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JHARKHAND 2013

JHARKHAND RURAL HEALTH MISSION SOCIETY - TB CONTROL PROGRAMME

A Programme dedicated to TB Control

Annual New Smear Positive: Case Detection Rate,Jharkhand - 2013

> 70 %

60 - 69 %

<50 %

50 - 59%

STATE TB CELLJHS BUILDING, ROOM NO. 1 & 2, RCH CAMPUS, P.O. NAMKOM,

RANCHI – 834010Tele/Fax: 0651-2261940, E-mail: [email protected]

Journey so far……….. 2014: Reach the Three Million

2013: Stop TB in my lifetime Call for a world free of TB.

2012: Stop TB in my lifetime Call for a world free of TB.

2011:OnthemoveagainstTB:Transformingthefighttowardselimination

2010: On the move against TB: Innovate towards action

2009: I am stopping TB

2008: I am stopping TB

2007: TB anywhere is TB everywhere

2006: Actions for life – Towards a world free of TB

2005:FrontlineTBcareproviders:HeroesinthefightagainstTB

2004: Every breath counts – Stop TB now!

2003: DOTS cured me – it will cure you too!

2002:StopTB,fightpoverty

2001: DOTS: TB cure for all

2000: Forging new partnerships to Stop TB

1999: Stop TB, use DOTS

1998: DOTS success stories

1997: Use DOTS more widely

This publication can be obtained from:State Tuberculosis Cell, Ministry of Health & Family Welfare, JHS Building, Room No. 1 & 2, RCH Campus, P. O. Namkum, Ranchi, Jharkhand – 834 010. Mail: [email protected] Web-link: www.jrhms.jharkhand.gov.in/RNTCP.aspx

MESSAGEIndia has the highest number of TB cases in the world, accounting for approximately one-fourth of the global TB incidence. It is a major public health challenge with a devastating socio-economic impact; affecting millions of people especially the economically productive age group, poor, vulnerable and marginalized sections of the society. The situation becomes a bit more complicated because of prevailing HIV and Drug Resistant TB (DR-TB), posing huge challenge to TB control measures.Revised National TB Control Programme (RNTCP), launched nationwide in late nineties and early part of this century in a phased manner, to curb and control this eternal menace, has started to yield the desired results. Directly Observed Treatment - Short Course Chemotherapy (DOTS) strategy, recommended by World Health Organization and adopted by RNTCP is accepted worldwide as the best strategy for the TB control programme. It ensures adherence to therapy and should be used for all types of TB patients including HIV-TB and DR-TB patients.The progress made by RNTCP in the state has been encouraging and acclaimed nationally. The state has been able to achieve & maintain the main programme objectives continuously for the last seven years. But we need to strive harder to further consolidate the programme, incorporating effectively the newer initiatives likemanagementofHIV-TB&DR-TB,TBnotification,qualitycaretoall typesofTBpatients,more&moreinvolvement of private health sector etc.The WHO 2013 Global TB Report highlights that three million people are missed globally every year by public health systems. Many of these three million people live in the world’s poorest, most vulnerable communities and include groups such as migrants, miners, drug users and sex workers. This year world TB day theme “Reach the Three Million - Find, Treat, Cure TB” aptly conveys that TB control activities should comprehensively & strategically work towards reaching these missing patients to achieve Universal Access to TB Care.I am glad that an Annual Report for 2013 of the TB program is being published by Jharkhand Rural Health Mission Society - TB Control programme, which not only showcases the experiences & achievements of the programme but will also motivate all others involved in the TB control to join hands with State TB Cell, Jharkhand for this noble cause of TB control, contributing to the cause of developing healthy and economically productive population.

(B.K. Tripathi)

MESSAGETuberculosis (TB) is one of the oldest diseases known to mankind since time immemorial and continues to be a major public health problem even in today’s modern world. India has the highest TB burden in the world, accounting for almost one fourth of the global TB incidence. Efforts are on to curb this perpetual nemesis in the form of “Revised National TB Control Programme (RNTCP)”,whichiswellrecognizedgloballyforitsqualitydiagnosisandfreeofcosttreatment,benefitingpatientsofTB.Overaperiodofyears,RNTCPhasexpandeditsservicesofqualitymanagementofTBcarebybringingTB-HIVcollaborativeactivitiesandProgrammaticManagement of Drug Resistant TB (PMDT) under its umbrella.

It is a matter of pride to note that our state has achieved and maintained the national objectives of Success Rate and Case Detection Rate for New Smear Positive (NSP) cases over 85 % & 70 % respectively since 2007. It has been possible due to concomitant involvement of Government sector, Private sector, NGO & Private practitioners.

Despite the fact that TB is curable and free of cost management of TB cases is available under RNTCP, our currenteffortstofind,treatandcureeveryonewhogetsillwiththediseasearenotsufficient.Globally,outofthe nine million people who get sick with TB in a year, one third of them are “missed” by public health systems. For the “Missed Three Million” this year’s world TB day theme is “Reach the Three Million - Find, Treat, Cure TB”.

I sincerelybelieve thatnoone shouldbe leftbehind in the fightagainstTB.ThisWorldTBDay,one&allshouldvowforacomprehensiveglobalefforttofind,treatandcurethemissingthreemilliontoaccelerateourprogress towards the Millennium Development Goal.

On the occasion of World TB Day and publication of Annual Status Report for 2013 by Jharkhand Rural Health Mission Society - TB Control programme, I extend my compliments to all those involved in TB control efforts across the state for their hard work, dedication and commitment. I wish them all the success in future.

(Ashish Singhmar)

MESSAGESince ages Tuberculosis (TB) continues to be a major public health issue. The morbidity and mortality caused by this curable and preventable disease still remains a cause of concern. The co-morbid conditions like HIV infection, Diabetes mellitus, Tobacco & Alcohol abuse etc. along with emergence of Drug Resistant Strains are further complicating the problem.

The services offered by Revised National TB Control Programme (RNTCP), based on internationally acclaimed DOTs Strategy, strives to achieveUniversal Access to TB care by strengthening quality of services& PPMinitiatives; implementing Programmatic Management of Drug Resistant TB (PMDT) spanning to all districts of Jharkhand, TB-HIV collaborative activities in collaboration with Jharkhand State AIDS Control Society (JSACS) along with special plan for scheduled areas; and aligning with NRHM supervisory structures.

World TB Day provides the opportunity to raise awareness about TB-related problems & solutions and to support worldwide TB-control efforts. While great strides have been made to control and cure TB, people still get sick and die from this disease and many more are missed by the public health system in our country and acrosstheglobe.MuchmoreeffortsareneededtofindandtreatthemissingTBpatientswhoareestimatedtobe around three millions globally. This year world TB theme advocates in this line - “Reach the Three Million - Find, Treat, Cure TB”. To pursue towards this noble cause private health sector and public sector should join handstogetherprovidingallTBpatientsthebenefitoffreeTBmanagementservices.

On the occasion of publication of the RNTCP Annual Status report 2013, I wish to reiterate that it is a privilege to be associated with the noble cause of TB control measures and I wish all success to the entire RNTCP team along with whosoever committed to work tirelessly for the same.

(Dr. Sumant Mishra)

RNTCPJharkhand 2013

Revised national tubeRculosis contRol pRogRamme

FOREWORD...

The World TB Day is celebrated on 24th March every year to commemorate discovery of causative organism of Tuberculosis (TB) - Mycobacterium tuberculosis bacillus by German Microbiologist Dr Robert Koch.On the auspicious occasion of World TB Day 2014, it brings immense pleasure to produce the Annual Performance Report of 2013, with a glimpse of achievements madebyRevisedNationalTBControlProgramme(RNTCP)inthefieldofTBCarein Jharkhand. This report also aims at enlightening the reader with the information about-the TB control measures under RNTCP in Jharkhand. This informative magazine will be of use not only to medical fraternity but also to all sections of the society. The valuable data will help us in setting new benchmarks and also help us to understand any lapses or key areas where it needs to be strengthened.State TB Cell along with the RNTCP team of Jharkhand acknowledges the efforts & inputs of all the concerned making this Annual Report possible within time & takes this opportunity to express the gratitude towards all the TB Patients who taught the programme a lot about TB & TB Care.On World TB Day this year, we are focusing attention on how to reach the three million people with TB who are missed globally by public health systems. The Team hereby also appeals all to join hands in the battle against Tuberculosis with the theme given for the year 2014 World TB Day... “Reach the Three Million - Find, Treat, Cure TB”. Let us vow together, to unite under the umbrella of RNTCP to curb the eternal menace of TB.

(Dr. Rakesh Dayal) StateTBOfficer

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RNTCPJharkhand 2013


There are heroes who have won the battle against TB and spreading the light of warrior hood, similarly there arelegendswhosacrificedtheirlivesinthebattleagainstTB.Thiseditionisdedicatedtobothofthemwhocanbe anybody from a common man of Jharkhand to the legendary personalities in the history.

Here are some legends from history to be commemorated…

*Adolph Hitler & Nelson Mandela – TB Survivors

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Photo Gallery

Review meeting chaired by Honorable Health Minister

Honorable Health Minister visiting RNTCP stall –Swasthya Mela at Bokaro

DDG (TB) with Central TB Division Team at State TB Cell

National Coordination Committee (NCC) meeting at Ranchi Release of Annual Report by DDG (TB) during NCC meeting at Ranchi

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Abbreviations:ACSM Advocacy, Communication & Social

Mobilization JRHMS Jharkhand Rural Health Mission Society

AFB Acid Fast Bacilli LPA Line Probe Assay

AIDS AcquiredImmunodeficiencySyndrome LRSLala Ram Swaroop Institute of TB (Now National Institute of TB & Respiratory Diseases – NITRD)

ART Anti-Retro-Viral Therapy LT Lab TechnicianARTI Annual Risk of TB Infection MDGs Millennium Development GoalsC & DST Culture & Drug Sensitivity Testing MGIT 960 Mycobacterium Growth Inhibitory Test 960CBCI Catholic Bishops Conference of India (NGO) MoHFW Ministry of Health & Family WelfareCBCI CARD Project

CBCI Coalition Against AIDS & Related Disease Project MO IC MedicalOfficerInCharge

CBNAAT CartridgeBasedNucleicAcidAmplificationTest MO TC MedicalOfficerTBControlCHAI Catholic Health Association of India (NGO) MTB Mycobacterium Tuberculosis CP Continuation Phase NACO National AIDS Control OrganizationCTD Central TB Division NIRT National Institute for Research in TBC&DST Culture & Drug Susceptibility Testing NRL National Reference LaboratoryDDG Dy. Director General NRHM National Rural Health MissionDMC Designated Microscopy Center NTI National Tuberculosis Institute

DOTS Directly Observed Treatment Short Course PATH Promoting Appropriate Technologies for Health (NGO)

DTC District TB Center PHC Primary Health CenterDTO DistrictTBOfficer PHI Peripheral Health Institute

DRS Drug Resistance Surveillance PMDT Programmatic Management of Drug Resistant TB

EQA External Quality Assessment PSI Population Services International (NGO)

FIND Foundation for Innovative & New Diagnostics (NGO) RNTCP Revised National Tuberculosis Control

ProgrammeGFATM Global Fund for AIDS TB & Malaria STC State TB CellGLC Green Light Committee STCI Standards of TB care in IndiaGoI Government of India STDC State TB Training & Demonstration CenterGoJ Government of Jharkhand STLS Senior TB Laboratory SupervisorHCW Health Care Worker STO StateTBOfficerHIV HumanImmunodeficiencyVirus STS Senior TB Treatment SupervisorICTC Integrated Counselling and Testing Centre TAP Tribal Action PlanIEC Information, Education & Communication

IMA Indian Medical Association The UNION (IUATLD)

International Union Against TB & Lung Diseases(NGO)

IP Intensive Phase TRC, Chennai

Tuberculosis Research Center, Chennai (Now National Institute for Research in Tuberculosis – NIRT)

IRL Intermediate Reference Laboratory TU Tuberculosis UnitISTC International Standards of TB Care WHO World Health Organization

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Tuberculosis & Revised National TB Control Programme –An OverviewTuberculosis, well known as TB, Yakshma or Tapedik in the community isa disease, known since ages and referred as "Rajyakshama" in the ancient Indian Medical literatures. It mainly affects lungs but can affect any part of body. Little was known about the pathogenesis and communicability of the disease before the late 18th century.

The world changed on the evening of March 24, 1882, when a thin near-sighted German Physician, Robert Koch, working over decades on the disease, read his paper in the Physiological Society of Germany in Berlin. He stated that 1/7th of all human being in world die of tuberculosis. It is an infectious disease caused by bacteria and gave meticulous details about the presence of bacilli in the sputum of an infected patient. When Koch finishedhispresentation,theaudiencesatinstunnedsilence.

Tuberculosis (TB) is a disease caused by bacteria called as Mycobacterium Tuberculosis. TB spreads through air. When a person suffering from pulmonary tuberculosis coughs or sneezes, millions of TB bacilli are spread in air embedded in the tiny droplets and droplet nuclei. When a person inhales, these micro particles get lodged in the terminal bronchiole and the alveoli to infect a person. This infection may later on result into TB disease.

As no drug or combinations of drugs were effective against TB till middle of the 20th century, the main line of treatmentwasgoodfood,openairanddryclimateinsanatoria.Streptomycin,thefirstantibioticwhichshowedanti-tuberculosis effect; was discovered in 1943 by Dr. Selman A. Waksman. Later a series of antibiotics viz. Isoniazide, PAS, Pyrazinamide, Ethambutol, Thiacetazone and Rifampicin were discovered and were used in the TB treatment and are still in use. Many newer molecules are under trial. The latest molecule which has shown promising effect against TB bacilli is ‘Bedaquiline’.

Despite of all these developments still today, tuberculosis is a major public health problem. Every day more than 900 people i.e. 1 person per two minutes die due to TB in our country. High mortality especially among socio-economically productive age group causes huge economic losses to the society and country.

The tuberculosis (TB) burden in India is truly staggering. About 40% of the adult population of the country is estimated to be already infected with Mycobacterium tuberculosis. Based on the National survey for annual risk of TB infection (ARTI) which is at 1.5%,the incidence of new smear positive TB cases in the country is estimated as 75 new smear positive cases per 100,000 populations. Once infected, an individual has on average a 10% life-time risk of developing TB disease. Every year nearly 2.2 million new TB cases occur, of which nearly 800 000 are infectious (smear positive pulmonary) TB cases. India has more people with active TB disease than any other country in the world. Also, an estimated 2.34 million individuals in India are now living with HIV/AIDS. With HIV infection being recognized as the most potent risk factor for progression from TB infection to active disease, the potential impact of the HIV epidemic on TB control in India is large.

National TB Control Programme (NTP) was implemented from 1962 to 1998. However it had limited success with only 30-40% treatment completion rate amongst patients put on treatment. Govt. of India started Revised National TB Control Programme (RNTCP) with Directly Observed Treatment short course (DOTS) strategy at few selected sites in 1993 on pilot basis. With encouraging results of pilot project, the Central TB Division, Govt. of India decided to extend Revised National TB Control Programme in India since 1998.

