NATIONAL T.

B
CONTROL
PROGRAMME
PRESENTED BY:
AYUSHI RAINA
CLINICAL INSTRUCTOR
 INTRODUCTION
 Tuberculosis is the most frequent cause of
death from any infectious agent. It is a leading
cause of death in the age group 15-44,
especially in women, where it is responsible
for 10% of deaths.
 Global burden of TB
 9.4 million (139/lakh) new cases in 2011 (acc.
To WHO report 2011)
 Global incidence of TB has peaked in 2004
and is declining.
 1.77million deaths in 2007, 98% in low-
income countries
 MDR-TB -prevalence in new cases around
3.6%
NATIONAL T.B CONTROL
PROGRAMME

The National TB control programme

was launched in 1962.under this
programme school children were
subjected to montonx testing and
negative case were given BCG
vaccination.
OBJECTIVES OF NTCP
 To reduce the incidence of tuberculosis.
 To detect the maximum number of TB cases.
 Under NTCP “ District Tuberculosis Clinic” have been
set-up the activities of DTC are following:-
 Provide BCG vaccination to all new born babies.
 Sputum examinations are done to detect cases.
 Registration of all sputum positive cases.
 Symptomatic treatment is offered.
 Supervision for TB control, drug supply and good
quality of anti-tuberculosis work.
 REVISED NATIONAL TB CONTROL
PROGRAMME ( RNTCP)
 NTCP did not fulfill the expected outcomes. So
RNTCP was launched . Reason of failure of the
program were following:-
 Lack of finance /budget.
 Lack of trained staff.
 Inadequate supply of anti-tuberculosis drug.
 Inadequate laboratory facilities.
 Poor integration of tuberculosis care.
 Inadequate treatment of cases, discontinue
treatment prematurely.
OBJECTIVES OF RNTCP

Cure rate for severe

cases through “
Case detection is directly observed
emphasized treatment short
course” ( DOTS) has
raised to 85%.
ACTIVITIES OF RNTCP
 Sufficient finances
 IEC enhanced
 Laboratory facilities ( sputum microscopy, chest X-ray)
are standardized.
 Anti-tuberculosis treatment regimens are standardized.
 Well oriented and trained staff appointed.
 Tuberculosis clinics were set-up.
 NGO’s voluntary agencies are encouraged to involve in
implementation of DOTS.
 DOTS introduced.
(DOTS ) Directly observed
treatment , Short-course
 The DOTS strategy along with other components
of the stop TB strategy, implemented under the
RNTCP in India, is a comprehensive package for
TB control.
 The DOTS strategy is cost-effective and is today
the international strategy for TB control
programmes.
DOTS is a systematic strategy which
has five components:-

Political &
Good quality
administrative Good quality drugs
diagnosis
commitment

Supervised Systematic
treatment to ensure monitoring and
the right treatment accountability
 FEATURES

Early detection of TB.

Priority is given to sputum positive
cases .
Close supervision is done while
administration of Anti- tuberculin drugs.
Registration ,monitoring and regular
follow-up.
PREVENTIVE MEASURES
 LEAVELL’S LEVELS OF PREVENTION
Stage of disease Level of prevention Type of response

Pre-disease Primary Prevention Health promotion and

Specific protection

Latent Disease Secondary prevention Pre-symptomatic

Diagnosis and
treatment

Symptomatic Disease Tertiary prevention • Disability limitation for

early symptomatic diseas
• Rehabilitation for late
Symptomatic disease
Level of prevention
Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention
 1. Primordial prevention
 Primordial prevention consists of actions and
measures that inhibit the emergence of risk
factors in the form of environmental,
economic, social, and behavioral conditions
and cultural patterns of living etc.
 It is the prevention of the emergence or
development of risk factors in countries or
population groups in which they have not yet
appeared .
 Contd…
 For example, many adult health problems
(e.g., obesity, hypertension) have their early
origins in childhood, because this is the time
when lifestyles are formed (for example,
smoking, eating patterns, physical exercise).
 Contd…
 In primordial prevention, efforts are directed
towards discouraging people from adopting
harmful lifestyles
 The main intervention in primordial
prevention is through
• Individual
• mass education
 2. Primary prevention
 Primary prevention can be defined as the
action taken prior to the onset of disease,
which removes the possibility that the disease
will ever occur.
 It signifies intervention in the pre-
pathogenesis phase of a disease or health
problem.
 Primary prevention may be accomplished by
measures of “Health promotion” and “specific
protection”
 Contd…
 Health promotion activities can be
• using appropriate hand washing techniques
 Contd…
 vaccination to prevent disease occurrence (the only
vaccination for TB on the market is the bacille
Calmette-Guérin (BCG) vaccine)
 Contd…
 Specific protection activities
 Another form of primary prevention for TB is
environmental control, such as
▪ ultraviolet lights

▪ ventilation
 Contd…
Primary prevention
Health promotion
Health education
Environmental modifications
Nutritional interventions
Life style and behavioral changes
Specific protection
Immunization
chemoprophylaxis
Use of specific nutrients or
supplementations
Protection against occupational hazards
Safety of drugs and foods
Control of environmental hazards,
e.g. air pollution
 Contd…
 It includes the concept of
positive health.

