBERCULOSIS is one of the ancient diseases.
 Chronic infectious disease.
 CAUSATIVE ORGANISM-Mycobacterium tuberculosis
 Mainly affects the lungs-Pulmonary tuberculosis
 Can also affect intestine ,meninges ,bones
& joints,lymph glands,skin & other tissues-Extrapulmonary
TB

4. Burden of the disease
 TB remains a worldwide public health problem and
one the most challenging communicable disease to be
controlled and prevented.
India
20%
Non-HBCs
 India is the country with highest burden 20%
in the world & accounts for nearly China
Other 13 HBCs
1/5th of the global burden. 16%
14%
Philippines
3% Indonesia
6%
Ethiopia
3% Nigeria
Pakistan 5%
3% Bangladesh South Africa
4% 5%

5.  The NTP has been in operation since 1962.
 In 1992, The govt of India, WHO and the World bank
reviewed NTP and introduced RNTCP.
RNTCP is one of the largest public health programmes in
the world.
• 85% cure rate through DOTS
Phase I(1998-2005) • 97% of the population covered
• To decrease the morbidity & mortality due to TB & to cut the transmission
Phase II(2006-2011) • DOTS plus (CAT IV drugs) included to treat MDR & XDR TB
Phase III(2012-2015) • Early detection & treatment HIV associated TB , MDR & XDR TB cases
 Evaluation of RNTCP is very much essential to know the
outcome of treatment ,statistics of tb detected & treated-
mainly HIV associated & drug resistant cases , reasons for
interruption , to assess the effectiveness of the program
and educating public about the importance of
RNTCP.

6. Aims and objectives
 To assess the treatment outcomes of RNTCP in Dharwad
district in 2010 & 2011.
 To identify gaps and underlying contributing factors.
 To explore the reasons for interruption of treatment.
 To assess the effectiveness of the management.

7. Materials & methods
 Place: District Tuberculosis centre(Hubli), Dharwad
district, Old Hubli.
 Duration: 662012 – 572012
 Sample Size & Population: Recorded cases registered
during the period of 2010 and 2011 in the whole Dharwad
district & patient feedback of about 50 patients
 Type of Study: combination of record based study and
observational study
 Statistics: The data collected from questionnaire was
entered and analysis was done in SSPS version 20 statistical
software.

8. Inclusion criteria:
 All TB cases recorded under RNTCP in
Dharwad district during January 2010 to December 2011
for record analysis.
 Observational study from KIMS, Old Hubli & Dharwad
civil hospital.
 Performance indicators for Dharwad, National, State
(Karnataka) data were collected from the website
www.tbcindia.org.
 Incidence, trends of case detection, treatment outcomes,
cure rate and success rate,etc was analyzed.
Exclusion Criteria:
 TB patients who have not been registered under DOTS
treatment..

9. DISCUSSION 2010 1st
half
2010 2nd
half
2011 1st
half
2011 2nd
half
17.88 17.88 18.07 18.07
lakh lakh lakh lakh
Total population
6543 8009 7263 8610
Smear examined
757 743 751 742
Smear positive (11.6%) (9.27%) (10.34%) (8.65%)
Treatment
541 544 540 542
(71.47%) (73.21%) (71.9%) (73.05%)
 The numbers of sputum smears examined are increasing every year
suggesting that the efficiency of RNTCP is increasing .

10.  Of the remaining: < 5% on Non DOTS , an average of
6.3% are initial defaulters
 NSP cases are more common among the economically
productive age group, i.e.15-44 yrs, more so in 35-44
age group.
 It is least common among 0-14 age group ,i.e. around
1%.

11. 70 62.79
63.26 62.75 59.55
60
50
37.25 37.21 40.45
40
36.74 Male
Percentage
30
Female
20
10
0
2010 1st half 2010 2nd half 2011 1st half 2011 2nd half
 Incidence of NSP tuberculosis is more among males than in females
in both the years.

12. Conversion rate
89
88.39
88.5
88
87.5
86.73
87
Percentage
86.5
86 85.64 85.55
85.5
85
84.5
84
2010 1st half 2010 2nd half 2011 1 st half 2011 2nd half
 Sputum conversion rate among NSP should be >90%, but it is less in
Dharwad district in both the years.

13. Success rate
83.00%
81.87
82.00%
81.48
81.00%
Percentage
80.00%
79.00% Success rate
78.00%
77.89 78.32
77.00%
76.00%
75.00%
2010 1st half 2010 2nd half 2011 1st half 2011 2nd half
 Cure rate for NSP should be >85%, this target has not been achieved in
both the years in Dharwad district.