Inlastfifteenyearssinceitsinception,theprogrammehasincorporatedseveralpolicydecisionsandnewerinitiatives. In 12th Five Year Plan (2012-17), the programme has entered in an ambitious National Strategic Plan(NSP)withathemeof“UniversalAccessforqualitydiagnosisandtreatmentforallTBpatientsinthecommunity” with a target of “reaching the unreached”. The early and complete detection of all TB cases

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in the community, including drug resistant tuberculosis, HIV associated TB, TB among the vulnerable and marginalised population with greater engagement of private sector are the major focused areas in NSP. For closer patients’ supervision the districts and states have to plan for increased number of Tuberculosis units (TUs) to bring it down to the Block Programme Management Units (BPMUs).

Vision:A“TBfreeIndia–throughachievingUniversalAccessbyprovisionofqualitydiagnosisandtreatmentforallTB patients in the community.”

Goal:To decrease the morbidity and mortality, by early diagnosis and early treatment to all TB cases thereby cutting the chain of transmission.

Objectives:1. Toachieve90%notificationrateforallcases2. To achieve 90% success rate for all new and 85% for re-treatment cases3. TosignificantlyimprovethesuccessfuloutcomesoftreatmentofDrugResistantTBCases4. To achieve decreased morbidity and mortality of HIV associated TB 5. To improve outcomes of TB care in the private sector

RNTCP was launched in Jharkhand in September 2000 under the guidance of Central TB Division, GoI, with Ranchi&Palamuasthefirsttwoimplementingdistrictswhichwasscaledupinphasedmannerwithcompletegeographical coverage in March 2005 with inclusion of Godda &Giridihunder the umbrella of RNTCP. State TB Cell under “Jharkhand Rural Health Mission Society – TB Control Programme” and 24 District TB Centres under “District health Societies-TB Control Programme” have been established to supervise and monitor the implementation of this programme effectively. Detailed planning for implementation of the programme is done at State and District levels. Jharkhand has made rapid progress in expanding TB Control Services under Revised National TB Control Programme.

Currently, entire state population is having the access to directly observed treatment-short course (DOTS) under the Revised National TB Control Programme. As on today all 24 districts in the state are implementing the programme as per the guidelines of Central TB Division (CTD) and the Jharkhand Rural Health Mission Society(JRHMS)toensurethefreequalityservicestoTBpatients.

Jharkhand State has initiated Programmatic Management of Drug Resistant TB services in 2010 with guidance from the Central TB Division. This was initiated with two districts (Ranchi & Dhanbad) in 2010 and presently Jharkhand has successfully achieved 100% geographical coverage for PMDT Servicesin February2013.

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TB Epidemiology: Overview of Incidence, Prevalence & Mortality Tuberculosis (TB) remains a major global health problem. Though India is the second largest populous country in the world, it accounts for nearly 26% of the global TB burden.WHO estimated burden of tuberculosis in India, 2012

Number (Millions) Rate per 100,000 persons

Incidence 2.2 (2.0-2.4) 176 (159-199)

Prevalence 2.8 (1.9-3.9) 230 (155-319)

Mortality 0.27 (0.17-0.39) 22 (14-32)

No (%) of TB patients with known HIV status & No (%) of tested TB patients found HIV positive 821,807 (56 %) 44,063 (5.4%)

EstimatedMDRTBamongnotifiedpulmonaryTBpatients 64,000 (49,000-79,000) 5.1 (3.7-6.4)

TotalConfirmedCasesofMDR-TB 16,588 1.69 (1.45-2.02)

Although the number of TB cases and deaths remain large, there has been major progress towards achieving the global targets for reduction in the burden of the disease. The 2015 MDG targets of halting and reversing TB incidence have been achieved, with TB incidence falling globally for several years (2% per year in 2012). TB mortality rate has fallen by 45% globally since 2000 and the Stop TB Partnership target of 50% reduction by 2015 is now within reach.

The burden of TB disease among women and children:TheburdenofTBmorbidityandmortalityamongwomen(femalesaged≥15years)andchildren(peopleaged≤15years)isoftenunderestimatedandislargerthanrealized.Therewereanestimated2.9millionnewcasesof TB and 410,000 deaths from the disease among women in 2012. Among children, there were an estimated 530,000 new TB cases in 2012 and 74,000 deaths among children who were HIV negative.

Achievements of Jharkhand in RNTCP:RNTCP was launched in the state in 2000 with two districts Ranchi &Palamu as the implementing districts and the total geographical coverage was achieved in 2005. Since the launch of the programme in the year 2000: Sputum smear of more than 11.84 lakh of TB suspects have been examined and more than 2.26 lakh Smear

positive cases have been detected by the Designated Microscopy Centres (DMCs) spread over the state. A total of 3,57,576.TB patients have been put of DOTS treatment by more than 19,000 decentralized DOT Centres

(~80% by Sahiya & Community Volunteers) with a Success rate of 90% of New Smear positive TB cases. The state is constantly achieving the twin objectives: 1. to achieve and maintain cure rate of at least 85%

among New Smear positive patients and 2. to achieve and maintain the case detection rate of at least 70% of the estimated NSP cases since 2007.

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RNTCPJharkhand 2013


Annual New Smear Positive Case Notification Rate (2001 – 2013) and Treatment Success Rate (2001 – 2012), Jharkhand

66%61% 70% 72% 72% 72% 72% 68%

41%

61%

71%72%

75%77% 77%

71% 70%

87%89% 89%

87%90% 90% 91%

86%83%

86%87% 87% 87% 88%

90%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012 2013

NSP CDR % India NSP CDR % JharkhandNSP Success Rate India NSP Success Rate Jharkhand

TB Case finding activities and notification rates (2005 - 2013)

Year

Total population

covered under RNTCP (lakh)

Sputum Microscopy Services Case Notification

Suspects Examined

Sputum Smear positive cases diagnosed

Total TB cases notified

Total sputum smear positive cases notified

Number Rate Number Rate Number Rate Number Rate

2005 292 84369 289 13268 45 26118 89 11143 38

2006 292 112432 385 18289 63 33009 113 15899 54

2007 296 126457 427 20474 69 36218 122 18584 63

2008 300 137407 458 21110 70 38366 128 19033 63

2009 304 142864 470 21658 71 39559 130 20118 66

2010 310 150883 487 22760 73 36506 118 21030 68

2011 330 155736 472 23051 70 38574 117 21537 65

2012 337 154965 460 22364 66 36666 109 20834 62

2013 344 163133 476 22509 65 35561 103 22509 65

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Suspect Examination Rate and Smear Positive Case Notification Rate, Jharkhand (2005 -2013)

Trends in Case Notification by types of TB Cases, Jharkhand (2005 – 2013)

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Trend Suspects examined per Smear positive cases detacted, Jharkhand (2005 - 2013)

RNTCP Performance of Jharkhand State at a glance (Key indicators) in 2013

Sr. No. Indicators Achievements %

1 Population covered (in lacs) 344

2 TB Suspects examined out of total new adult OPD 1,63,133

3 TBSuspectsexaminedperlacpopulationperquarter 119

4 Sputum Smear Positive Patients diagnosed 22,509 14%

5 Sputum Smear Positive Patients living in the district and put on DOTS 20,839 93%

6 New Sputum Smear Positive Patients put on treatment 18,129

7 Annual New Sputum Smear Positive case detection rate per Lac 53 70%

8 Total TB Cases put on treatment 35,561

9 AnnualTotalCaseNotificationRateperLac 104

10 Annual New Sputum Smear Negative case detection rate per Lac 9,717 28

11 Annual New Extra Pulmonary case detection rate per Lac 2,270 8%

12 Annual Paediatric case detection rate among New cases 1,249 4%

13 % of retreatment cases out of all smear positive cases 2,710 13%

14 % of new smear positive out of total new pulmonary cases18129 out of

65%27846

15 3 Months Sputum Conversion of New Smear Positive cases registered in the last 4 quarters

16483 out of91%

18058

16 Cure Rate of New Sputum Positive Cases registered in last year15043 out of

84%17915

17 Success Rate of New Sputum Positive Patients registered in last year16147 out of

90%17915

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RNTCPJharkhand 2013


Scatter Graph: Annualized NSP Case Detection Rate (2013) & Treatment Success Rate (2012), Jharkhand

Population in Jharkhand covered under DOTS and total TB patients Annually put on treatment (2000 – 2013)

Types of TB patients diagnosed in Jharkhand by the programme

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NIKSHAY: A Case Based Web Based ICT application for TBTo keep a track of the TB patients across the country, the Government of India has introduced a system called NIKSHAY. The word is combination of two Hindi words “NI” and “KSHAY” meaning eradication of tuberculosis. NIKSHAY (www.nikshay.gov.in) is a web enabled application, which facilitates monitoring of universal access of TB patients data by all concerned. The system has been developed jointly by the Central TB Division (CTD) of the Ministry of Health and Family Welfare and National Informatics Centre (NIC) and it was launched by the Government of India in June 2012.

A gazette notificationwas issued by the Government of Indiamandating all public or private health carefacilities to inform the details of TB patients diagnosed or treated by them to NIKSHAY repository. NIKSHAY registers all such health establishments and TB patients.

Objectives:Short term:

1. To facilitate individual patient wise monitoring tracking of TB treatment2. To automate reporting, once the case wise data is regularly entered and updated3. To facilitate online referral / transfer mechanism with real time information transmission to prevent

patient loss4. To monitoring of TB Treatment saving the lead time in hard copy updating in TB register5. To make available of real time data at block & district for prioritized, focused supervision6. To create electronic Database of all TB patient details, for further in-depth analysis7. Effective Programme management (e.g. e-HRD, e-procurement e-supply chain, e-cash transfer)

Long term: 1. Linking the TB Database with UID (2016-17) for extending social welfare schemes 2. Disease trend & pattern studies for geographical understanding for epi-foci, using GIS for : Contact tracing,

identificationoflocal/focalepidemicsofMDR-TB,outbreaksinvestigationofXDR-TBNIKSHAY has been implemented at National, State, District and Tuberculosis Unit (TU) levels. Data entry, in terms of registering the TB patient, pre-treatment and follow-up tests, treatment, HIV status and contact tracing details, is done at TU level. More than 3.5 lakh TB patients have been registered in the country since its launch in June 2012. Such TB patient database is being used at district, state and national level for monitoring purposes.

Introduction of Mobile application/ SMS technology in NIKSHAY NotificationNIKSHAY utilises SMS technology in an effective manner. Through SMS, it communicates with TB patients and grass root level healthcare service providers as well as health and family welfare policy makers, health managers and health administrators at different tiers of the healthcare delivery system. Whenever a new patient is registered on NIKSHAY, an SMS is sent to the patient with registration ID and details of DOTS Operator along with advisory note to take the regular medicine. Daily SMS is sent to all monitoring authorities at national, state and district levels providing exact number of registered patients, Government & Private health institutes; profilesofState,District&TUlevelofficialsandcontractualmanpowerstatus.

Mobile application has been developed for TB notification. The application can be downloaded from theJRHMS website by health facilities (private doctors / labs etc) having android mobile with OS version 2.3.3 or above.AndTBnotificationcanbedoneovermobileinternet.Simpleusermanualisalsothereatthewebsitefor reference.

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In just one and half years of implementation, NIKSHAY has received National e-Governance Award (Gold) in sectoral category (Health care) for 2013-14

Mobile application of patient entry in NIKSHAY National e-Governance Award (Gold) in sectoral category for 2013-14

Status of NIKSHAY Entries:

NIKSHAY Entries National Jharkhand

TB Patients Registered under RNTCP 23,57,386 66,570

Peripheral Health Institutes (PHI) Registered 41,156 487

TuberculosisOfficialsProfileavailable 2702 72

DistrictTBOfficersProfileavailable 667 24

StateTBOfficersProfileavailable 35 1

Contractual Employees details available 6900 350

Non-RNTCP Health Establishments registered 63,830 233

Non-RNTCP Patients Registered 54,890 1047

Culture & Drug Resistant Labs Patients Registered 20414 134

Drug Resistant Tuberculosis Patients Registered 1937 55

Mandatory TB Notification by all clinical health facilities to Govt. – FAQs:What is TB notification? Reporting about information on diagnosis &/or treatment of Tuberculosis cases to the nodal Public Health Authority(forthispurpose)orofficialsdesignatedbythemforthispurpose.

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Who is expected to notify TB cases? Every healthcare providers meaning clinical establishments run or managed by the Government (including local authorities), private or NGO sectors and/or individual practitioners and diagnosing &/or treating TB patients such as all qualified health care providers (includes Registered Medical Practitioners, AYUSH,Diagnostic Centre) from Public sector and Private sector (Private laboratories, Private Practitioners, Corporate hospitals, NGOs, Nursing homes, Multi-specialty hospitals, Private clinics/ hospitals).

To whom TB cases should be notified? NodalPublicHealthAuthority(forthispurpose)orofficialsdesignatedbythemforthispurpose.State/UT&district-wise contact details are available on www.tbcindia.nic.in

How TB cases can be notified? Hardcopybypost,courierorbyhandtothenodalofficer Softcopybyemailfrompersons/institutesauthorizedforthispurposetothenodalofficer Using authorized mobile numbers by phone call, IVRS or SMS Using mobile application (android OS mobiles) Uploading of information directly on to the Nikshay portal http://nikshay.gov.in Direct online information transmission from newer diagnostic machines like CB-NAAT or MGIT etc.

Is there a provision for punitive / legal action if I do not notify TB cases in Constitution / MCI rules? Yes. As per MCI code of Ethics – Rules & regulations 2002, Chapter 7, Point 7.7, a registered medical practitioner givingincorrectinformationonhisnameandauthorityaboutNotificationamountstomisconductandsuchamedical practitioner is liable for deregistration.

Screen Shot of NIKSHAY Portal

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Photo Gallery

State Task Force (Medical Colleges) Meeting at Jamshedpur National Task Force (Medical Colleges) Meeting at Jaipur

Zonal Task Force (Medical Colleges) Meeting at Raipur

National Task Force (Medical Colleges) Meeting at Bhubaneshwar

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Photo Gallery

State Conference of IAPSM – Inauguration by MD JRHMS State Conference of IAPSM – Scientific Session

CME on TB & RNTCP at RIMS, Ranchi

MO-TC Batch for Training at STDC, Itki, Ranchi State level RNTCP Workshop in progress

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Curtailing the menace of Drug Resistance

Programmatic Management of Drug Resistant Tuberculosis (PMDT)One of the biggest challenges to TB control efforts is multi-drug resistant (MDR) TB. MDR TB is a subset of TB, caused by (Bacteria) Mycobacterium TB (M.TB), which is resistant to at least Rifampicin & Isoniazid (INH). It’spurelyalaboratorydiagnosis(Culture&DrugSusceptibilityTesting-C&DST),confirmedfromacertifiedlaboratory.

