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Title - $10.99
TB situation in Pune |
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About Pune Pune city informs that in 1778 A.D Pune was a small settlement called Punwadi, consisting often to fifteen houses. Nobody had dreamt at that point of time, that soon this Punwadi would become the headquarters of the great Maratha Empire and later the second capital of the Bombay Presidency during the British reign. Pune city is known as the cultural capital of the state of Maharashtra because of its rich Maratha cultural heritage! The first step towards establishing a municipal government in the city of Pune was taken in 1856, when the Pune Municipality came into existence under the1850 act. The fact that Pune may not generally be seen as a major tourist attraction is probably because it cannot boast of outstanding specimens of architecture. Today, Pune is one of the fast urbanizing districts in Maharashtra , with 46.27%urban and 53.73% rural population (2001 census). The population of Pune Municipal Corporation is 25.5 lacks spread over an area of 430 sq. kms. Pune city includes Pune Municipal Corporation and the suburbs. The city has been divided into 124 census wards. General Health Infrastructure in Pune City : The health department of the PMC started functioning in1950. It started providing the basic health care services to the population through its hospitals, peripheral dispensaries, and an infectious diseases hospital. Pune City today has a wide range of facilities for diagnosis and treatment under the general health services set up, which also includes services for tuberculosis ( Annexure IA ). The Pune Municipal Corporation (PMC) run peripheral dispensaries where the patients are provided with primary health care. Tuberculosis control in Pune city is under National Tuberculosis Programme (prior to RNTCP). Since the formation of the Pune Municipal Corporation(PMC), TB patients did not have any special arrangement for diagnosis and treatment, except for the special wards for TB patients in the Infectious diseased hospital. The Pune city TB control programme was implemented in1962 on the lines of the National Tuberculosis. The private medical sector is an important and rapidly growing source of health care in India . Private medical providers (PMP) are a diverse group, known to be poorly regulated by government policies and variable in the quality of services provided. Studies of their practices have documented inappropriate prescribing as well as violation of ethical guidelines on patient care. However, despite the critique that inequitable services characterized the private medical sector, PMPs remain important and preferred providers of primary care. This paper argues that their greater involvement in the public health framework is imperative to addressing the goal of health equity. Through a review of two research studies conducted in Pune , India , to examine the role of PMPs in tuberculosis (TB) and HIV/AIDS care, the themes of equity and access arising in private sector delivery of care for TB and HIV/AIDS are explored and the future policy directions for involving PMPs in public health programmes are highlighted. The paper concludes that public-private partnerships can enhance continuity of care for patients with TB and HIV/AIDS and argues that interventions to involve PMPs must be supported by appropriate research, along with political commitment and leadership from both public and private sectors. The performance of NTP(National Tuberculosis programme) Three years case study record from the PMC for the years previous to the implementation of the RNTCP shows that out of a total of 15,647 TB patients diagnosed at the PMC clinics taken together 3671 patients were sputum smear positive cases . Thus of the TB cases detected in a year at the clinics 23.46% were sputum smear positive. Even though the RNTCP was incorporated in Pune city in the third quarter of 1995 as second pilot phase, along with Raigad district in rural Maharashtra, the present cases discusses the RNTCP implementation over a period of six years from 1st quarter of 1996 to 4th quarter of the year 2001. Among the detected cases more than 90% of the cases were put on DOTS, while the rest were given the conventional treatment under the NTP. The number of new sputum positive cases is closer to 50% of the total TB cases registered under RNTCP in all the six years of RNTCP implementation. The cure rate among the new sputum positive patients has steadily increased from about 75% in 1996 to 88% in 2000. But at the same time the cure rate among the sputum positive relapse cases shows plenty of variation. A comparison of this cases indicates that the cure rates of the sputum positive cases increased from year 1996 to 2000, whereas the same among the sputum negatives increased for the first two years, to remain nearly steady thereafter. The death rate among the sputum positive and sputum negative cases have shown very little variation over the period . The failure rate among the new sputum positive 90 cases