Active case finding(ACF): tuberculosis

Group 3
Sidharth Mohan-135
Sindhuja-136
Sivaguru Pillay-137
Snega-138
Sonali Sindhu-139
Soorya-140
Sowmiya-141
 INTRODUCTION TO TUBERCULOSIS

• Tuberculosis is caused by bacteria- Mycobacterium tuberculosis that most often affect the
lungs. It is curable and preventable.
• Worldwide, TB is the 13th leading cause of death.
• Globally, the cumulative fall in TB incidence rate was 13.5% between 2015 and 2020.
 BURDEN OF TB

• Most of the TB statistics for India are collected by the Government National Tuberculosis
Elimination Program(NTEP).
• The WHO TB statistics for India for 2021 gives an estimated incidence figure of 2.9million cases.
• This is a rate of 193 per 1,00,000 population. The TB incidence is the number of new cases of
active TB disease during a certain time period.
• The WHO’s TB mortality rate was estimated to be 35 cases per 100000 people.
 ACTIVE CASE FINDING(ACF)

• It was introduced in 2017

• ACF comprises collection of health provider-initiated approaches that involves actively
screening people for TB and initiating treatment for those diagnosed.
• Case finding in TB consists of early identification of individuals with presumptive TB signs/risk
factors at the first point of contact with the health system ( be it pubic or private sector)
followed by prompt diagnosis using high-sensitivity diagnostic tests.
 METHODOLOGY
• The in-charge faculty and PG’s briefed the questionnaire and gave hands on training for data
collection using Epicollect app
• List of Anganwadi’s to be surveyed obtained and area mapping was done.
• Logistics for data collection that includes adequate number of falcon tubes, sputum lab request
forms, chalks were insured.
• The students were allotted to the same families as in their Family Adoption Program(FAP)
• Purpose of the study was explained to the study subjects in detail and informed oral consent
was obtained from the head of the family or adult who is reliable
• An household ID was assigned to each household with specific markings. No
individual ID’s were given.
• Data was collected using epicollect for each household separately. Separate forms
for each individuals were added. For those individuals who were not available ,
proxy entry was made.

Eg: COL-PHC-AWC-team ID-HH ID

COL- IGMC&RI
PHC- Mettupalayam
AWC- Shanmugapuram2
So, IGM-MET-SH2-23-00XX
QUESTIONNAIRE
 Cardinal symptoms of TB

• Productive cough for more than 2 weeks that does not respond to antibiotics
• Hemoptysis( present or not present)
• Chest pain
• Low grade fever for more than 2 weeks
• Night sweats for more than 1 month
• Easy fatigability
• Significant weight loss of more than 10% within 6 to 12 months
 The lab requisition
form was filled by
Instructions for
Presumptive TB the PGs and two Those who had a
sputum collection Sample was
cases will be They were offered labelled sample vulnerability
was given – both collected by the
identified based a NAAT test container(Falcon scoring of two or
for spot sample NGO/ASHA worker
on the presence of (CBNAAT) tubes) was given more were
and early morning and sent to IRL
TB symptoms to the advised CXR.
sample
presumptive TB
cases.
 VULNERABILITY SCORING

Socio-demographic factors:
Age, indoor pollution, occupation, migrant
Clinical risk factors:
Underweight, household contact, past history, post history, post covid, diabetic,
immunocompromised state
Behavioural factors
Alcohol, tobacco smoking
Clinical factors:
Each has a score of 1:
• Post COVID
• Diabetic
• Bedridden receiving palliative therapy
• On dialysis
Each has score of 2:
• Underweight
• Household contact
• Affected with tb in past
• Post COVID that required hospital admission

Behavioural factors: ( each has a score of 1)

• Tobacco user/ smoker - current or in the past 1-3 years
• Alcoholic - current or in the past 1-3 years
 RESULTS
Total no of household
present[85]

No.of houses Locked houses Refuse to

visited in the
[14] participate[0]
morning[71]

Houses covered in
mop-up[9]
 HOUSEHOLDS

• Total no of households surveyed :85

• No of households willing in main round:71
• No of households refusing to participate: 0
• No of households locked:14
• No of households willing in mop up round:9
 HOUSEHOLDS
● Total no of households covered =71+9=80
● Percentage of coverage= 80/85 x 100= 94%
FIG1: PERCENTAGE DISTRIBUTION OF HOUSEHOLD
STATUS N=85
Household status
Visited Locked(Mop up) Refused
6% N=5