According to WHO Global TB Report 2013, 13% of the total TB deaths were contributed by MDR TB cases (37.7% among the subset of MDR TB cases). Of the 98 countries reporting at least one MDR TB case, ~20 countries reported exclusively MDR TB cases.

The Indian data available to date; shows that levels of MDR-TB remain relatively low, at around 3%, amongst newpatientsand12%inre-treatmentcases.HowevertheserelativelylowpercentagefigurestranslateintolargeabsolutenumberofMDR-TBcases,whocantransmittheirdrugresistantdiseasetoothersandrequireeffective immediate treatment.

India’s Revised National TB Control Programme (RNTCP) has geared up services to tackle this deadlier form of Tuberculosis & achieved 100% geographical coverage for DR TB Diagnostic & Treatment services last year. 63% of the districts in India diagnose MDR TB by early screening criteria (criteria C) as per guidelines & available resources.

Roll out Plan- Jharkhand MAPWithRanchi&Palamuas first twodistricts, Jharkhand initiatedrenderingPMDTservicessinceDecember2010 and by Feb 2013 all of 24 districts were providing the DR-TB diagnostic & Treatment services.

Phase 1 - Dec 2010

Phase 2 - June 2012

Phase 3 - Dec 2012

Phase 4 - Feb 2013

DR TB Centre

C & DST Lab

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RNTCPJharkhand 2013


Over all following is the snap shot of diagnostic & Treatment services available in Jharkhand…

Diagnostic Services offered - Microscopy: Free Quality Assured Microscopy Centres – 300 LED-FM:FreeQualityAssured/Certified-atall3MedicalCollegesinJharkhand. Quality Assured/ Certified Solid Culture & DST: Free for all eligible programme patients at Intermediate

Reference Laboratory - Itki TB Sanatorium Quality Assured/ Certified Molecular & Rapid Diagnostics: Line Probe Assay: Free for Free for all eligible programme patients at Intermediate Reference

Laboratory - Itki TB Sanatorium CartridgeBasedNucleicAcidAmplificationTesting(CBNAAT)-FreeforFreeforalleligibleprogramme

patients at Ranchi Sadar & Bundu CHC Labs & Techniques under pipeline: ItkiTBSanatorium–BSLIII(includescertificationforLiquidCulture) Rajendra InstituteofMedical Sciences (RIMS) -Under certification for Solid (RIMSRanchi, PMCH

Dhanbad & MGMCH Jamshedpur proposed for BSL IIITreatment Services: More than 19000 DOT centres in 24 Districts of Jharkhand. DR TB Centres - Itki TB sanatorium & PMCH Dhanbad. 3rd& 4th DR TB Centres are under up gradation at

District TB Centre Dumka District Hospital at Jamshedpur Free,qualitydrugstoalldiagnosedTB(TB/MDR/XDR)patientsdiagnosedunderRNTCP. Pre-treatment Evaluation (Lab and clinical evaluation), Treatment initiation, stabilization on standardized

regimens. Specialized centres (DRTB Centre/ DOTS Plus Sites) for DR TB treatment services Patient discharged for ambulatory decentralized treatment through DOT providers near to his place of

residence & is followed up clinically and microbiologically during the treatment.Service Enablers: Sputum Collection and transport (cost) supported by RNTCP, till the most decentralized point of care Travel cost reimbursement for patient and 1 attendant for initiation of Category IV at DR TB centre Travel cost reimbursement for patient and 1 attendant for follow up visit to District TB Centre, DR TB

Centre & Intermediate Reference Laboratory (IRL, ITKI) Travel cost reimbursement for patient (HIV reactive) and 1 attendant for early initiation of Anti-Retroviral

Therapy (ART) Honorarium of Rs 2500/- (1000 for initial 6-9 months & 1500/- for 18 months) for DOT Plus Providers Tribal area enablers Rs 250/- per patient for cured or treatment completed patient Rs 100/- to Rs 200/- for Sahiyyas supporting sputum collection and transport

Achievements: StateDrugStore&Districtdrugstoresupgradedforstorageconditions,temperaturecontrol,firecontrol

measurestoensurequalityassureddrugsforDRTBCentre All the TB suspects and patients visiting PHCs in all 24 districts are being evaluated for TB and MDR TB A mechanism of sputum collection and transport from all the districts to IRL Itki, so that the patient need

not travel to Ranchi for Culture and DST.

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RNTCPJharkhand 2013


Electronic reporting to all districts (DTC) to avoid delays in reporting Patient wise monthly boxes (customized for patient weights) transported to the districts (courier

mechanism) and transported to peripheral DOT providers within 7 daysOver recent years Jharkhand’s service linkage and MDR Screening efforts have improved exponentially, leading one step towards early diagnosis & treatment.

45 117

729

2359

0

500

1000

1500

2000

2500

3000

2010 2011 2012 2013

MDR TB Suspects Tested at IRL Itki

Till date, 3250 MDR TB Suspects tested 535 MDR TB cases have been diagnosed & 417 have been initiated on treatment. On an average >80% of the diagnosed MDR TB cases are successfully initiated on treatment immediately. This treatment regimen contains second line anti T.B. drugs and is given for the period of 24-27 months. Over last 2 years, ˜5-9% MDR cases have been refusing treatment & died before Treatment initiation. Jharkhand has been reporting averagely good treatment outcomes among MDR TB case cohorts.

DR TB Centres, Jharkhand

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Operational Researches - Introspection & Eye Openers:TheRNTCPhasbeenpromotingOperationalresearches(ORs)forfieldlevelintrospectionoftheprogramme& evidence generation. The results helped programme to evolve with time.

RNTCP Jharkhand has contributed in some of following projects/studies Completed in collaboration with Central TB Division – Prevalence of HIV in TB Suspects CB NAAT Evaluation Project Screening of TB patients for DM.

Completed in collaboration with Rajendra Institute of Medical Sciences (RIMS), Ranchi - AssessmentoftreatmentofCATIchildrenasDOTSbeneficiaries(PaediatricsDepartment) Random survey of Knowledge, Attitude and Practice for TB among patients of CAT I paediatric patients

(Paediatrics Department) Assessment of Health seeking behaviour and reasons for delay in diagnosis for TB patients in

Jharkhand (PSM Department) Ongoing ORs - “Acceptability of DOTS among Tribal population of Jharkhand” by PSM department, RIMS,

Ranchi Ongoing Thesis by PG students of PSM department, RIMS, Ranchi Occurrence and correlates of pulmonary tuberculosis in HIV positive patients attending ART centre in

Rajendra Institute of Medical Sciences, Ranchi A study ondetection of pulmonary tuberculosis amongpatientswith history of cough≥ 2weeks

attending medicine OPD, RIMS, RanchiFollowing are abstracts of few Operational researches conducted in RNTCP Jharkhand over past few years.

Improving TB surveillance by strengthening TB notification, Bokaro, JharkhandDr. Rajeev Ranjan Pathak1, Dr. Rakesh Dayal2, Dr. Vaibhav Ghule1, Dr. B. P. Gupta3

1 WHO RNTCP India, 2 State TB Cell, Jharkhand, 3 District TB Cell, Bokaro

Background:India accounts for the highest tuberculosis (TB) burden in the world. An estimated 2.2 million new cases of tuberculosis and 270,000 tuberculosis related deaths in 2012, representing one fourth of the global burden of incident cases of tuberculosis and mortality1.However,theNationalTBControlProgrammeinIndianotified~1.18millionnewTBcasesandalmosthalfofpatientsweremissedintheRNTCPnotification2. The missed number of patients may initially seek help from the private healthcare sectors or the unorganised sectors, where diagnosis, treatment, and reporting practices often do not meet national or international standards for tuberculosis.Thisleadstodelayindiagnosisandinadequatetreatmentresultinginextendedinfectiousness,treatmentfailures,highrelapsesandacquireddrugresistance.ThismayresultinadvertentlytotheTBcontrolprogramme in India.

In2012Govt.ofIndiahasmadethetuberculosisanotifiablediseaseandagovernmentorderhasbeenissuedtonotify all the tuberculosis cases either diagnosed or put on treatment both in public and private sectors to RNTCP. Tolearnthelessonsfromthefield,assesstheprogressandimproveuponourplansforthisintensivesupportneededtotheTBnotificationfromprivatesectorsaletterhadbeenissuedfromCentralTBDivision,GoItopilottheTBnotificationinthedistrictsselectedinthestate.InthisregardtwodistrictsBokaroandPaschimiSinghbhuminthestateofJharkhandwereselectedtopilottheTBnotificationfromtheprivatehealthfacilitiesinthedistricts.

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RNTCPJharkhand 2013


Methodology:Baseduponthegeographicalconditions,populationstructureandpeopleprofileinitiallytwodistrictsBokaroandPaschimiSinghbhumofJharkhandwereselectedforpilotingtheTBnotificationfromtheprivatesector,but later on focused on Bokaro district. The pilot study was informed and advocated to the MD, Jharkhand RuralHealthMissionand thestatedirectiveswere issued to theconcernedChiefMedicalOfficersand theDistrictProgrammeOfficersbytheStateTBCellregardingthepilotstudy.

Pilot study district profile:Industrial area in North Chhotanagpur division of Jharkhand with population of 2.14 million people, mostly rural(39%urbanpopulation)withpopulationdensityof720people/sq.kmandoverallliteracyrateof73.48%3.Thedistrictnotified115/100,000TBcasesin2012.

Pilot Study period: 1st April 2013 to 30th September 2013.

Steps undertaken: DistrictadvocacyandsensitizationforTBnotificationandpilotstudyinthedistrict. SensitizationofallRNTCPstaffandgeneralhealthsystemofficers.Linelistingoftheblockwiseprivate

health care facilities. District level workshop with NGO partners, Civil Society representatives, IMA and representatives from

private health care providers in presence of district administration and authorities. Dissemination of TB notificationorders,FAQsforTBnotificationandtoolsfornotification.

Registration of all health providers outside RNTCP (laboratories / Private practitioners / clinics / hospitals etc)inCasebasedwebbasedonlinenotificationportal“Nikshay”.

Weekly collection of data from the registered health facilities and on line entries of the TB patients in Nikshay portal at district level.

Result:By the end the study period data was extracted from the Nikshay portal. During the study period a total of 83 private health facilities including 32 multi-speciality Hospitals/clinic/ Nursing Homes, 21 laboratories and 40 singlepractitioners/clinicswereregisteredforTBnotifications.Ofthe83registeredprivatehealthfacilities,140TBpatientswerenotifiedduring thatperiod (Table-1).Among140notified101aremaleand39arefemale TB patients and ~40% of them belong to the 25-34 year age group ( Graph-1). In the same period of two quartersthedistrictnotified1241TBpatientsinRNTCPfrompublicsectorhealthfacilities.Overall,1381TBpatientswerenotifiedinthedistrictduringthestudyperiodofwhich140werefromtheprivatesectorwithoverall contribution of ~10.1%

Table 1: Characteristics of Private health facilities registered and notifying TB patients in district of Bokaro, Jharkhand

Type of Health facilities Health facilities registered In Nikshay

No. of TB cases notified

Private Hospital/Clinic/Nursing Home etc.(multi) 32 18Private Laboratory 11 2Private Practitioner/Clinic etc.(single) 40 120

Total (Private Health Facilities) 83 140Notifiedhealthfacilities&TBnotificationinPublicsector(2Q13) 23 1241Overall health facilities registered in Nikshay 106 1381Percentage contribution from health facilities other than Public 10.14%

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RNTCPJharkhand 2013


Graph 1: Percentage distribution (Age groups & Gender) of TB patients notified from the Private health facilities between April to September 2013, Bokaro, Jharkhand

Discussion: The collaborative efforts between the RNTCP and the private providers in the state improved the case notificationandthisneedstobeconsolidatedforthesurveillanceofTBinthedistrictsandthestate.Itwillprovide information of the magnitude of the TB problem in the community and an important step for estimating disease burden accurately and planning necessary services to all. It provides the window to look into the private sector for their TB case management. The larger involvement of the private health care facilities in TB control programme provides the data for the health seeking behaviour of the community and an input to revise our National TB control strategies.

Constraints and Gaps identified: MandatoryTBnotificationorderneedstobepublicisedatalllevels Facility registration in Nikshay Vs The Clinical Establishments (Registration & Regulation) Act, 2010 Health facility registration in Nikshay: Voluntary Vs Compulsory with lists available in state/districts. Patients’confidentiality:concernwithdistrictauthoritiesaswellthebiggerinstitutions. Concern/legalityinTBnotificationfromPrivatehealthfacilities. Poor awareness of TB cases & TB diagnostics endorsed by RNTCP. Concern/legality in wrongly diagnosed TB cases or not following the standard guideline for TB care. NocommercialbenefitonTBnotificationtoPrivateHealthfacilities.

Reference:1. Revised National Tuberculosis Control Programme. TB India 2013: Annual Status Report. Central TB

Division, Director General of Health Services, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India.

2. World Health Organization. Global Tuberculosis Report 2013. World Health Organization: Geneva, Switzerland. 2012. WHO/HTM/TB/2012.6

3. The Commissioner & Registrar General of the Indian 2011 Census

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RNTCPJharkhand 2013


Opportunities to detect tuberculosis among severely acute malnourished children admitted to nutritional rehabilitation centres in Bihar, India, 2012R Pathak,1 BK Mishra, 2 S Ghosh, 3 A Sreenivas, 1 M Gandhi, 1 A Kumar, 4 P Moonan, 3 S Mannan1

1TBControlinIndia,WHOcountryofficeforIndia,NewDelhi,2HealthandFamilyWelfare,Govt.ofBihar,StateTuberculosis Training and Demonstration Centre, Patna, India; 3Division of TB Elimination, US Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA, USA; 4Research, International Union AgainstTuberculosisandLungDisease,South-EastAsiaRegionalOffice,NewDelhi,India.

Background: In India, approximately 86,000 new pediatric tuberculosis (TB) cases occur each year. In 2011, the state of Biharnotified62TBcasesper100,000population,and4.4pediatriccasesper100,000.However,TBdiagnosisamongchildrenisdifficult,especiallythosethatareimmunocompromised.Recentstatisticsshowthat,amongchildren less than 3 years old in Bihar, about 58% were underweight and about 4% were severely acutely malnourished (SAM) and are at the highest risk of mortality. Nutritional Rehabilitation Centres (NRCs) treat SAM children less than 60 months old and provide an opportunity to detect and manage TB cases in one of the most vulnerable groups of children in India.

Methods: At7selectedNRCsinBihar,medicalofficersandnursingstaffusedtheRevisedNationalTuberculosisControlProgramme (RNTCP) pediatric guidelines to evaluate and treat TB among SAM children during July¬–December 2012. SAM children were screened for TB based upon clinical history, household contact exposure to TB, chest radiograph,Mantoux tuberculin skin testing and sputum smearmicroscopy,when available. IdentifiedTBcases were provided medical and nutritional support at the NRCs for 21 days and received post-discharge follow up on a fortnightly basis for two months. To evaluate TB reporting to RNTCP for treatment and follow-up management, we compared NRC registers and cross-matched all SAM children names and ages with RNTCP TB treatment registers.