14. Cure rates
100.00%
90.00%
80.00%
70.00%
60.00% Hubli
50.00% Dharwad
Percentage
40.00% Kundgol
30.00% Kalghatgi
20.00%
10.00%
0.00%
2010 Jan-June 2010 July-Dec 2011 Jan-June 2011July-Dec
 Cure rate is highest in Kalghatgi TU & least in Kundgol TU.
 Dharwad and Hubli TUs are showing consistent cure rates in both the
years

15. Death rate
16
14
12
10
Hubli
8 Dharwad
Percentage
6 Kundhgol
Kalgatagi
4
2
0
2010 1st 2010 2nd 2011 1st 2011 2nd
Hubli TU had the highest death rate in 2011.
Kalghatagi TU showed the lowest value in 2011.
Dharwad TU and Kundgol TU are showing varying trends.

16. Cure rates
88.00%
86.00%
84.00%
82.00%
80.00% DHARWAD
Percentage
78.00% KARNATAKA
76.00% INDIA
74.00%
72.00%
70.00%
2004 2005 2006 2007 2008 2009 2010 2011
 Dharwad is having cure rate less than state performance.
Karnataka has lesser cure rate than national sputum conversion rate.
The cure rates have increased in 2011 when compared to 2010 in district and state
and also in the country.

17. Questionnaire results
Female -
32%
Male - 68%
There are more number of TB cases among males than in females, this
may be due to more contacts among males during work hours and less
personal hygiene among them
Males are more exposed to environmental pollutants than females

18. 16
14
5
12
10 Female
No. of patients
8 8
6 1 Male
1 11
4
5 6
2 5 4
1
0 1 1 1
0-10 11-20 21-30 31-40 41-50 51-50 61-70 71-80
years years years years years years years years
Age in years
Tuberculosis is more among 21-30 years of age , this group contains the people
who are working, students and etc where risk of contact transmission from person
to person is more.
These age groups are to be protected by proper health education about personal
hygiene and immunization for prevention of TB.

19.  32% of cases are found to be unskilled workers &
unfortunately the other 34% are students, 16% being
housewives & 14% are skilled workers.
 78% belongs to low socioeconomic status & remaining 22
% to middle SES.
 Vaccination coverage rate is less than 75% in this area.
 Among total cases in the age group 0-10 years 50% were
found to be vaccinated
 Cough and evening rise of temperatures are the chief
complaints of the patients approached.
Around 78% of patients have these complaints.

20.  14% of the cases have contact history .
 12% of the contacts of the patients have symptoms.
 34% dispose sputum in bathroom or basin,16% into
the spit box ,26% on open ground and cover with sand
& remaining 24% do not use any definitive methods..
 20 of 34 male patients & 9 out of 16 female patients
are aware that TB is a communicable disease.

21.  About 14% of the cases have h/o similar treatment
with anti TB drugs in the past and are now under
CAT II as defaulters.
 84% patients are under CAT I, remaining 16% are in
CAT II (14% of default & 2% as relapse case).
 88% patients are regular in treatment ,
6% interrupted due to side effects of drugs &
6% were unable to follow up.

22.  Importantly 4% i.e, 2 cases have HIV associated TB.
 88% patients find that response from RNTCP unit is
good , 10% are satisfied & 2% found it unsatisfactory.
 All the patients are provided with the drugs on every
visit regularly & observed while taking drugs by the
DOTS provider.

23. Conclusion
 RNTCP program implemented successfully in
Dharwad district according to the guidelines.
 Though conversion rates & cure rates are less in
district than that of the state& national rates , there is
a gradual increase in the performance indicators since
then.
 The programme is working efficiently acc to the
patient feedback.
 But there are interruptions in treatment due to side
effects & improper follow up .

24. LIMITATIONS
 Lack of time
 TB cases treated at private hospitals and clinics have
not been included in the records.
 Some data like Cross-referrals between RNTCP and
ICTC was not provided.
 Lack of availability of records of MDR & XDR cases.

25. Recommendations
 Periodic training & monitoring of all lab technicians &
DOTS provider.
 Ensure that all the registered patients are started on
treatment & regularly followed up.
 Early detection & treatment of HIV associated TB &
MDR-TB,XDR & TDR TB patients.
 All the supervisory staff like DTO, STS need to
strengthen their supervisory activities.
 Strengthening the evaluation program.