 The WHO has recommended the following

approaches for the primary prevention of T.B.
Both the approaches are complementary.
 Contd…
a) Population (mass) strategy

b) High- risk strategy.

 
 a) Population strategy
 Tuberculosis (T.B) is primarily a mass
disease. The strategy should therefore be
based on mass approach focusing mainly on
the control of underlying causes (risk factor)
in whole population, not merely in
individuals.
 b) High risk strategy
 Identification of risk :- By means of simple test
such as sputum test, the tuberculin skin test (tst) it is
possible to identify individuals at special risk.
 Contd…
Specific advice:- The patient should be advised
 Tb is infectious, but it may be cured or arrested if
patient take medication as prescribed.
 Cover nose and mouth when coughing, laughing and
sneezing.
 Wash hands very carefully after any contact with the
body substances, masks, or soiled tissues.
 Contd…
 Wear masks when advised. Make sure they
are tight fitting and change them frequently.

 Treatment may be necessary for the long time.

Take medication exactly as prescribed and
report any side effects to doctor.

 Don’tstop medication for any reason without

doctor’s supervision. Compliance with
treatment is essential.
 3. Secondary prevention
 Themain aim of secondary prevention is to
prevent the recurrence & progression of T.B.

 Earlydetection of cases (e.g. screening tests,

and case finding program)

 Treatment
 Contd…
 Secondary prevention attempts to arrest the disease
process, restore health by seeking out unrecognized
disease and treating it before irreversible pathological
changes take place, and reverse communicability of
infectious diseases.
 It thus protects others from in the community from
acquiring the infection and thus provide at once
secondary prevention for the infected ones and
primary prevention for their potential contacts.
 a) Early Detection of latent TB infection (LTBI)

The Tuberculin Skin Test (TST) :- The first is a

skin test in which testing material, called
tuberculin, is injected intradermally into the
individual and in 2 to 3 days, the patient
returns to the health care worker who checks
to see if there is a reaction to the test.
 
 Contd…
 QuantiFERON-TB Gold (QFT-G) :-The second
test used to identify LTBI is QFT-G, a blood test that
measures how a person’s system reacts to the
bacteria that causes TB.
 Contd…
 Secondary prevention of TB involves the identification and
testing of targets groups of people and communities with
greater likelihood of being infected. Some of these high risk
groups are:
 Health care workers who work with patients at risk of TB
 Those who have lived or traveled extensively in areas
where TB is endemic
 Immunocompromised individuals
 Those who have had a recent positive conversion of a skin
test
 Persons who live in a congregant setting (e.g. jails and
nursing homes)
 b) Treatment of LTBI

 Patientswho are identified as being infected

with TB should be evaluated for active TB
disease, by receiving a chest X-ray, and a
focused clinical evaluation. Once active
disease is excluded, one of the following
treatments should be taken
▪ Multidrug therapy
▪ DOTs
 Contd…

Multidrug therapy
Contd…
DOTs
 4. Tertiary prevention
 Tertiary prevention defined as “all
measures available to reduce or limit
impairments and disabilities, minimize
sufferings caused by existing, departures
from health and to promote the patient’s
adjustment to the condition.”
Rehabilitation of the patient by giving
vocational, psychological and medical
components based on team work.
 Contd…
 The treatment of people who have already
developed a disease is often described as tertiary
prevention. Each person with infectious TB has
the potential to infect many others; however, the
site of the infection is important in determining its
capability to spread.
For example, the lungs and larynx are two
common organs where TB may be highly
infectious. If instead, the TB infection is localized
to areas such as lymph nodes or outside the lung,
treatment is necessary, yet it is not transmissible
 Role of nurse in
prevention and control
of T.B
Contd…
1. Identify symptoms of TB.
Contd…
2. Ensure that pt. brings sputum
from home (morning sputum)
Contd…
3. Proper disposal of sputum.
Contd…
4. Ensure follow-up of pts on ATT.
Contd…
5. Help to remove fears & taboos
towards the disease.
Contd…
6. Immunize children with BCG at
earliest age.
Contd…
7. Educate the community that TB is
curable & a productive life is possible.
Contd…
8. Help in screening of whole family
where a case of TB is identified.
Contd…
9. Appropriate training to the health
personnel's and volunteers.
Contd…
10. TB patients should be taught to
use tissues to cover coughs and
sneezes.
Contd…
11. A surgical mask must be worn by a TB
patient whenever they leave the isolation
room.
Even if a Skin Test is
Negative…..
FFever
Coughing THINK TB!
up Blood
Anorexia
ChillsChiclls

Fatigue
Loss
of Appetite
Difficulty
in
Breathing
Night sweats
THANK YOU