Results: Of 440 SAM children evaluated and screened for TB at the NRCs, 39 (8.9%) were diagnosed with TB, including 35 (90%) based upon 2 or more diagnostic criteria. Among SAM children, there was no statistical difference between TB cases and non-TB cases by age and gender; however the majority of TB cases were 13¬–36 months of age (69%). Among 34 children treated for TB, only 18 (46%) were reported to and treated by the RNTCP.

Conclusion: WhileNRCsidentifiedapproximately89TBcasesper1000childrenscreened,lessthanhalfwerenotreportedor treated by the national TB program. NRCs may be an important location for early TB case detection and treatment; however, more effort is needed to link this vulnerable population to RNCTP services.Courtesy: IJTLD Vol. 17 Dec. 2013 “Abstract Book 44th World Conference on Lung Health” Chairs: Jeffrey Starke (USA), Peter Burney (UK) Section: Adult and Child Lung Health OP-205-02

Enhanced testing of presumptive Multi Drug Resistant-Tuberculosis patients with intensified monitoring in Jharkhand, IndiaDr. Vaibhav Ghule1, Dr. Rakesh Dayal2, Dr. Rajeev Pathak1, Dr. Ranjeet Prasad2 1-World Health Organization, 2-Department of Health & Family Welfare, Government of Jharkhand, Introduction:India shares one fourth of global tuberculosis (TB) burden. India, China and Russian federation accounted for more than half of estimated 300000 multi drug resistant tuberculosis (MDR TB) cases across the globe

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RNTCPJharkhand 2013


in 2012. TB, especially MDR-TB is a major public health problem for Revised National Tuberculosis Control Programme (RNTCP) of India with high adverse outcomes.

MDRTBispurelyalaboratorydiagnosismadeaftercultureanddrugsusceptibilitytesting(C&DST)incertifiedlaboratories. In India,around 3% of new and 17% of previously treated TB cases are estimated to have MDR TB.RNTCP of Jharkhand could test only ˜ 750 (50%) of ˜1500eligiblebeneficiariesin2012. It is critical to have early and accurate diagnosis for timely treatment intervention and hence better treatment outcome. But, estimated numbers of samples from eligible MDR Suspects didn’t reach testing facility, possibly delaying MDR TB diagnosis.

Programme offers free diagnostic and treatment services to eligible patients as early as possible. Jharkhand initiated phase wise implementation of PMDT services in 2010 & has achieved full geographical coverage in Feb 2013. The Criterion for earliest suspicion of MDR amongst TB cases was rolled out since Feb 2013 across Jharkhand. This criterion includes all pulmonary Retreatment patients, HIV - TB coinfected patients, PulmonaryTBcontactsofknownMDR-TBpatientsandallfollow-upsmearnon-convertorsasbeneficiaries.

Methodology:An interventional study was conducted in selected six districts of Jharkhand involving monitoring of programme reports by a structured reporting tool over April 2013 to September 2013.

The study was conducted in six districts of Jharkhand namely Hazaribagh, Palamu, West Singhbhum, Gumla, Simdega and Saraikela-Kharsawan covering 20 TUs and 72 Microscopy centres with a population of 8.2 million.TU and DMC wise monthly monitoring tool was introduced in these districts (in/ after July 2013) for analysis of Referral for Culture & DST register kept at District Level.

Involvement of Microscopy Centres in identifying and referring MDR TB Suspects samples to certifiedIntermediatereferencelaboratory(IRL),Itki,Ranchiwastrackedonmonthlybasistoidentifynull/inadequatereferral units.

Discussion/ Conclusions:StudyidentifiedweaknessinmonitoringofpresumptiveMDR-TBpatients’samplereferralinstudypopulationofJharkhandandwasrectifiedbymonthlymonitoring.

Intensifiedsub-districtlevelandmicroscopycentrewisemonthlymonitoringimprovesnumberandproportionof eligible presumptive MDR TB patients sample tested for diagnosis over the period.

Results:Intensifiedmonitoring shows6%additional cumulativeyield inpresumptiveMDRcases tested (O.R.5.65,R2=80%)

Table : Sputum samples of presumptive Multi Drug Resistant Tuberculosis patients tested in six intervention districts of Jharkhand

Study Period Tested Not Tested Total Odd’s Ratio

Apr-Sep 2013 347 (63.1%) 203 (36.9%) 5505.65 (95% CI 3.69-8.64)

Apr-Sep 2012 33 (23.2%) 109 (76.8%) 142

*Interventional six intervention districts of Jharkhand India.

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RNTCPJharkhand 2013


Proportion of eigible presumptive MDR TB suspects tested

Figure 1: Proportion of Eligible presumptive Multi Drug Resistant Tuberculosis (MDR-TB) patients sample tested - Trend in six interventional districts of Jharkhand, India (___: Trend with Intervention, ---: Trend without intervention)

Figure 2: Comparision with non-intervention districts of Jharkhand

Suggested reads:WHO Global TB Report 2013, Guidelines for PMDT in India (May 2012), RNTCP Performance Reports – Jharkhand, Annual Report - RNTCP Jharkhand 2012.

An assessment of Health Seeking Behaviour and reasons for delay in diagnosis of TB patients in JharkhandProf Dr. S. Haider*, Prof Dr. V. Kashyap**, Dr. V. Sagar***, Dr. M. Kumar**** and Mr. S.B. Singh

*Prof & HOD, **Prof, ***Asso. Prof, ****Tutor, Lecturer cum statistician – Department of Preventive & Social Medicine, Rajendra Institute of Medical Sciences, Ranchi

Background:The annual report of Jharkhand for the year 2010 indicates that new smear positive case detection rate (%) for the state is 77%. But in 8 out of 24 districts, it’s below the desired level of 70%. These districts are from different divisions scattered throughout the state. Hence, to maintain the currently achieved Case Detection Rate and to achieve uniform implementation, we must know the factors which contribute to delayed case detection.

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RNTCPJharkhand 2013


Objective: To know the Health seeking behaviour & reasons for delay in diagnosis of TB patients in Jharkhand & to suggest measures to increase the case detection rate of new sputum smear positive cases existing in the community.

Methods:Thepresentstudywasdescriptiveandcross-sectionalinnatureandincludesbothquantitativeandqualitativetechniques.ThisstudywascarriedoutinthefivedistrictsnamelySaraikela,Jamtara,Bokaro,LatheharandGumlarepresentingonedistricteachfromthefivedivisions.Thesamplesizeincludes300patientsonintensivephase attending DOTS clinics, 30 STS/STLS/LT/ Pharmacist/ANM, 30 MOIC, 05 DTO and 1 STO.

Results & Conclusions:These studies revealed that 26.3% male patients are in age group (20-49) who are more prone to get infection with TB. In rural areas (73.8%) patients approach DOTS and (19.7%) visits to Private Doctors, (4.1%) patients visits to AYUSH doctors and very few visit to RMP. Majority (97.2%) of TB patients undergoing DOTS therapy said that their family members believe DOTS as effective mode of treatment. 95.7% treated TB patients suggested that in case of need they will refer other patients to visit DOTS centre for TB treatment. 71 % respondents reported that lack of awareness was the leading cause of delay in treatment because 66% patients were denied ofanyIECmaterial.Familymembersandhealthworkers(Sahiyya,ANM,andAWWetc)werethefirstpersonsto decide over health related matters. 98.6% patient reported that DOTS take nearly one week time to initiate treatment. 52 % patients reported that they get the report of their sputum test in three to seven days which may be one of the service delivery barriers. 63.1% patients reported that staff of DOTS centre started process of treatment within one hour. 97.2% patients did not report any problem in getting medicine at DOTS centres. Migration was found very vital pushing factor that disrupts the full treatment of Tuberculosis. Shortage of staffs,logistics,communicationproblemamongpatientsandDOTproviders,requirementofmorevisitsanddelayedinitiationoftreatment,lackofseparatewaitingroom,difficultyintrackingofdefaulterpatientwereprominent service delivery barriers. Drug side effect was found to discourage continuation of TB treatment. Lack of awareness, habit of substance use (Hadia, Alcohol) and migration for search for work were leading cause of delay in diagnosis of TB patients. Habit of substance use especially Hadia (Local alcohol) was found responsible for poor prognosis of tuberculosis.

Recommendations: There should be provision of a separate counselor and TBHV at each DMC. Counseling of all DOTS

beneficiaries shouldbea routineprocess irrespectiveof firstor regularvisits.Followingcomponentsshould be emphasized during counseling - side effects, importance of completing the recommended course, disadvantage of stopping medicine in-between. Awareness programme for DOTS must be strengthened and importance of transfer- in and transfer- out should be explained during counseling.

CounselingofallDOTSbeneficiariesincludingre-visitors. StrengtheningofawarenessprogramforDOTSwhichshouldalsoincludeinfluentialcommunityleaders. Collaboration with health related NGOs and other hospitals like PSUs, corporate, missionaries etc. Transfer-in and Transfer out process to be strengthened. Strengthening of process of retrieval of defaulters. Some encouraging mechanisms for the persons who bring the TB patients to DOTS. Strategies to motivate DOTS staffs and community. Special strategy in tribal areas / migrant population to overcome the socio-cultural barriers. Sputum Collection Centre should be at 20000-30000 population to increase the case detection with some

adequatetransportationmechanismtocarrythesamplestotheDMC.

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TB HIV COLLABORATIONThe interaction between HIV infection and tuberculosis (TB) is well documented. Although 40% of the population is infected with TB, only a small proportion develops active TB disease. HIV-infection compromises the immunity of the person and there are higher chances for death of HIV infected TB patients than HIV non infected TB patients during or after treatment for TB. The risk of recurrence of TB even after successful TB treatment is much higher in HIV-infected

TB is the most common opportunistic infection and cause of mortality among people living with HIV (PLHIV). Itisdifficulttodiagnoseandtreatowingtochallengesrelatedtoco-morbidity,pillburden,co-toxicityanddruginteractions. Studies indicate that emphasis needs to be on early diagnosis linked to TB and HIV treatment. DOTsisnotonlyacceptedregimenforHIVpatientsbutalsoimprovesthequalityoflifeandincreasesthelifespan of the HIV infected TB patients.

IntensifiedTB-HIVpackagehasbeenintroducedinJharkhandintheyear2011.Thereisadedicated“TB-HIVsupervisor” in every district for the supervision of TB-HIV collaborative activities. With the active collaboration with Jharkhand AIDS Control Society (JSACS), 17336 patients were tested for HIV status of all diagnosed TB cases in 2013 in 172 (52%) collocated DMC and HIV testing facilities (ICTCs/ F-ICTCs/ ART centres). Out of the tested TB patients 237 (1.37%) patients were found to be TB-HIV co-infected. There is provision of decentralized CPT to all co-infected patients and linking them to early initiation of TB treatment and initiation of ART. All the co-infected patients have the provision of patient support for sending them to the ART centres linked to the district. In the joint effort to strengthen the TB-HIV collaborative activities, efforts are on to have 100% decentralized HIV testing in facility integrated HIV testing centres in DMC PHIs where ICTCs are not co-located

Trends in Number (%) of registered TB patients with known HIV status, 1q08- 4q13, Jharkhand

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%100.0%

0

2000

4000

6000

8000

10000

12000

1q082q083q084q081q092q093q094q091q102q103q104q101q112q113q114q111q122q123q124q121q132q133q134q13

Known HIV status Unknown HIV status Proportion with known HIV status

Trends in Number (%) of registered TB patients with known HIV status, 1q08- 4q13, Jharkhand

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Success Stories & Community Volunteerism

Advocacy by Cured PatientJh jktw jke] firk& egkchj jke] xzke& uokM+hikM+k] yksgjnxk dks 15 fnu ls yxkrkj [kkalh FkkA xzkeoklh ,oa iM+kfl;ksa ds crkus ij cyxe tk”p ftyk ;{ek dsUnz] yksgjnxk esa djkus vk;kA cyxe dk ifj.kke /kukRed fudykA u;k jksxh QsQM+s dk ik;s tkus ij 6 ekg dk nok lfg;k ds ek/;e ls f[kyk;k x;kA xgu pj.k ds var esa cyxe tk”p djkus ij ifj.kke _.kkRed vk;kA rFkk vafre cyxe tk”p ifj.kke _.kkRed vk;kA og vc iw.kZ :i ls LoLF; gks x;k gS rFkk jktfeL=h dk dk;Z dj vius ifjokj dk ikyu iks"k.k dj jgk gSA vc vius xkao esa nks lIrkg ls vf/kd [kkalh gksus okys yksxksa dks tkx:d dj fudVre LokLF; dsUnzksa esa cyxe tk”p gsrq izksRlkfgr dj jgk gSA

Jh cxky eqewZ] mez 60 o"kZ firk Lo0 jkel; eqewZ xzke& fx/kuhigkMh iapk;r f'koigkM] ftyk nqedk dk jgusokyk gSA mlss Vhch ds ckjs esa irk Fkk ysfdu tk”p ,oa nok fu%'kqYd feyrk gS] irk ugha FkkA ,d fnu xzke Hkze.k ds le; Jh eqewZ dh iRuh fx/kuhigkMh dh lfg;k pqMdh lksjsu ls feyh ,oa vius ifr ds ckjs esa crk;kA vxys fnu lqcg pqMdh cyxe dh fMCch esa lqcg dk cyxe o Jh eqewZ dks ftyk ;{ek dsUnz] nqedk ysdj vk;h tgkW cyxe ds nks uewuksa tk”p djkus ds mijakr _.kkRed ik;k x;kA nks lIrkg dk ,aVhck;ksfVd nok lnj vLirky] nqedk ls fn;k x;k ,oa nqckjk cyxe tk”p gsrq vkus dks dgk x;kA

