Performance of Revised National Tuberculosis Control Programme (RNTCP) in tribal areas in India.

BACKGROUND & OBJECTIVES: The Revised National Tuberculosis Control Programme (RNTCP) provides free diagnostic and treatment services to all tuberculosis (TB) patients registered under it. Equitable access, implying a preference for the most hard-to-reach groups particularly for tribal areas, is a major concern for RNTCP. This study was conducted to assess the performance of RNTCP in terms of case detection and cure rates in areas dominated by tribal groups in India. METHODS: We used the RNTCP data collected by the Central TB Divison, Government of India. RNTCP has a systematic monitoring mechanism which tracks the outcome of every patient put on treatment. There is a standardized recording and reporting structure in place; indicators are monitored regularly at every level of the health system; and regular supervision ensures quality of the Programme. The main indicators include the number of cases diagnosed and the percentage of patients who are successfully treated. These indicators were used to assess the RNTCP performance in tribal areas. RESULTS: We observed a poor performance in terms of case detection rate (CDR) in tribal and backward districts as compared with other districts in India. Among tribal districts 53 per cent in 2010, 45 per cent in 2011 and 56 per cent in 2012 had CDR of new smear positive <70%. It was also observed that 26 per cent of tribal dominated districts had CDR of <51 per cent in 2012. More than 50 per cent of tribal districts were not able to achieve more than 85 per cent of cure rate. INTERPRETATION & CONCLUSIONS: The findings of this study suggested that the overall RNTCP performance in tribal areas was not optimal, and the target of >85 per cent of core rate was achieved by less than half of the tribal districts.

TB free India: Reaching the unreached tribal population under National Tuberculosis Elimination Programme.

India is the highest TB burden country in the world. The burden however is not uniform in different strata including tribal population - one of the key affected populations in the country. As the evidences from tribal population are hardly available, most of the policies and strategies implemented under National Tuberculosis Elimination Programme (NTEP) are usually based on the evidences from general populations. NTEP is continuously taking steps to strengthen TB services in tribal areas. The Social Action Plan including Tribal Action Plan is in place and the appropriate strategies are incorporated in the National Strategic Plan (NSP) to ensure universal access to quality TB services to vulnerable population groups. However, its implementation becomes challenging especially in tribal areas as different tribal groups have their own unique ways of dealing with health issues. These issues are therefore required to be addressed holistically involving all the stakeholders. In view of this a symposium was jointly organized by the Central TB Division (CTD), Govt. of India and ICMR - National Institute of Research in Tribal Health (NIRTH), Jabalpur on 17th and 18th December, 2019 at ICMR - NIRTH, Jabalpur. It provided an excellent platform for all the stakeholders from different parts of the country to share their experiences in tuberculosis particularly among marginalized populations. The recommendations emerged out of this interactive symposium highlight the sincere effort of NTEP to tackle TB situation in tribal population and show the way forward towards India's TB elimination goal by 2025 especially in hard to reach tribal areas.

Filariasis control in rural areas through detection and treatment with diethylcarbamazine.

A pilot study for control of bancroftian filariasis through detection and treatment of microfilaria (mf) carriers and filaria disease cases with Diethylcarbamazine (DEC) undertaken in the rural areas of Srikakulam and Vizianagaram of Andhra Pradesh showed that this chemotherapeutic method of control of filaria in rural areas is feasible and acceptable to society. During first round of detection and treatment 20,300 mf carriers (90.6 per cent of detected) and 6,588 disease persons (86 per cent of detected) in Srikakulam and 7,097 mf carriers (94.8 per cent of detected) and 1,436 disease persons (93.4 per cent of detected) in Vizianagaram were treated with DEC tablets. These areas were again surveyed after five years and detected cases were treated with DEC with coverage of treatment ranging from 82.3 per cent to 95 per cent for both mf & disease cases and decline in mf and disease rate was noted to be 52.4 per cent and 50.9 per cent respectively in Srikakulam and 42.2 per cent for mf rate in Vizianagaram. The mf reduction was appreciably high (50 per cent or more) in 11 PHCs of Srikakulam and 4 PHCs of Vizianagaram. The mf rate reduction was the highest in the age group of 1 to 4 year indicating that the transmission has been cut down significantly. The vector infection rate showed reduction by 50 per cent during second round of detection and treatment as compared to first round, indicating significant reduction in transmission potential.