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A controlled study of the effect of domiciliary tuberculosis chemotherapy programme in a rural community in South India

Frimodt-Moller, J and Acharyulu, G S and Kesava Pillai, K (1981) A controlled study of the effect of domiciliary tuberculosis chemotherapy programme in a rural community in South India. Indian Journal of Medical Research, 73 (4(Sup)). pp. 1-80. ISSN 0971-5916

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To study thc ellicttq of a domiciliary drug-therapy programme in the control of tuberculosis in a rural community, an investigation was set lip in 1958 under the auspices of the Indian Council of Medlenl I{C!IClln:h ill 12 towns with populations ranging from 6000 to 25000, all within 160 km of Madanapallc (Andhra Pradt'Sh). The prevalences of bacillary and radioloj.(ic~ll cases of pulmonary tuberculosis in adults (llgcd 15 )T or more) were estimated in .. ch town by carrying out a hase-Iine random sample survey iu 1959; also, the prevalences of tuberculous infcl'tion in all schoolchildrt,n aged 5 to 9yr wen' estimated. These thn.'t' in.dices of prevalence were used to rank the 12 towns and tben ndomlyallocate them into two l'omparable groups of 6 towns each, designated as 'Ireatment' and '~:ontmJ' tOWIlS. In treatment tOWIIS, intensi"e case finding ,,-as undertaken hy means of 2 X-ray surveys (suney I during 1960-61 and survey II during 1962-64) l'ovcring alllldults, sputum examinations by microSl'op' Hnd culture when indicated, and eriodic follow lip of all 'suspect' cases with X-ray and SPlltuDl examinations. All bacillary cases were offered domiciliary treatment for onc ~'ear with isoniazid and PAS in the J treatment IOWll~ (selected at random) a.nd with isoniazid alone in the other 3 town.·,. Of 148 2easc~ eligible for trcat-at ment in tJlC 6 treatment towns, 15 per l'en.t refused treatment nd 29 per cent discontin.ued chemotherapy prematurely. In lhe rontrol towns, 0.0 spcdal faeililies for di~gn()sis 01' calment ,vere introduced, and patients w~'re left to the routine treatment facilities aV:lilahk' locally. A tuberculosis prcntlcm:e survey (~ul'l'ey Ill) t'O\'cri~ all adults was 1.1lrried out iD 9.1112 towns during 1965-68, am! lhi:; ~:l." followed hy a random tuberculin sample survey during 1966-69. The overall results of treatment at the end of one year ,,'eJ'e.' (i) among cases initially positive hy micro~opy, 10 per' nt died, 33 per locnt rcmllincd sputum-positive IUld 51 per cent became sputum-negative in INH-PAS towns, the mrl'lsponding percentages fur INH lowns being 15, 48 and 37 per cent respectivel~'; (ii): moug cases initially positive by culture ()nJy, 6 per ent died, 26 J1er cent remained sputum-posithc and 68 per cent became sputum negative in lNH-PAS towns, tbe correspondi percentages for tile INH town~ being 1, 38 an. 55 IJer cent respectively. All the bacillary cases (treated or untrcatt'lf) were followed up and their status at the end of 5 yr was 40.4 per cent dead, 18.2 per cent sputum-positive and 41.4 pCT cent sputum-ne'~ative. Spntum status at one year had considerable prognostic value. Of 532 sputum-negative ea .. at one year, 18 per l'ent were dead, 16 per CCDt sputuDl-posithe and 66 per cent sputum-ncgath'e 5 yr aftenvards, where'd!! the corresponding percentagt'S for (JIC 319 sputum-positive cases at one year were 56, 20 llnd 24 respectively. There was an intennl of about 2l ~'r between sunc)' [ and survey [[ and ahout 4 yr between survey [J and survey 111 in the 6 treatmellt towns. The prevalence of badllary cases in these sUr\'eys was age-standardised, cousidering separately l'UseS found hy microscopy and cases found by culture only. The lJlean prevalence of cases (Wsitive hy microscopy in the 6 treatment towns was 6.81 per thousand in survey I and it decre~sed significanUy (P < 0,01) to 5.01 in survey nand 4.83 in survey Ill. Change of culture technique during the course of the investi~ation complicated the interpretation of prcva· lenl'C:l of culture-positive cases. BetwCCR the 1959 base-line survey and tbe resurvey in 1965·68, the prevalence ()f smear-positive tuberculosis decreas~d from 5.92 per thousand adults to 4.78 in the 6 treatment towns, and similarly from 5.72 to 4.21 in the 6 control towns. The prcvalenl-e of 'culture only-positive' cases was 3.85 and 2.44 per thousand adults in the treatment and control towns respectively at the base-line survey and (with the more sesnsitive culture technique) 4.92 and 4.82 per thousand adults at the resurvey in 1965·68. Lastly, tho tuberculin survey in 1966·69 did not I" .,'ell! any' significant differences between the tr t· ment and the control towns. The inability ofthe domiciliary treatment programme to make an impact on the prevalefl:lc of tuberculosis in the rural community around Madanapalle is a finding that has cOllsidera lie siJ,(nilicance in the context of the tubercUlosis control programme in fndia; the rl'asons for the failure aud its implications are discussed.

Item Type: Article
Uncontrolled Keywords: TRC Study paper; Madanapalle Study
Subjects: Tuberculosis > Clinical Research
Divisions: Clinical Research
Depositing User: Dr. Rathinasabapati R
Date Deposited: 27 Jun 2014 06:50
Last Modified: 18 Sep 2018 11:19

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