Jh eqewZ dk nqckjk cyxe tkp _.kkRed ik;k x;k ,oa fpfdRlk inkf/kdkjh ds }kjk ,Dljs djkus dk lykg fn;k x;kA ,Dljs fjiksZV /kukRed ik;k x;k ,oa dsVsxjh ,d dh nok lfg;k }kjk nh x;h ,oa crk;k x;k dh dqy N% ekg rd nok lsou ,oa izR;sd nks&nks ekg esa cyxe dh tk”p djkuk gSA i;Zos{kd ds {ks= Hkze.k ds le; Jh eqewZ us crk;k x;k fd mlss vPNk yxus yxk ,oa nok dh izfr fo'okl c< x;k rFkk nok dk lsou fu;efr djrs gq, izR;sd nks&nks ekg ds ij varjky cyxe dk tk”p djkrk jgk gSA lfg;k us nok lekfIr ds ,d lIrkg iwoZ tkap djk;k ,oa fpfdRlk inkf/kdkjh us mls jksxeqDr ?kksf"kr fd;kA mls ,oa lfg;k dks jksxeqDr gksus ds mijkar izksRlkgu jkf'k iznku dh x;hA

og xzke LkHkk esa Vhch ds y{.k] tk”p] mipkj ,oa izksRlkgu jkf'k ds ckjs es crkuk ugha Hkwyrk gS rFkk nwljs lansgkLin ejht dks fu%'kqYd tk”p ,oa nok lsou djus gsrq izsfjr djrk gSA

orZeku esa lansgkLin ejht ekbdy lksjsu] eqa'kh gkalnk] ,oa 'kysUnz eajkMh dks mlus cyxe tk”p djkus dh lykg nh ,oa mues Vhch ik;k x;k rFkk os lHkh nok dk lsou dj jksxeqDr gks pqdsa gSa mUgsa Hkh izksRlkgu jkf'k fey pqdk gSA

mlus ;g Bkuk gS fd og vius xkao dks Vhch ls eqDr djkus ds fy, vkthou iz;kl djrk jgsxkA

jksx eqDr ds ckn

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RNTCPJharkhand 2013


MotivatedAngan Wadi SevikaworkingtowardsTBControl - An example for others>kj[k.M jkT; ds prjk ftys ds gaVjxat iz[k.M vUrxZr xzke iapk;r tksjh esa crkSj vkaxuckM+h lsfodk ds :i esa dk;Zjr elks- lktnk ckuks ftUgksaus RNTCP izksxzke esa ,d lQy MkV~l izksokbMj ds :i esa o"kZ 2006 ls vc rd dqy 23 ;{ek ejhtksa dk lQy mipkj@iwjk dkslZ ¼MkV~l½ }kjk djok pqdh gSA

xzke tksjh ,d vR;ar gh fiNM+k {ks= gS rFkk ;gk¡ ds vf/kdka'k Vh-ch- ejht cgqr gh xjhc rFkk vf'kf{kr gS] ftldh otg ls MkV~l dk iwjk dkslZ f[kykus esa dkQh dfBukbZ;ksa dk lkeuk djuk iM+rk gSA

bl ifjfLFkfr esa Hkh lktnk ckuks viuk fgEer ugha gkjrh gS vkSj gj gky esa MkV~l dk iwjk dkslZ ejht dks viuh ns[k&js[k nsrh gSA Kkr gks fd o"kZ 2006 esa gh lktnk ckuks ds ifr dk nsgkar gks pqdk gSA ,sls esa ifjokj esa ckfd lnL;ksa us Hkh buls viuk ukrk rksM+ fy;sAbl fo"ke ifjfLFkfr esa lktnk ckuks us vius /kS;Z dk ifjp; nsrs gq, vkt Hkh MkV~l izksokbZMj ds :i esa u flQZ vius xkao cfYd vkl&ikl ds pkj&ikap xkao esa viuh igpku Vh-ch- okyh nhnh ds :i esa cuk pqdh gSA buds Vh-ch- ejhtksa ds izfr leiZ.k dks ns[kdj gaVjxat iz[k.M ds dbZ lfg;k@vkaxuckM+h lsfodk rFkk vU; MkV~l izksokbZMj Hkh buls izsj.kk ysrs gSA vkt lktnk ckuks dgrh gS fd eq>s rc vikj [kq'kh gksrh gS tc esjs }kjk ,d Vh-ch- ejht Bhd gksdj viuk vkSj viuk ifjokj dk thou ;kiu djrk gS] rc eq>s yxrk gS fd eSus ,d O;fDr dh tku cpkdj ,d ifjokj dks mtM+us ls cpk;kA buds ljkguh; dk;ksZa ls izHkkfor gksdj vklikl ds lHkh lEiznk; ¼fgUnq] eqfLye½ us pank bdëk dj budh nqckjk 'kknh vDVqcj 2013 esa djok nh gSA viuh nqckjk 'kknh dk Js; ;{ek fu;a=.k dk;ZØe dks nsrh gS vkSj dgrh gS fd vkt lekt esa esjh tks igpku cuh gS] eSa tks dqN Hkh gw¡ ;g ;{ek fu;a=.k dk;ZØe dh otg ls gSA eSa thouiz;ar ;{ek fu;a=.k dk;ZØe tqM+h jgw¡xhA

TB awareness measures at Dumka – Media Sensitization fnukad 26-12-2013 dks ftyk ;{ek dsUnz nqedk esa iqujhf{kr jk"Vªh; ;{ek fu;=a.k dk;ZØe ds rgr izsl izfrfuf/k;kas dk ,d&fnolh; ;{ek tkx:drk ,oa mUeq[khdj.k dk;ZØe fd;k x;kA dk;ZØe dk fof/kor mn~?kkVu eq[; vfrfFk Jh lfPpnkuan jk;] ofj"B i=dkj] nSfud fgUnqLrku] Mk- Mh-,u- ik.Ms;] v/;{k] IMA ,oa Mk- ,-,e- lksjsu] ftyk ;{ek inkf/kdkjh] rFkk MkW- eukst dqekj] fpfdRlk inkf/kdkjh }kjk la;qDr :Ik ls fd;k x;kA ftyk ;{ek inkf/kdkjh us mUeq[khdj.k dk;ZØe ds vk;kstu dk eq[; m}s'; ij izdk'k MkykA

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RNTCPJharkhand 2013


izsl izfrfuf/k;ksa dks ;{ek jksx ,oa blds fpfdRlk ds fofHkUu igyqvksa ij foLrkj ls tkudkjh nh x;hA izsl izfrfuf/k;ksa ds chp ;{ek fo"k; ij ,d fyf[kr izfr;ksfxrk dk Hkh vk;kstu fd;k x;kA izFke ,oa f}rh; LFkku izkIr djus okysi=dkjksa dks iqjLdkj ls lEekfurfd;k x;kA

bl volj ij ftyk ds lHkh ehfM;kdehZ;ksa us ladYi fy;k fd Vhch ds mUewyu esa viuh lgHkkfxrk fuHkkdj TB free India dk fuekZ.k djsaxsA izsl izfrfuf/k;ksa ds fy, vk;ksftr bl mUeq[khdj.k dk;ZØe ls ;{ek jksx ds fu;a=.k esa izHkko'kkyh ,oa nwjxkeh ifj.kke ifjyf{kr gksaxsA

TB awareness measures at Dumka – School AwarenessOn the occasion of 158th Santhal Pargana Foundation Day, a quiz & essay competition was organized on21.12.2013 by District TB Centre, Dumka in collaboration with Johor Manav Kendra – a local NGO.

Large number of school children participated in the event & all were enlightened about Tuberculosis and ongoing TB control measures. Winners of the competition were felicitated by DTO. Such IEC activities had helped in spreading awareness of TB among school children about signs, symptoms & treatment of TB. This helped in aided referrals of TB suspects to nearby TB centres for diagnosis & treatment.

TB awareness measures at Gumla – “Jhanki” as a part of Independence Day celebration 15 vxLr 2013 dks Lora=rk fnol ds miy{k ij xqeyk iz'kklu vUrxZr fofHkUu foHkkxksa ,oa laLFkkvksa }kjk >kafd;ka fudkyh xbZA ftyk xzkeh.k LokLF; lfefr] vkj-,u-Vh-lh-ih- }kjk ,d vkdZ"kd >kadh fudkyh xbZ] ftldk eq[; mís'; ;{ek chekjh ds izfr yksxksa dks tkx:d djuk rFkk ;{ek ls lacaf/kr Hkzkafr;ksa dks feVkuk FkkA >kadh }kjk yksxksa dks ;g crkus dk iz;kl

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RNTCPJharkhand 2013


fd;k x;k fd ;{ek chekjh ds mijkUr >kM+&Qaqd rFkk vks>k] Hkxr bR;kfn ds va/kfo'okl esa iM+dj yksx chekjh dks vkSj c<+k nsrs gSaA bl chekjh dk ,d gh bykt gS vkSj og gS MkWV~lA

xqeyk ftys ds vU; lHkh foHkkxksa] fo|ky;ksa] dkWyst] Loa;lsoh LkaLFkkvksa }kjk iznf'kZr >kafd;ksa esa vkj-,u-Vh-lh-ih- dh >kadh dks x.kekU; yksxksa] izsl dh mifLFkfr rFkk gtkjksa dh la[;k esa mifLFkr turk ds chp ljkgrs gq, izFke iqjLdkj ls lEekfur fd;k x;kA >kadh ds }kjk ;{ek chekjh lacaf/kr tkx:rk tuekul rd igqWpkus esa lQyrk vftZr dh x;hA

Low Cost innovations for mass awareness: Sahibganj DistrictSahibganj is one of the remotest districts in Jharkhand bordering with Bihar and West Bengal and having hard to reach geographical areas with hilly terrains and flood hit planes. In spite of allgeographical difficulties, the district is one ofthe best performing districts in the TB Control programme. The onus goes to personal initiatives and local innovation to generate awareness of the programme among the masses.

In view of massive religions gathering besides river/ ponds during “Chath festival” to pay “arghas” to setting & rising Sun God, the District TB Cell Sahibganj took the initiative to generate mass awareness during the festival. Lots of people gather IEC activity on boat during Chhat puja at the bank of river Ganges,

Sahibganj, Jharkhand

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RNTCPJharkhand 2013


at the bank of holy river the “Ganges” during the occasion, an IEC activity was planned with IEC display and miking on a moving boat. This proved to be an attraction for the local people & gathered good response. More than ten thousand people got information of RNTCP with regards to TB suspects, suspect referrals, free services, TB HIV in a short span of time with minimum cost. This event was further telecasted by the local channel “AAB TAK” and was appreciated by the Civil Society and the local administration. The whole event was activelysupervisedbytheDistrictTBOfficer&RNTCPteamofSahibganj.

Low Cost innovations for mass awareness: West Singhbhum DistrictThe West Singhbhum district has taken enthusiastic approach in spreading awareness for T.B. prevention & treatment by innovative ACSM activities.

The district has developed banners, posters, hand bills & IEC Canopy in their local tribal “Ho” language for spreading the information about the awareness & approach towards T.B.

The District has created an audio clip in their local tribal language for T.B. awareness, which is being played in areas of public gatherings such as Weekly markets (hat), Melas etc.

The DTO of this District took an initiative to involve the Civil Surgeon, health workers & local people to organize and enact street plays in Hospital premises & Melas. The audio clip and street play were developed with the help of the local artists, which has proved to be cost effective impactful intervention.

Corporate Social Responsibility involvement for mass awareness: West Singhbhum DistrictThe District RNTCP team of West Singhbhum also took initiative by involving corporate sectors under Corporate Social Responsibility for ACSM activities. Hoardings to raise the awareness were put in the district at strategic locations. Theseinterventionshavebenefittedthelocalpeoplealotwhichisbeingreflectedbysubstantialincreaseinnumberof TB suspect referrals as well as TB cases in the district.

Felicitation of DTO, Sahibganj on State Foundation Day by Chief Minister of Jharkhand The TB control programme (RNTCP) in Jharkhand is recognized as awellperformingprogramme.Thisisbecauseofthekeyfieldstaffsandtheablesupportofprogrammeofficersinthedistricts,wholeadfrom the front and take initiatives with innovations to reach out the people.

This year the Government of Jharkhand recognised the efforts made byDistrictTBOfficer,SahibganjintheTBControlprogramme.Dr.P.P.Pandey, DTO, Sahibganj was felicitated with presentation of “Letter of Appreciation” by the Chief Minister of Jharkhand SriHemant Soren on the State Foundation Day.

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RNTCPJharkhand 2013


Mainstreaming of Civil Societies & Inter-Sectoral CoordinationGreater involvement of civil society is envisaged in the National Strategic Plan 2012-17 of RNTCP to yield in diminishingthegapbetweenthepatientandprovider,improvementincasefindingandholding,involvementof other care providers and increased awareness with stigma reduction. Role of civil society is one of the key dimensions in bridging the gaps in TB care and control. The Global Fund also provides grant directly to the civil society focusing on greater involvement of civil society in the domain of advocacy, communication and social mobilization. There are nine key partners involved in the state under various projects supported by different donors such as Global Fund, TB Reach (Stop TB) and Eli Lilly.

Project Axshya (Global Fund R 9) Global Fund Round – 9 supports Project Axshya in 22 districts of Jharkhand out of 374 districts across the country through International Union Against TB and Lung Disease (The Union) and World Vision India (WVI) as Principal Recipients (PRs) in 15 and 7 districts respectively. Catholic Health Associations of India (CHAI), Emmanuel Hospital Association (EHA) and Population Services International are sub recipients (SR) to ‘The Union’ and CARE is the SR to WVI. CHAI and EHA have also involved more than 50 NGOs (@ 4 in each district) at district level and CARE implements through 3 Sub Sub Recipients (SSRs). The matrix below speaks in consolidate Project Axshya in Jharkhand.

Name of the Partner Operation Districts InterventionFocus Activities

CHAI

Chatra, Deoghar, Garhwa, Giridih, Gumla, Hazaribagh, Jamtara, Latehar, Lohardaga, Pakur, Ranchi, Saraikela-Kharsuan. West Singhbum (Total– 13)

Improve the reach, visibility and effectiveness of RNTCP through civil society support

Engage communities and community-based care providers to improve TB care and control, especially for marginalized and vulnerable populations including TB-HIV patients

ACSM: Community / GKS meeting; school activities, mid-media activities, patient sensitisation on Patient Charter, ICTC and DMC meeting, Formation of District TB Forum to advocate for patient’s cause.

Training and Sensitisation: Community Volunteers, Rural Health Care Providers (RHCPs), AYUSH and PLHIV networks/Targeted Interventions and Care and Support Centres on RNTCP. Training of health staff on Soft Skill. Sensitisation of NGOs on NGO-PP schemes;

Case Finding: Intensive outreach in vulnerable and marginalised areas; Suspect Referrals through Community Volunteers, Sputum Collection and Transportation;

Treatment Outcome: Retrieval of initial defaulters and treatment interrupters.

EHA Palamu and Sahibganj (Total – 2)

PSI Ranchi, Palamu, Giridih (Total – 3)

CARE

Bokaro, Dhandbad, Dumka, Godda, Koderma, Purbi Singhbum and Simdega (Total – 7)

CBCI-CARD GF RCC/SSF TB ProjectGlobal Fund also funds Catholic Bishop’s Conference of India (CBCI) for the involvement of Catholic Health Facilities (CHFs). The objective of the interventions is to improve access to the diagnostic and treatment servicesofRNTCPwithintheCHFsleadingtoimprovethequalityofcareforTBpatients.Underthisproject,124 catholic health facilities (CHF) are listed, with presence of 8 dioceses in all 24 districts. Many CHFs are participating in the programme. The matrix below represents some of the major CHFs contributing to RNTCP in the domain of suspects’ referrals and TB diagnosis.