94%(N=80)
 TOTAL POPULATION=80

SYMPTOMATICS=NIL
VULNERABLE=80

POSITIVE=NIL
NEGATIVE
= NIL
HIGH
LOW =16
=50 MODERATE
=14

CHEST
XRAY
=30
 POPULATION

• Total no of individuals :80

• No of males:63
• No of females:17
FIG:2 PERCENTAGE DISTRIBUTION OF POPULATION
N=80

Population
Males Females

21%(N=17)

79%(N=63)
PERCENTAGE DISTRIBUTION OF PRESUMPTIVE TB
SYMPTOMS
None of people presented with symptoms of,

•Cough≥14days
•Fever ≥14 days
•Significant weight loss
•Presence of blood in sputum
•Chest pain in last one month
•Expectoration more than two weeks
•Fatigue more than a month
•Night sweats more than a month
•Loss of appetite more than a month
TABLE 2 :Percentage distribution of vulnerability status of the population surveyed
N= 80

VULNERABILITY SCORING NUMBER OF PERCENTAGE

CASES
VULNERABLE High Score 16 20%

Moderate Score 14 18%

Low Score 50 63%

Fig:3 Percentage distribution of vulnerability status of the population
surveyed N= 80
VULNERABILITY

20%(N=16)

LOW
MODERATE
HIGH
18%(N=14)
63%(N=50)
TABLE 3 : Percentage of individual requiring investigation like chest X ray,
CB-NAAT and periodic follow up

NUMBER OF CASE PERCENTAGE

Periodic follow up 50 63%

Chest X Ray 30 37%

CB-NAAT 0 0%
Fig:4 Percentage of individual requiring investigation like chest X ray, CB-NAAT and periodic
follow up
N=80
Investigations
CXR FOLLOW UP

37%(N=30)

63%(N=50)
BEHAVIOURAL FACTORS
TABLE 4: Percentage distribution of behavioural factor of vulnerability scoring N=80
Mettupalayam Shanmugapuram on 4/2023

BEHAVIOURAL FACTORS NUMBER OF CASES PERCENTAGE

Alcoholic 7 9%

Smoker 5 6%

None 68 85%
Fig:5 Percentage distribution of behavioural factor of vulnerability scoring N-
80 in Mettupalayam Shanmugapuram on 4/2023

BEHAVIOURAL FACTORS
none of the above Alcoholic Tobacco user/ Smoker

6% N=5

9%(N=7)

85% N=68
CLINICAL FACTORS

TABLE:5 Pecentage distribution of clinical factor of

diabetes N=80

CLINICAL FACTORS NUMBER OF CASES PERCENTAGE

DIABETIC 9 12%

NON - DIABETIC 71 88%

Pecentage distribution of clinical factor of diabetes N=80
Diabetes
DIABETES NON DIABETIC

12%(N=9)

88%(N=71)
CLINICAL FACTORS
TABLE 6 :Pecentage distribution of clinical factor for covid
N=80
CLINICAL FACTORS NUMBER OF CASES PERCENTAGE

POST COVID 12 15%

NON COVID 68 85%

Pecentage distribution of clinical factor for covid N=80

COVID
POST COVID NON COVID

15%(N=12)

85%(N=68)
CLINICAL FACTORS

Out of 80 people ,14 members are above 60 years and 2 of

them having occupational risk and there are migrants
Assessment on ATT History

• No. of people in past ATT and currently on ATT in mettupalyam - nil

No. of people opted for FALCON SPUTUM
TEST in Mettupalaym,Shanmugapuram on 4/23
• No.of falcon sputum test provided – nil (asymptomatic –not
applicable)
 SUMMARY
• In our study, 80 (94.1%) out of 85 households were covered while 14(16.4% )
houses were locked.
• Houses covered in mop up are 9(10.5%)
• 63 (79%) persons were male while 17 (21%) persons were female.
• Out of 80 people covered none of them were presumptive TB patients
• Out of total population 16 (20%) individuals are high risk , 14 (18%) are
moderate risk and 50 (63%) are low risk individuals.
• Chest X-Ray was given for 30 (37%) individuals
• Out of the surveyed population,5 (6%) were tobacco users/smokers, while
7(9%) consumed alcohol.
• Among the total population, 9(12%) are diabetic.
• None of individuals were previously infected with TB ( past ATT) and currently
infected with TB ( current ATT)
• CXR camp is not yet conducted in Hospital Street of Shanmugapuram area