The awareness of tuberculosis in India was centered on the extent of people’s knowledge regarding the most important facts about the disease such as how it is caused and characteristics of the causative micro-organism; how infection spreads to human beings; how, when and where the disease generally occurs, and the like. This assumption underlying the approach was that most people are either ignorant or not fully knowledgeable about the disease, especially in developing countries like India where literacy is low. Further, that ignorance and incomplete knowledge lead to all kinds of prejudices, social taboos and stigma on the one hard and improper response by patients to fight their disease on the other hand. Both these manifestations are met with all too frequently. Over and above this, the hypothesis lends logic as well as substance to itself by providing a plausible basis and purpose to the efforts at health education.

The studies have been conducted in India as well as outside to investigate this approach to awareness. The results of these studies are not particularly supportive of the hypothesis. For example, the NTI research in rural Anantapur district in the late fifties, which led to the formulation of DTP, had shown that knowledge among the people about main features of tuberculosis was reasonably high; certainly higher than what was believed then. Besides, some other studies had shown that awareness is greater among urban people, males, literates and young adults compared with rural folks, women, illiterates and the old. but where socio-economic conditions are very different, have shown generally similar results. Even as recently as 1987, studies done in rural West Bengal and North Arcot district in the South, and reported at the Lucknow National Conference, have shown that from 50 to 80% of the people are knowledgeable about tuberculosis, the higher figure being in respect of the educated persons, community leaders and patients of tuberculosis. Not withstanding all this, social prejudices and the traditional attitudes.

It will be wiser to give 10% lower dose than to give 10% higher dose as 10% lower dose does not sacrifice the efficacy of the drug with the exception of thiacetazone. 10% higher dose is likely to produce toxic reactions in the patient. The shows ratio between minimum inhibitor concentration to achieve bactericidal concentration and peak serum concentration that normally is achieved in a patient.

The drugs in therapeutic doses do produce toxic and hypersensitivity reactions. The hypersensitivity reactions occur usually in atopic individuals. These are dose independent and the drugs could be reused in many cases after desensitization. The toxic reactions are usually dose-dependent, precipitated by associated disease conditions, deficiency states usually in non-atopic individuals. Once a patient develops toxic reaction to an anti-tuberculosis drug, we should not restart with the same drug to which the patient has developed toxic reaction. In the following tables the adverse reactions have been divided into hypersensitivity reactions and the toxic reactions to individual drugs. The toxic reactions have been subdivided into major, minor and rare (Girling, 1984; Griffen, 1979; Addington, 19796, and Rose et al., 1983). From all these above cases we can very well conclude that the adverse reactions vary from 3% to 8%, hence we cannot call them highly toxic. Upto 10% adverse reactions are within acceptable limits for different regimens. When a patient develops toxic or hyper sensitive reaction our first approach should be to stop all Anti-T.B. drugs as in multi-drug therapy we do not know which drug is the culprit.

India used BCG vaccine as part of their TB control programs, especially for infants. The protective efficacy of BCG for preventing serious forms of TB (e.g. meningitis) in children is high (greater than 80%). However, the protective efficacy for preventing pulmonary TB in adolescents and adults is variable, from 0 to 80%. In the India children aged 10-14 were typically immunized during school until 2005. (Routine BCG vaccination was stopped as it was no longer cost-effective. India continue to be offered BCG vaccination. The drugs available in India are sufficient to treat successfully almost all TB cases .It is essential that the patient must receive therapeutically effective doses to achieve bacteriostatic/bactericidal action on tubercle bacilli. The doses of drugs are recommended as mgm/kg. of body weight. It is not possible for the manufacturers of drugs to tailor them for individual patients. Hence International Union Against Tuberculosis and Lung Diseases have recommended doses (Recommendation from the Committee on Treatment of IUAT, 1988) of drugs taking body weight standard of 50 kg .

Links:

Lilly MDR-TB Partnership
 

References:

1. Epidemiology of tuberculosis : Current status in India A.K. Chakraborty
Epidemiology Analyst, Bangalore, India Received January 10, 2003

2. TB Management in the workplace, An Introduction to Business in India.