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RNTCPJharkhand 2013


TB Diagnostic services Suspect Referral to RNTCP

CHFs

St. Joseph Hospital, Jamshedpur Holy Cross Hospital, Giridih Carmel Hospital, Latehar Snehdeep Holy Cross Hospital,

Hazaribagh St. Francis Hospital, Deoghar

(During 2013, from these hospitals 1124 suspects were examined and 190 were found smear positive TB including 3 of repeat sputum)

St. Urusula Hospital, Konbir, Gumla AshaSewaKendra,Gomia, Bokaro Missionaries of Charity TB Centre, Balidih, Bokaro Holy Family Hospital, Koderma Missionary of Charity, Jamtara Mercy Hospital, Godda Missionary of Charity, West Singhbum Missionary of Charity (Brother), Pakur Holy Family Hospital, Mandar, Ranchi Missionary of Charity, Dumka Missionaries of Charity, Palamu

(From these institutions, 1776 suspects were referred, out of which 358 found smear positive in 2013.)

Indian Medical Association (IMA)IMA has been entrusted with a Project to increase participation of private practitioners which is one of major thrustofRNTCPinthepostscenariodeclarationofTBasanotifieddisease.Presently,ithastheresponsibilitytosupportRNTCPintwoaspects(i)ensuringinvolvementofPrivateClinicsasPHIand(ii)facilitatingTBNotification.

TB Reach ProjectGramin Samaj VIkas Kalyan Manch (GSKVM) is implementing an ‘INNOVATIVE METHOD’ through the STOP TB Partnership Programme in supplementing the work of RNTCP to reach to more number of TB patients in comparison to recent past years. It works in Daltonganj TU of Palamu covering 3 DMCs namely Chainpur, DaltonganjandBishrampurwithanapproachof‘NoTBpatientisleftunidentifiedinthecommunities’.

Eli Lilly‘The Union’ through its local partner Sankalp Jyoti implements a Lilly Foundation Grant in association with Lilly MDR TB Partnership in the district of Khunti to involve RHCPs in TB care and control through a mobile application technology with necessary capacity building on RNTCP and the application. This pilot project has two interoperable applications – (i) Application for RHCP and NGO Supervisor and (ii) Application for RHCP Lab Technician.Theflowchartintheboxdemonstratesthemodusoperandiofthetechnologybasedreferralsystem.

Chest Symptomatic Cases

NGO Supervisor (NS)

Lab Technician (DMC)

Referred Chest Symptomatic Cases

Rural Health Care Providers (RHCP)

Central Server Database

Results of Sputum examination Results of Sputum

examination / info within 7 days if lost to follow up

A SMS will be sent to NS, RHCP and the patient if the patient is loss to follow up after diagnosis

A SMS of the sputum result will be sent to the

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RNTCPJharkhand 2013


This system has ‘application mockup’ for RHCP and LT and basic DOTS protocol support. Further, this also advocates for involving RHCPs as the DPs. The pilot is operational in Khunit and likely to be extended to Hazaribagh in 2014. In the pilot at Khunti, 314 referrals made by RHCPs and 160 reached DMC for diagnosis, 22 found positive and put on DOTS and 19 among them take DOTS through RHCP.

Involvement of NGOs and PPs under RNTCP SchemesRNTCP encourages involvement of NGOs, Private Providers (PPS), Civil Society Organizations, Private Laboratories, Civil Society Organizations, Charitable hospitals, Private Hospitals and Mission Hospitals etc. to be part of the programme through various schemes. There are 10 different schemes as per CTD guideline for NGO-PP. 20 organizations have been involved across Jharkhand as per the table below.

DistrictsNGO-PP Schemes

ACSM Sputum Collection Centre

Sputum Transportation DMC ( A ) TB Unit Total

Bokaro 0 2 1 0 0 3

Dumka 1 0 0 0 0 1

Giridih 0 0 0 1 0 1

Godda 0 3 3 0 0 6

Gumla 0 1 0 0 0 1

Jamtara 0 0 0 1 0 1

Pakur (DTO) 0 1 1 0 0 2

Palamu 0 0 0 0 1 1

Purbi Singhbhum 0 1 1 1 0 3

Sahibganj 0 0 0 1 0 1

Total 1 8 6 4 1 20

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RNTCPJharkhand 2013


Photo Gallery

Flagging off – World TB Day (2013) Rally at Dhanbad World TB Day (2013) Rally at Dhanbad

World TB Day (2013) Rally at Dhanbad

World TB Day (2013) Celebration and Rally at Khunti

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RNTCPJharkhand 2013


Photo Gallery

Community Meeting on World TB Day (2013) at Chainpur Block, Palamu

World TB Day (2013) Rally at Palamu

Community awareness programmeon World TB Day (2013) at Dumka

World TB Day (2013) Rally at Dumka

School Health Programme on TB at Gumla Community Meeting in Hard to reach area – Gumla

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RNTCPJharkhand 2013


Photo Gallery

Community Meeting in Hard to reach area – Gumla “Nukkad Natak”as awareness drive at Dumka

“Awareness Stall” in Health Camp at Dumka

Cross check of slides by STO during DMC Visit – Gumla STO Interacting with MO during field visit – St. Ursula Hospital, Basia, Gumla

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RNTCPJharkhand 2013

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| 39 |

RNTCPJharkhand 2013


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TB ca

ses

with

know

n HI

V stat

us

Prop

ortio

n of

TB H

IV

coinf

ected

am

ong

tested

Prop

ortio

n of

HIV

infec

ted TB

pa

tient

s put

on

CPT

(RT r

epor

t)

Prop

ortio

n of

HIV

infec

ted TB

pa

tient

s put

on

ART

(RT r

epor

t)Bo

karo

9.29

855%

91%

75%

1128

94%

1199

100%

921

83%

1898

83%

37%

1.5%

100%

80%

Chatr

a5.3

323

3%84

%61

%46

382

%56

310

0%34

380

%74

687

%36

%0.7

%0%

100%

Deog

har

4.24

323%

95%

77%

796

90%

884

100%

729

86%

785

72%

90%

0.3%

50%

25%

Dhan

bad

4.86

110

5%94

%79

%12

8991

%13

5696

%11

4686

%14

6457

%24

%1.6

%57

%57

%Du

mka

10.37

382%

93%

82%

892

83%

1078

100%

576

69%

1917

96%

76%

0.2%

0%20

%Ga

rhwa

7.32

665%

88%

75%

547

79%

692

100%

323

57%

1211

80%

7%6.9

%Gir

idih

7.33

835%

91%

81%

1279

89%

1416

99%

819

77%

1549

82%

21%

5.3%

0%10

0%Go

dda

8.04

464%

85%

77%

603

81%

739

99%

317

58%

1002

72%

41%

1.0%

Guml

a6.6

331

4%90

%79

%50

183

%60

610

0%28

560

%81

394

%87

%0.1

%Ha

zarib

agh

7.29

604%

92%

76%

967

97%

996

100%

710

81%

1443

93%

52%

5.8%

8%92

%Jam

tara

11.52

122%

94%

76%

513

86%

596

100%

346

76%

779

83%

45%

0.5%

Khun

ti5.9

625

6%92

%72

%26

891

%29

510

0%17

777

%49

010

0%37

%0.0

%Ko

darm

a6.4

113

5%85

%68

%17

792

%19

310

0%13

791

%23

473

%35

%9.6

%0%

90%

Lath

ehar

7.79

406%

95%

90%

471

89%

531

100%

278

61%

602

81%

28%

0.0%

0%10

0%Lo

hard

aga

11.83

165%

78%

56%

201

77%

255

97%

134

64%

379

100%

67%

0.4%

Paka

ur7.4

624

2%90

%79

%62

674

%84

510

0%30

443

%12

4395

%54

%0.0

%Pa

lamu

10.49

127

5%94

%81

%14

2995

%15

1010

0%11

0489

%17

3663

%42

%0.9

%0%

67%

Pash

chim

i Sin

ghbh

um8.3

664

3%93

%85

%11

5283

%13

9210

0%63

161

%20

6081

%83

%0.1

%0%

0%

Purb

i Sin

ghbh

um10

.7586

4%93

%83

%14

3790

%15

7999

%11

3087

%23

2480

%51

%3.6

%30

%80

%

Ramg

arh

6.76

314%

86%

63%

515

97%

532

100%

266

66%

719

84%

51%

1.2%

0%10

0%Ra

nchi

7.67

109

5%94

%71

%14

4594

%15

3499

%10

8587

%18

0168

%46

%1.1

%33

%11

7%Sa

hibga

nj8.9

275

6%88

%75

%69

987

%79

710

0%40

580

%10

8074

%87

%1.8

%88

%96

%Sa

raike

la - K

harsa

wan

6.76

373%

93%

78%

596

88%

680

100%

358

59%

1020

73%

43%

0.2%

0%10

0%

Simde

ga9.9

116

3%78

%52

%38

785

%44

798

%18

665

%61

491

%39

%0.4

%10

0%10

0%Jha

rkha

nd7.8

812

494%

91%

77%

1838

188

%20

715

99%

1271

075

%27

909

80%

49%

1.4%

26%

84%

| 40 |

RNTCPJharkhand 2013


istr

ict w

ise

Annu

al T

reat

men

t Out

com

e of

New

TB

case

s (2

012)

Imple

ment-

ing Di

strict

s

New

Smea

r Pos

itive

New

Smea

r Neg

ative

New

Extra

Pulm

onary

Regis

t-ere

dCu

reCo

mp-

leted

Died

Failu

reDe

-fau

lted

Tran

s ou

tSw

itche

d to

Cat IV

Regis

t-ere

dCo

mp-

leted

Died

Failu

reDe

-fau

lted

Tran

s ou

tSw

itche

d to

Cat IV

Regis

t-ere

dCo

mp-

leted

Died

Failu

reDe

-fau

lted

Tran

s ou

tSw

itche

d to

Cat IV

Boka

ro11

2485

%3%

2%1%

8%0%

0%56

791

%1%

1%7%

0%0%

283

95%

1%1%

2%1%

0%Ch

atra

551

74%

15%

2%2%

0%0%

0%24

171

%26

%1%

2%0%

0%21

81%

19%

0%0%

0%0%

Deog

har

836

93%

3%2%

0%2%

0%0%

134

96%

1%0%

3%0%

0%46

98%

0%0%

2%0%

0%Dh

anba

d13

7289

%1%

2%0%

7%0%

0%72

687

%1%

0%12

%0%

0%21

987

%2%

0%11

%0%

0%Du

mka

1007

75%

10%

4%0%

8%0%

0%74

489

%3%

0%8%

0%0%

3694

%3%

0%3%

0%0%

Garh

wa61

281

%6%

4%2%

4%0%

0%74

692

%1%

0%6%

0%0%

5796

%0%

0%4%

0%0%

Giridi

h11

5682

%6%

1%1%

7%0%

0%28

680

%2%

0%18

%0%

0%93

90%

0%0%

10%

0%0%

Godd

a57

182

%7%

4%2%

2%0%

0%52

594

%2%

1%3%

0%0%

4295

%2%

2%0%

0%0%

Guml

a52

384

%7%

4%1%

1%0%

0%15

496

%3%

0%1%

0%0%

6598

%2%

0%0%

0%0%

Haza

ribag

h89

887

%3%

3%1%

4%0%

0%54

895

%3%

0%2%

0%0%

147

98%

2%0%

0%0%

0%Jam

tara

461

88%

2%2%

0%6%

0%0%

199

84%

3%0%

13%

0%0%

1794

%6%

0%0%

0%0%

Khun

ti24

987

%2%

5%1%

3%0%

0%76

88%

0%3%

9%0%

0%50

98%

2%0%

0%0%

0%Ko

darm

a19

268

%14

%2%

1%13

%0%

0%93

71%

11%

0%18

%0%

0%20

70%

5%0%

25%

0%0%

Lath

ehar

425

93%

2%3%

0%2%

0%0%

199

95%

2%0%

3%0%

0%47

96%

2%0%

0%2%

0%Lo

hard

aga

216

82%

0%7%

1%10

%0%

0%10

081

%2%

0%17

%0%

0%44

93%

2%0%

5%0%

0%Pa

kaur

734

85%

3%4%

1%7%

0%0%

269

88%

3%0%

9%0%

0%26

92%

0%0%

8%0%

0%Pa

lamu

1200

89%

3%1%

1%4%

0%0%

837

91%

2%0%

7%0%

0%21

895

%0%

0%4%

0%0%

Pash

chim

i Sin

ghbh

um11

4584

%4%

7%0%

3%1%

0%10

0488

%5%

0%6%

1%0%

104

98%

0%0%

2%0%

0%

Purb

i Sin

ghbh

um13

0386

%2%

5%1%

5%0%

0%64

684

%3%

0%12

%0%

0%28

492

%3%

0%4%

1%0%

Ramg

arh

462

75%

10%

4%0%

7%0%

0%28

590

%4%

0%6%

0%0%

113

97%

2%0%

1%0%

0%Ra

nchi

1278

85%

1%4%

1%3%

5%0%

824

75%

8%0%

2%11

%3%

356

92%

5%0%

2%1%

0%Sa

hibga

nj58

775

%10

%4%

2%4%

0%0%

574

96%

1%0%

3%0%

0%73

93%

1%0%

5%0%

0%

Sarai

kela-

Khar

sawa

n62

289

%2%

3%0%

4%0%

0%46

787

%5%

0%8%

0%0%

6290

%2%

0%8%

0%0%

Simde

ga39

168

%7%

6%1%

18%

0%0%

109

82%

4%0%

15%

0%0%

6571

%2%

0%28

%0%

0%Jha

rkha

nd17

915

84%

6%3%

1%5%

0.5%

0%10

353

88%

4%0%

7%1%

0%24

8893

%2%

0%4%

0.5%

0%

| 41 |

RNTCPJharkhand 2013


District-wise outcome of Smear Positive Retreatment cases 2012

Districtsv No. registered Cured Completed Died Failure Defaulted Transferred

outSwitched to

Cat IV

Bokaro 225 65% 7% 8% 2% 12% 2% 5%

Chatra 79 30% 59% 0% 9% 0% 0% 1%

Deoghar 80 85% 5% 4% 3% 3% 0% 1%

Dhanbad 167 68% 4% 5% 1% 15% 1% 5%

Dumka 153 54% 22% 6% 0% 18% 0% 0%

Garhwa 99 71% 12% 7% 6% 4% 0% 0%

Giridih 206 58% 23% 4% 6% 8% 0% 0%

Godda 98 74% 5% 6% 9% 2% 0% 3%

Gumla 58 64% 19% 9% 0% 2% 2% 5%

Hazaribagh 172 56% 19% 9% 8% 7% 0% 1%

Jamtara 81 62% 10% 7% 1% 19% 0% 1%

Khunti 27 48% 11% 15% 7% 15% 0% 4%

Kodarma 32 63% 6% 6% 13% 13% 0% 0%

Lathehar 84 77% 1% 10% 2% 4% 2% 4%

Lohardaga 48 67% 0% 6% 4% 21% 0% 2%

Pakaur 102 78% 9% 2% 5% 6% 0% 0%

Palamu 221 74% 5% 5% 3% 11% 0% 1%

Pashchimi Singhbhum 90 70% 8% 12% 2% 4% 3% 0%

Purbi Singhbhum 269 65% 4% 10% 2% 16% 0% 3%

Ramgarh 104 52% 18% 6% 4% 11% 0% 0%

Ranchi 295 55% 4% 6% 3% 7% 19% 5%

Sahibganj 101 60% 21% 2% 7% 5% 0% 5%

Saraikela - Kharsawan 65 77% 15% 3% 0% 5% 0% 0%

Simdega 63 35% 24% 13% 3% 25% 0% 0%

Grand Total 2919 63% 12% 6% 4% 10% 2% 2%

Outcome of Smear Positive Retreatment cases for Jharkhand in 2012 (excluding "Others")