has shown remarkable decline, as also that among sputum positive relapse. Others remain stable with regards to death & failure. The defaulter rates among the sputum negatives however was as high as a little more than 20%, that declined to less than 10% in the year 1998 to remain steady since then. Unlike for the sputum negative cases, the defaulter rates among the sputum positive cases decreased from five percent in 1996 to less than three percent in 1997. It again increased to around five percent in 1998 and has since remained steady at five percent. Among all the above cases the number of male sputum positive patients always out numbered the number of females. This shows that the male to female ratio (for sputum positive cases) has been more or less steady from 1996 to 2001.The Evaluation of Performance against Expectation Indices Annexure II gives the comparison between the estimates on expectations and the actual performance of the RNTCP in Pune City with respect to the diagnosis and DOTS coverage. Except for the year 1997, The Total Case Detection Rate (CDR) for all cases as well as for the new sputum smear positive cases has shown a steady increase. The DOTS coverage expressed as DOTS Detection Rate or DDR, however shows poor progress in the initial couple of years. However since 1998 it has almost doubled for the next two years. It shows little increase thereafter, 65.5% in 2000 to 67.4% in the year 2001 (Annexure II). As the DOTS in the city progressed in the sixth year of implementation in 2001, the case detection rate (CDR) as well as DOT detection rate (DDR) has consistently been on the increase. However the city programme is yet to achieve the global target of 70% case detection. Public- private mix is a step towards partnership. The government of India has recently published its guidelines for involving the private sector in the RNTCP. But the PMC had envisaged the private sector involvement as early as in the 1998 when the first orientation (called Continued Medical Education or CMEs) session for the private medical practitioners was conducted by the programme. Since then 23 CMEs have been conducted for the private sector involvement in the programme by August 2002. But the PMPs contribution is not documented meticulously and the records are not maintained in the format prescribed by the RNTCP guidelines. RNTCP Progress in Pune City : RNTCP implementation in Pune city is progressive. This can be seen form the establishes the fact that except for the initial two years, the cure rates have been above 85%, which is more than the national estimates. The case detection however has been always a little less than the expected 70 %.Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune , India . The present study was undertaken with the objective of comparing the anti tuberculosis drug resistance pattern of M. tuberculosis isolates from HIV seropositive and seronegative tuberculosis patients in Pune , India . As a part of an ongoing study on efficacy of directly observed treatment-short course (DOTS) in HIV seropositive and HIV seronegative tuberculosis patients in Pune, consecutive patients attending TB clinics of Talera General Hospital and Yashvantrao Chavan Memorial Hospital of Pimpri- Chinchwad Municipal Corporation, Pune, between September 2000 and July 2004 were screened for enrollment in the study. Those who had no previous history of tuberculosis treatment and were diagnosed as having pulmonary tuberculosis by sputum smear microscopy using Ziehl Neelsen’s acid fast staining and / or on radiological findings were enrolled. A total of 175 patients were enrolled during the study period. Seventy M. tuberculosis isolates, 94.7 per cent (36/ 38) from smear positive and 24.8 per cent (34/137) from smear negative patients were obtained and included for the present analysis. Of these, 30 isolates were from HIV seropositive and 40 from HIV seronegative tuberculosis patients. The sputum samples were processed by modified Petroff’s method, inoculated on Lowenstein-Jensen (LJ) medium (Hi-Media Laboratories Ltd, Mumbai) and the isolates were identified by conventional biochemical methods. Drug resistance pattern of M. tuberculosis isolates to four primary anti-tuberculosis drugs. Data on the prevalence of drug resistance from the Army Hospital , Pune showed a very low level of initial resistance to isoniazid and the authors have explained that this lower level of drug resistance in this population could be due to the minimal chance of indiscriminate exposure of anti-TB agents prior to reporting to the hospital26. However, it should be emphasized that several of these reports, except those from the TRC, NTI and the Armed Forces Group, may have inherent limitations due to flaws in methodology and hence need to be interpreted with caution. Links: 1. TB in the news: TB is a killer, but Pune is fighting it References: 1. TUBERCULOSIS CONTROL IN PUNE CITY: A HISTORICAL PERSPECTIVE Health Administrator Vol : XV, Numbers : 1-2, pg. 89-96 Indian J Med Res 121, April 2005, pp 235-239
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