Enable doctors and NGO's interested in TB control to interact
Indian research in TB
The research and action in the tuberculosis field in India show an astonishing range of creative work done only within only a decade and half(1950-65).By any reckoning this could be considered as an outstanding chapter in the history of public health.Three of the research studies
Comparison of home and sanatorium treatment
Field trial of BCG vaccine
Development of a felt need oriented tuberculosis programme
have dramatically altered the approaches being followed all over the world,both in developed and underdeveloped regions(Banerji D:Ind J Tub,1993,40,61)
To list all the notable works will be difficult.A brief attempt will be made here to cite some of the research works.We cannot claim to list all the efforts made,as it will be a stupendous task
Chemotherapy studies Comparison of home and sanatorium treatment Banerji(loc cit)stated that long before Streptomycin,PAS and INH became available to the general population,BK Sikand had pioneered organised home treatment on a large enough scale through NewDelhi Tuberculosis centre.When the specific drugs became available,he and other TB workers conceptualised the need for a scientific study of all the facets of domiciliary treatment.A comparison of sanatorium and domiciliary treatment of cases of pulmonary tuberculosis at the Tuberculosis chemotherapy centre Madras was the culmination of their efforts.This study showed that results in sanatorium patients despite good accommodation,nursing care,rich diet and prolonged bed rest were not superior to those in patients treated in overcrowded homes who had a poor diet and much less rest.The risk to close family contacts was studied for 5 years particularly in initial non reactors to tuberculin.There was no difference in the incidence of disease between the contacts of patients treated at home and those of sanatorium patients.Thus domiciliary treatment did not entail any special danger that might have been prevented by sanatorium treatment.(Ramakrishnan CV et al 1961,Bull WHO,25:339, Tuberculosis chemotherapy centre 1959,Bull WHO 21,51)These findings prompted a radical departure from traditional sanatorium treatment and opened new prospects for nation wide TB programs in developing countries. Supervised intermittent chemotherapy
Originally it was believed that antituberculosis drugs needed to be given everyday in order to maintain drug concentration in the body continuously at inhibitory levels.In vitro experiments have demonstrated that after a culture of Mycobacterium tuberculosis had been exposed to certain drugs for some time it took several days (the "lag period") before new growth occurred.Though experimental findings cannot be mechanically transferred to man these results were promising enough to be explored in clinical studies.A controlled clinical trial was therefore undertaken at the Tuberculosis chemotherapy centre Madras .A standard oral regimen of INH and PAS was compared with a twice weekly regimen of 1 G of injection streptomycin IM plus 14mg per kg body weight given orally in a single dose.The oral regimen was dispensed for self administration.For the intermittent regimen the treatment was fully supervised ie each patient had to first take his INH tablet in the presence of the staff who checked that the tablet had actually been swallowed and then received the injection.It was shown that the intermittent regimen was highly successful and perhaps slightly more effective than the daily regimens(Tuberculosis chemotherapy centre Madras,Bull WHO 1964,31:247)
In the 1960's the Indian Council of medical Research conducted two nationwide surveys at 9 urban chest clinics((Ind Jour Med Res 1968,56,1617 and (Ind Jour Med Res 1968,57,823).The results of the first survey showed a resistance level of 8.2% to INH alone,5.8% to Streptomycin alone and 6.5% to both the drugs .The primary resistance levels seen respectively in these two surveys were 14.7% and 15.5% to Isoniazid and 12.5% and 13.8% to Streptomycin.
Over the years ,the centre has in a series of controlled trials,developed chemotherapy regimens suitable for applicable under programme conditions.It is not possible to list all these studies here.
Frimodt Moller and PV Benjamin had made preliminary efforts to determine the size of problem which finally led to to the well known national sample survey(NSS)in 1955-58 (Tuberculosis in India a sample survey,1955-58 Special report .Indian Council of medical research New Delhi 1959).NSS was a pioneering effort and the findings stressed the necessity to extend diagnostic and treatment facilities to rural areas.Another important study was the longitudinal epidemiological survey in Bangalore rural district in the 1960's(Gothi GD Incidence of pulmonary tuberculosis and change in bacteriological status of cases at shorter intervals,Ind Journal of Med Research 1978,68,564).
Apart from estimating the incidence of infection and disease it provided valuable insight into the natural history of tuberculin positive individuals and of persons with radiologically or bacteriologically active disease. Click here for Tabulated findings of surveys
Another ambitious study in experimental epidemiology was the enquiry into the protective value of vaccines prepared from some common strains of BCG((Baily GVJ Trial of BCG vaccines in South India for Tuberculosis prevention,Ind Journal of med research 1980,72,1)
Closely following an epidemiological survey of tuberculosis in Tumkur district of Karanataka,a sociological study was designed by National Tuberculosis Institute to measure the degree of awareness of the patients in terms of "consciousness","worry" and "action".It became apparent that about half the patients suffering from tuberculosis at any point of time had already taken "action" at the nearest health centre for relief of their suffering(Banerji D and Anderson S :A sociological study of the awareness of symptoms suggestive of Pulmonary tuberculosis 1963,Bull WHO 29,665).It was obvious that if appropriate facilities were provided at these centres,the cases could be diagnosed and treated at such centres.
In order to establish the case finding potential of the strategy an operational study was carried out.It showed that if symptomatics selected are subjected to direct smear sputum examination at the peripheral health institutions about 50% of the cases prevalent in the district could be diagnosed.Instead if cases were referred for Xray examination at district headquarters only about a quarter of the cases among symptomatics would attend and could be diagnosed(Baily GVJ et al 1967 Bull WHO 37,875)
National Tuberculosis Institute has carried out a number of other studies to find the potential for involving multipurpose workers in case finding and treatment,to assess the results of chemotherapy(conventional later SCC)under programme conditions.
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