Type of Retreatment cases

No. registered Cured Completed Died Failure Defaulted Transferred

outSwitched to Cat IV

Relapse 1605 65% 12% 6% 3% 9% 3% 36

Failure 164 44% 12% 8% 16% 11% 0% 16

Treatment after default 1150 63% 12% 7% 2% 11% 2% 16

Total 2919 63% 12% 6% 4% 10% 2% 68

| 42 |

RNTCPJharkhand 2013

Revised national tubeRculosis contRol pRogRammeTB

Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

icts

TB Un

it

Popu

lation

(in

lakh

) co

vered

by

RNTC

P

No. o

f su

spec

ts ex

amine

d

Annu

al Su

spec

ts ex

amine

d pe

r lak

h po

pulat

ion

Rate

of ch

ange

in

susp

ects

exami

ned p

er lak

h pop

ulatio

n (co

mpare

d to

prev

ious y

ear)

No of

sm

ear

posit

ive

patie

nts

diagn

osed

Susp

ects

exam

ined

per s

mear

po

sitive

case

dia

gnos

ed

Rate

of ch

ange

in

susp

ects

exam

ined p

er s+

ca

se di

agno

sed

(comp

ared t

o pr

eviou

s yea

r)

Annu

al sm

ear

posit

ive

case

de

tectio

n rat

e

Annu

al sm

ear

posit

ive ca

se

notificationrate

[fr

om CF

R: sm

+ ca

ses (

NSP +

Rel +

TA

D)/la

kh Po

p]

Annu

al tot

al ca

se

notification

rate

Annu

al ne

w sm

ear

posit

ive ca

se

notificationrate

(%

)

Annu

al ne

w sm

ear

nega

tive

case

notification

rate

Boka

roBe

rmo

427

6768

77%

262

1114

%65

5910

148

65%

23Bo

karo

BGH

632

6856

0-2%

372

99%

6459

137

4560

%36

Boka

roDT

C Cha

s6

2626

462

2%25

210

18%

4445

8842

56%

25Bo

karo

Gomi

a4

2394

623

25%

211

1151

%55

5610

048

65%

28Bo

karo

Petar

war

310

3941

6-20

%14

27

2%57

5882

4863

%11

Chatr

aCH

ATRA

619

9334

9-5%

321

614

%56

5387

4763

%27

Chatr

aSim

aria

416

7544

425

%23

87

5%63

7095

6384

%16

Deog

har

DTC

TU8

4505

541

-4%57

28

0%69

5772

5269

%10

Deog

har

Madh

upur

TU6

4056

713

32%

398

109%

7072

8668

91%

6Dh

anba

dBA

GHMA

RA5

2534

525

2%29

09

16%

6064

103

5473

%24

Dhan

bad

BCCL

514

8528

8-2%

166

940

%32

3180

2939

%24

Dhan

bad

DHAN

BAD_

DTC

428

8964

95%

463

68%

104

5913

347

63%

45Dh

anba

dGO

VIND

PUR

830

2638

7-1%

334

9-1%

4348

8346

61%

23Dh

anba

dJH

ARIA

228

1111

8213

0%29

99

-7%12

612

821

512

216

3%61

Dumk

aDu

mka D

TC5

3414

683

19%

450

816

%90

7913

764

86%

42Du

mka

Jarmu

ndi

631

9356

5-19

%30

610

30%

5457

114

5168

%47

Dumk

aSh

ikarip

ara5

2965

573

11%

358

837

%69

7012

963

84%

47Ga

rhwa

Garh

wa7

3422

496

-5%48

37

-6%70

5211

943

57%

53Ga

rhwa

Naga

runt

ari

318

6655

411

8%27

37

4%81

9919

988

118%

67Gir

idih

DTC-

GIRI

DIH

723

9632

12%

440

5-3%

5947

7039

53%

12Gir

idih

DUMA

RI7

1723

255

3%37

75

3%56

6270

5269

%5

Giridi

hJA

MUA

519

4237

910

%34

26

-4%67

6388

5978

%19

Giridi

hRA

JDHA

NWAR

424

8359

446

%33

47

-4%80

8297

7296

%9

Godd

aDT

C God

da5

1595

316

-12%

262

6-14

%52

4471

3749

%20

Godd

aMa

haga

ma4

2085

523

39%

275

8-17

%69

6213

655

74%

57Go

dda

Sund

arpa

hari

214

4958

527

%25

96

-7%10

511

321

693

124%

74Gu

mla

Basia

TU4

1279

356

6%22

96

4%64

6482

5979

%9

Guml

aGu

mla T

U5

1478

308

26%

223

711

%46

4677

3850

%17

Guml

aRa

idih

690

716

1-34

%14

56

-17%

2628

3525

34%

3

| 43 |

RNTCPJharkhand 2013


Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

ictTB

Unit

Annu

al pr

eviou

sly

treate

d cas

e notification

rate

Annu

al pr

eviou

sly

treate

d sm

ear

posit

ive ca

se

notification

rate

No(%

) of

pedia

tric

case

s out

of

all ne

w ca

ses

3 mon

ths

conv

ersio

n rat

e of

new

smea

r po

sitive

pa

tient

s

3 mon

ths

conv

ersio

n rat

e of

retrea

tmen

t pa

tient

s

Cure

rate

of ne

w sm

ear

posit

ive

patie

nts

Succe

ss rat

e of

new

smea

r po

sitive

pa

tient

s

No (%

) of al

l Sm

ear Po

sitive

cas

es sta

rted

RNTC

P DOT

S wi

tihin

7days

of

diagn

osis

No(%

) of al

l Sm

ear Po

sitive

cas

es reg

istere

d wi

tihin

one

month

of sta

rting

RN

TCP D

OTS

treatm

ent

No(%

) of cu

red

smear

posit

ive

cases

having

en

d of tr

eatme

nt fol

low up

sputu

m do

ne wi

thin 7

day

s of la

st dose

No(%

) of

cases

regist

erd

receiv

ing

DOT t

hroug

h a c

ommu

nity

volun

teer

Propo

rtion

of

all re

gister

ed

TB ca

ses wi

th kn

own H

IV sta

tus

Propo

rtion

of

TB pa

tients

kn

own t

o be

HIV in

fected

am

ong t

ested

Boka

roBe

rmo

2410

145%

89%

83%

82%

89%

228

97%

236

100%

199

90%

342

84%

32%

0.8%

Boka

roBG

H34

1437

6%91

%64

%82

%84

%32

093

%34

410

0%22

179

%64

781

%34

%0.7

%Bo

karo

DTC C

has

94

102%

92%

88%

86%

93%

234

91%

258

100%

220

86%

390

78%

51%

2.0%

Boka

roGo

mia

188

134%

92%

87%

92%

93%

202

93%

217

100%

200

88%

333

87%

37%

3.5%

Boka

roPe

tarwa

r18

107

4%89

%74

%85

%86

%14

410

0%14

410

0%81

68%

186

91%

30%

0.0%

Chatr

aCH

ATRA

106

184%

77%

57%

72%

94%

235

78%

300

100%

187

83%

432

87%

21%

1.9%

Chatr

aSim

aria

137

52%

92%

65%

76%

98%

228

87%

263

100%

156

76%

314

87%

56%

0.0%

Deog

har

DTC

TU7

511

2%96

%76

%93

%97

%42

390

%47

210

0%38

684

%43

272

%92

%0.4

%De

ogha

rMa

dhup

ur TU

94

205%

94%

78%

93%

95%

373

91%

412

100%

343

89%

353

72%

87%

0.2%

Dhan

bad

BAGH

MARA

189

297%

92%

76%

83%

86%

271

88%

306

99%

261

91%

443

89%

23%

1.8%

Dhan

bad

BCCL

152

134%

92%

64%

88%

90%

141

88%

150

94%

157

79%

5513

%8%

0.0%

Dhan

bad

DHAN

BAD_

DTC

2911

317%

91%

80%

90%

91%

236

90%

246

94%

229

83%

343

58%

25%

3.4%

Dhan

bad

GOVI

NDPU

R11

216

3%97

%88

%94

%94

%34

391

%35

093

%26

787

%30

053

%24

%0.0

%Dh

anba

dJH

ARIA

206

194%

97%

80%

88%

90%

298

98%

304

100%

232

89%

323

63%

34%

1.7%

Dumk

aDu

mka D

TC28

159

2%93

%85

%79

%89

%31

780

%39

610

0%20

969

%64

694

%66

%0.7

%Du

mka

Jarmu

ndi

156

142%

91%

79%

73%

87%

284

88%

321

100%

172

74%

615

95%

75%

0.0%

Dumk

aSh

ikarip

ara17

714

2%95

%80

%73

%88

%29

178

%37

210

0%19

364

%65

698

%86

%0.0

%Ga

rhwa

Garh

wa19

945

7%84

%72

%77

%91

%27

075

%35

810

0%17

157

%67

780

%8%

4.3%

Garh

waNa

garu

ntar

i35

1117

3%93

%80

%86

%90

%27

783

%33

410

0%15

258

%53

479

%5%

12.5%

Giridi

hDT

C-GI

RIDI

H13

719

4%90

%80

%80

%91

%31

490

%33

195

%21

278

%44

781

%28

%0.0

%Gir

idih

DUMA

RI12

1030

8%93

%84

%85

%93

%37

990

%41

910

0%26

687

%42

188

%29

%12

.9%Gir

idih

JAMU

A7

415

4%87

%76

%77

%87

%29

892

%32

410

0%16

371

%43

096

%17

%2.6

%Gir

idih

RAJD

HANW

AR11

1013

4%93

%83

%87

%93

%28

884

%34

210

0%17

869

%25

162

%7%

3.4%

Godd

aDT

C God

da13

714

5%89

%81

%82

%87

%19

589

%21

296

%12

777

%23

975

%56

%0.0

%Go

dda

Maha

gama

177

235%

91%

85%

82%

96%

186

74%

249

100%

9754

%32

460

%36

%1.5

%Go

dda

Sund

arpa

hari

4419

82%

76%

67%

83%

92%

222

80%

278

100%

9347

%43

982

%35

%1.6

%Gu

mla

Basia

TU10

58

3%91

%75

%81

%93

%16

371

%23

110

0%10

554

%27

994

%79

%0.0

%Gu

mla

Guml

a TU

138

196%

88%

78%

86%

94%

200

91%

218

100%

125

63%

347

94%

95%

0.3%

Guml

aRa

idih

53

32%

90%

86%

85%

93%

138

88%

157

100%

5565

%18

795

%84

%0.0

%

| 44 |

RNTCPJharkhand 2013


Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

ictTB

Unit

Popu

lation

(in

lakh

) co

vered

by

RNTC

P

No. o

f su

spec

ts ex

amine

d

Annu

al Su

spec

ts ex

amine

d pe

r lak

h po

pulat

ion

Rate

of ch

ange

in

susp

ects

exam

ined p

er

lakh p

opula

tion

(comp

ared t

o pr

eviou

s yea

r)

No of

sm

ear

posit

ive

patie

nts

diagn

osed

Susp

ects

exam

ined

per s

mear

po

sitive

ca

se

diagn

osed

Rate

of ch

ange

in

susp

ects

exam

ined p

er s+

ca

se di

agno

sed

(comp

ared t

o pr

eviou

s yea

r)

Annu

al sm

ear

posit

ive

case

de

tectio

n rat

e

Annu

al sm

ear

posit

ive ca

se

notificationrate

[fr

om CF

R: sm

+ ca

ses (

NSP +

Rel +

TA

D)/la

kh Po

p]

Annu

al tot

al ca

se

notifi-

catio

n rat

e

Annu

al ne

w sm

ear

posit

ive ca

se

notification

rate (

%)

Annu

al ne

w sm

ear

nega

tive

case

no-

tification

rate

Haza

ribag

hBa

rhi

525

5450

37%

279

918

%55

5775

4864

%12

Haza

ribag

hBa

rkag

aon

386

930

4-33

%10

78

-8%37

4290

4155

%38

Haza

ribag

hBis

hnug

arh

315

3147

615

%18

88

4%58

6275

5675

%8

Haza

ribag

hDT

C Sad

ar7

4561

656

-9%50

29

1%72

5598

4762

%29

Jamtar

aJam

tara D

TC6

2230

392

-13%

342

7-7%

6060

8851

68%

11

Jamtar

aNa

la8

1514

201

-52%

263

66%

3534

5828

37%

15

Khun

tiKh

unti_

DTC

211

9648

26%

171

70%

6959

120

5472

%39

Khun

tiTo

rpa

1086

387

-64%

141

616

%14

1519

1317

%2

Kode

rma

DTC K

odar

ma7

2375

317

12%

212

1113

9%28

2643

1926

%9

Lateh

arBa

rwad

ih2

1489

667

97%

164

9-10

%73

7412

568

91%

38

Lateh

arLa

theh

ar_D

TC5

3820

793

49%

394

1022

%82

7610

666

89%

23

Loha

rdag

aLo

hard

aga

714

2519

7-67

%26

65

-35%

3736

5228

38%

8

Paku

rMa

hesh

pur

518

3338

312

%29

96

2%62

6011

356

74%

35

Paku

rPa

kaur

DTC

428

9066

941

%57

65

-21%

133

129

180

118

157%

36

Palam

uCh

hatta

rpur

631

6651

6-6%

445

745

%73

7613

664

86%

44

Palam

uDa

ltong

anj_D

TC7

5351

816

63%

628

929

%96

8316

671

95%

56

Palam

uNa

vJiwa

n Hos

pital

535

9366

6-11

%49

27

-10%

9193

156

8110

8%37

Pasch

imi S

inghb

hum

Chak

radha

rpur

319

5656

527

%38

65

-29%

112

9614

486

114%

40

Pasch

imi S

inghb

hum

DTC C

haiba

sa3

1582

597

36%

259

617

%98

8821

876

101%

109

Pasch

imi S

inghb

hum

Jagan

athpu

r5

870

178

-68%

155

6-15

%32

3670

3446

%27

Pasch

imi S

inghb

hum

Jhink

pani

TU5

1112

242

-34%

193

630

%42

4374

3850

%26

Pasch

imi S

inghb

hum

Manjh

ari

312

9850

213

%23

06

55%

8988

154

8311

1%51

Pasch

imi S

inghb

hum

Mano

harp

ur7

1343

194

-36%

242

628

%35

3455

3141

%15

| 45 |

RNTCPJharkhand 2013


Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

ictTB

Unit

Annu

al pr

evi-

ously

tre

ated

case

notifica

-tio

n rate

Annu

al pr

eviou

s-ly

treate

d sm

ear

posit

ive

case

no-

tification

rate

No(%

) of

pedia

tric

case

s out

of

all ne

w ca

ses

3 mon

ths

conv

ersio

n rat

e of

new

smea

r po

sitive

pa

tient

s

3 mo

nths

co

nver

-sio

n rat

e of

retrea

t-me

nt

patie

nts

Cure

rate o

f ne

w sm

ear

posit

ive

patie

nts

Succe

ss rat

e of

new

smea

r po

sitive

pa

tient

s

No (%

) of

all S

mear

Po

sitive

ca

ses s

tarted

RN

TCP D

OTS

witih

in 7d

ays

of dia

gnos

is

No(%

) of

all S

mear

Po

sitive

case

s reg

istere

d wi

tihin

one

mont

h of

starti

ng RN

TCP

DOTS

trea

ment

No(%

) of

cured

smea

r po

sitive

case

s ha

ving e

nd

of tre

atmen

t fol

low up

sp

utum

done

wi

thin

7 day

s of

last d

ose

No(%

) of

case

s reg

isterd

re-

ceivi

ng DO

T th

roug

h a

comm

unity

vo

luntee

r

Prop

or-

tion o

f all

regis-

tered

TB

case

s wi

th

know

n HI

V sta

tus

Prop

or-

tion o

f TB

patie

nts

know

n to

be H

IV

infec

ted

amon

g tes

ted

Haza

ribag

hBa

rhi

1110

206%

98%

75%

96%

96%

283

97%

291

100%

253

93%

360

94%

76%

0.7%

Haza

ribag

hBa

rkag

aon

71

146%

87%

100%

84%

90%

121

100%

121

100%

124

92%

228

90%

16%

0.0%

Haza

ribag

hBis

hnug

arh

86

21%

94%

72%

93%

95%

188

94%

199

100%

119

79%

222

92%

34%

11.0%

Haza

ribag

hDT

C Sad

ar15

922

4%89

%75

%80

%87

%37

597

%38

510

0%21

466

%63

393

%58

%9.1

%Jam

tara

Jamtar

a DTC

239

41%

94%

73%

88%

92%

301

89%

339

100%

180

72%

425

85%

68%

0.3%

Jamtar

aNa

la14

66

2%94

%79

%89

%91

%21

282

%25

710

0%16

680

%35

481

%18

%1.3

%Kh

unti

Khun

ti_DT

C11

518

7%89

%75

%87

%90

%13

088

%14

710

0%73

74%

297

99%

39%

0.0%

Khun

tiTo

rpa

32

53%

95%

71%

88%

90%

138

93%

148

100%

104

79%

193

100%

35%

0.0%

Kode

rma

DTC K

odar

ma10

612

5%85

%68

%68

%84

%17

792

%19

310

0%13

791

%23

473

%35

%9.6

%La

tehar

Barw

adih

146

135%

90%

73%

87%

92%

144

87%

165

100%

8966

%12

957

%22

%0.0

%La

tehar

Lath

ehar

_DTC

1210

235%

97%

95%

95%

96%

327

89%

366

100%

189

58%

473

91%

32%

0.0%

Loha

rdag

aLo

hard

aga

118

145%

78%

56%

82%

82%

201

77%

255

97%

134

64%

379

100%

67%

0.4%

Paku

rMa

hesh

pur

205

82%

89%

92%

84%

87%

193

67%

289

100%

9941

%50

594

%54

%0.0

%Pa

kur

Paka

ur DT

C22

1115

2%91

%73

%86

%89

%43

378

%55

610

0%20

544

%73

895

%54

%0.0

%Pa

lamu

Chha

ttarp

ur21

1234

5%92

%82

%87

%93

%44

095

%46

510

0%34

987

%50

961

%44

%1.9

%Pa

lamu

Dalto

ngan

j_DTC

2512

516%

95%

77%

92%

94%

511

94%

542

100%

387

92%

828

76%

72%

0.4%

Palam

uNa

vJiwa

n Hos

pital

2212

395%

94%

83%

89%

93%

478

95%

503

100%

368

89%

399

47%

2%6.7

%Pa

schim

i Sing

hbhu

mCh

akrad

harp

ur16

1012

3%91

%88

%81

%81

%24

775

%33

110

0%91

44%

499

100%

86%

0.0%

Pasch

imi S

inghb

hum

DTC C

haiba

sa25

1219

4%92

%69

%78

%89

%20

788

%23

299

%13

071

%51

289

%93

%0.4

%Pa

schim

i Sing

hbhu

mJag

anath

pur

22

124%

97%

100%

90%

91%

144

82%

176

100%

151

77%

240

71%

86%

0.0%

Pasch

imi S

inghb

hum

Jhink

pani

TU8

53

1%98

%93

%83

%90

%16

785

%19

610

0%0

287

84%

63%

0.0%

Pasch

imi S

inghb

hum

Manjh

ari

95

103%

88%

100%

89%

92%

196

86%

225

99%

156

73%

332

83%

78%

0.0%

Pasch

imi S

inghb

hum

Mano

harp

ur6

37

2%96

%85

%86

%95

%19

182

%23

210

0%10

345

%19

050

%83

%0.0

%

| 46 |

RNTCPJharkhand 2013


Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

ictTB

Unit

Popu

la-tio

n (in

lakh)

co

vered

by

RN-

TCP

No. o

f su

s-pe

cts

exam

-ine

d

Annu

al Su

spec

ts ex

amine

d pe

r lak

h po

pulat

ion

Rate

of ch

ange

in

susp

ects

exam

ined p

er

lakh p

opula

tion

(comp

ared t

o pr

eviou

s yea

r)

No of

sm

ear

posit

ive

patie

nts

diagn

osed

Susp

ects

exam

ined

per s

mear

po

sitive

ca

se

diagn

osed

Rate

of ch

ange

in

susp

ects

exam

ined p

er s+

ca

se di

agno

sed

(comp

ared t

o pr

eviou

s yea

r)

Annu

al sm

ear

posit

ive

case

de

tectio

n rat

e

Annu

al sm

ear

posit

ive ca

se

notificationrate

[fr

om CF

R: sm

+ ca

ses (

NSP +

Rel

+ TAD

)/lak

h Pop

]

Annu

al tot

al ca

se

notification

rate

Annu

al ne

w sm

ear

posit

ive ca

se

notification

rate (

%)

Annu

al ne

w sm

ear

nega

tive

case

notification

rate

Purb

i Sing

hbhu

mBa

hrag

ora

416

9139

36%

339

56%

7975

124

6991

%33

Purb

i Sing

hbhu

mDT

C7

4721

665

-7%71

47

5%10

166

138

5168

%36

Purb

i Sing

hbhu

mGH

ATSIL

A5

1644

357

10%

391

4-2%

8583

117

6992

%20

Purb

i Sing

hbhu

mJU

GSAL

AI3

1159

393

62%

230

52%

7896

206

8010

7%60

Purb

i Sing

hbhu

mPO

TKA

348

315

0-16

%13

64

-17%

4240

7739

52%

34

Ramg

arh

Patra

tu2

2470

1161

107%

315

8-2%

148

141

214

124

165%

47

Ramg

arh

Ramg

arh_

DTC

519

9841

4-1%

240

82%

5048

8342

56%

25

Ranc

hiAn

gara

TU5

2078

429

9%19

511

17%

4044

7340

54%

18

Ranc

hiBu

ndu T

U5

1959

418

44%

222

940

%47

4769

4458

%11

Ranc

hiDo

randa

TU6

1398

217

-19%

176

8-29

%27

4170

3547

%12

Ranc

hiItk

i TU

234

0614

1874

%60

46

-3%25

114

723

611

014

7%58

Ranc

hiMa

ndar

TU2

1852

844

108%

187

1021

%85

9618

784

112%

58

Ranc

hiSa

dar T

U4

3896

1053

31%

712

5-15

%19

378

145

6485

%23

Sahib

ganj

Barh

ait4

1981

480

2%33

66

4%81

7512

669

92%

36

Sahib

ganj

Rajm

ahal

516

6132

1-12

%19

59

5%38

4177

3344

%24

Sahib

ganj

Sahib

ganj_

DTC

429

2079

612

%33

79

-21%

9275

147

6587

%52

Sarai

kela-

Khar

sawa

nCh

andil

732

9349

92%

302

11-5%

4646

9441

55%

32

Sarai

kela-

Khar

sawa

nDT

C-Sera

ikella

531

2869

511

%41

68

13%

9284

172

7499

%72

Simde

gaKo

lebira

511

3321

2-47

%17

96

11%

3434

5232

42%

18

Simde

gaSim

dega

DTC

315

7653

325

%27

36

2%92

9313

575

101%

31

| 47 |

RNTCPJharkhand 2013


Uni

ts A

nnua

l Per

form

ance

of R

NTC

P Ca

se D

etec

tion

(201

3), S

mea

r Co

nver

sion

(4th

Qua

rter

201

2 to

3rd

Qua

rter

201

3) &

Tr

eatm

ent O

utco

me

(201

2)

Distr

ictTB

Unit

Annu

al pr

evi-

ously

tre

ated

case

no-

tification

rate

Annu

al pr

evi-

ously

tre

ated

smea

r po

sitive

ca

se no

-tification

rate

No (%

) of

pedia

tric

case

s out

of

all ne

w ca

ses

3 mon

ths

conv

ersio

n rat

e of

new

smea

r po

sitive

pa

tient

s

3 mo

nths

co

nver

-sio

n rat

e of

retrea

t-me

nt

patie

nts

Cure

rate

of ne

w sm

ear

posit

ive

patie

nts

Succe

ss rat

e of

new

smea

r po

sitive

pa

tient

s

No (%

) of

all S

mear

Po

sitive

ca

ses s

tarted

RN

TCP D

OTS

witih

in 7d

ays o

f dia

gnos

is

No(%

) of

all S

mear

Po

sitive

case

s reg

istere

d wi

tihin

one

mont

h of

starti

ng

RNTC

P DOT

S tre

atmen

t

No(%

) of

cured

smea

r po

sitive

case

s ha

ving e

nd

of tre

atmen

t fol

low up

sp

utum

done

wi

thin

7 day

s of

last d

ose

No(%

) of

case

s reg

isterd

rec

eiving

DO

T th

roug

h a

comm

unity

vo

luntee

r

Prop

ortio

n of

all

regist

ered

TB ca

ses

with

kn

own H

IV

statu

s

Prop

ortio

n of

TB

patie

nts

know

n to

be H

IV

infec

ted

amon

g tes

ted

Purb

i Sing

hbhu

mBa

hrag

ora

137

71%

98%

90%

83%

85%

269

83%

324

100%

238

84%

268

50%

56%

0.7%

Purb

i Sing

hbhu

mDT

C33

1636

5%90

%74

%89

%89

%42

590

%46

699

%32

388

%70

271

%66

%3.4

%

Purb

i Sing

hbhu

mGH

ATSIL

A22

1414

3%94

%94

%86

%87

%37

799

%37

799

%28

294

%52

297

%49

%1.1

%

Purb

i Sing

hbhu

mJU

GSAL

AI39

1621

4%90

%85

%87

%90

%25

891

%28

310

0%21

285

%58

597

%39

%9.8

%

Purb

i Sing

hbhu

mPO

TKA

21

10%

91%

100%

83%

91%

108

84%

129

100%

7583

%24

710

0%18

%8.9

%

Ramg

arh

Patra

tu27

1716

4%90

%68

%67

%88

%29

799

%30

110

0%15

064

%39

186

%69

%1.6

%

Ramg

arh

Ramg

arh_

DTC

96

144%

82%

55%

93%

96%

218

94%

231

100%

116

70%

328

82%

30%

0.0%

Ranc

hiAn

gara

TU5

318

6%97

%10

0%93

%94

%20

496

%21

210

0%16

487

%33

997

%3%

11.1%

Ranc

hiBu

ndu T

U11

34

1%99

%92

%88

%88

%20

091

%21

810

0%14

275

%20

764

%34

%0.0

%

Ranc

hiDo

randa

TU11

526

7%94

%79

%70

%74

%23

891

%26

110

0%17

187

%29

265

%53

%2.1

%

Ranc

hiItk

i TU

5437

174%

88%

62%

90%

93%

352

100%

345

98%

236

100%

204

36%

68%

0.5%

Ranc

hiMa

ndar

TU32

129

3%94

%69

%83

%84

%19

291

%20

899

%15

572

%36

790

%18

%0.0

%

Ranc

hiSa

dar T

U26

1529

7%91

%72

%80

%91

%25

989

%29

013

0%21

799

%39

273

%71

%1.3

%

Sahib

ganj

Barh

ait11

725

5%87

%60

%63

%92

%26

385

%30

899

%20

585

%34

266

%94

%0.2

%

Sahib

ganj

Rajm

ahal

159

237%

81%

84%

80%

83%

175

82%

214

100%

6552

%33

083

%84

%4.5

%

Sahib

ganj

Sahib

ganj_

DTC

2210

255%

93%

76%

91%

97%

261

95%

275

100%

135

97%

408

76%

81%

1.6%

Sarai

kela-

Khar

sawa

nCh

andil

145

183%

91%

75%

87%

89%

265

87%

304

100%

9435

%48

578

%45

%0.0

%

Sarai

kela-

Khar

sawa

nDT

C-Sera

ikella

2210

183%

94%

81%

81%

83%

331

88%

376

100%

264

79%

535

69%

42%

0.3%

Simde

gaKo

lebira

22

62%

80%

91%

59%

69%

148

82%

178

99%

7859

%26

093

%29

%0.0

%

Simde

gaSim

dega

DTC

2217

93%

76%

44%

84%

90%

239

87%

269

98%

108

71%

354

89%

46%

0.5%

| 48 |

RNTCPJharkhand 2013


Photo Gallery

Regional PMDT Review of Eastern States at Kolkata Project “Axshya” Review meeting at Ranchi

DTO Review Meeting Chaired by Director in Chief, Health Services

Deliberations during DTO Review meeting

RNTCPJharkhand 2013

revised national tuberculosis control programme

Photo Gallery

Release of RNTCP Annual Report – Jharkhand on World TB Day 2013 by PS-Health

Media Advocacy by PS Health on World TB Day 2013

Signature Campaign on the occasion of World TB day 2013 - Mission Director – JRHMS

Commemoration of World TB Day 2013

Rally of School Children on World TB Day (2013) led by District RNTCP Team – Jamtara

Annual New Smear Positive: Smear Conversion Rate,Jharkhand – 4th Quarter 2012 to 3rd Quarter 2013

Annual New Smear Positive: Treatment Success Rate,Jharkhand –2012

> 90 %

80 - 89 %

<70 %

70 - 79%

> 85 %

< 85 %

Documents

A Programme dedicated to TB Control E M R …jrhms.jharkhand.gov.in/FileUploaded By User/RNTCP...R E V I S ED N A T IO N A L T UB E RC U L O S I S C O N T R OL P R O G R A M M E RNTCP