Abstract
The National Tuberculosis Control Programme was launched in 1961 and has three components – training, BCG vaccination and Case-finding (including treatment). The three objectives of the programme are: (i) Protection of at 1east 75% of the susceptible population with BCG vaccination. (ii) Identify at least two-thirds of the infectious cases prevalent in the community. (iii) Render 95% of those infections identified non-infectious with effective treatment. The training programme provides the various categories of skilled and trained personnel required for the proper organization and implementation of the programme. By the end of 1975, more than 5,000 people had beam trained in various aspects of the programme. No formal training in done in any of the states but the State Tuberculosis managerial Teams do give technical advice when required. The BCG vaccination programme is undoubtedly the most successful component of the programme. By the end of 1975 more than five million primary vaccinations had been performed in the country while more than 240,000 had been performed in the state of Negri Sembilan. By 1972, the target of vaccinating 75% of the eligible population had been achieved and by 1975, the programme was close to achieving the upper level (70 – 90%) of the suggestion of the 9th W.H.O. expert Committee on Tuberculosis. At the national level 88.3% of the eligible population had been vaccinated as compared to 86% at the state level. Since 1973, the State has also done very well in achieving a BCG vaccination of more than 90% coverage of all newborns. The success of this programme (and its benefits) Is seen by the decline in the number of cases of childhood tuberculosis and of tuberculosis of the meninges and the central nervous system admitted to government hospitals in the country, particularly after 1969. The case-finding programme was launched in 1963 with mass miniature radiography as the main case-finding tool. As this was found to be uneconomical and the yield relatively poor, a change to direct microscopy of sputum from respiratory symptomatics was made in 1969. The National Tuberculosis Centre estimates that only about 40% of the infectious sources prevalent in the country have been discovered. Since 1974 the State of Negri Sembilan has been discovering more sputum positive cases than its estimated annual incidence but the nation as a whole falls short of this target. Unfortunately, cases are still detected in the far advanced stage (about 40% of all cases), resulting in about 10% of all sputum positive cases dying, usually within the first month of diagnosis. It was also seen that most of the cases were diagnosed by urban health facilities indicating relatively poor awareness of the disease among health centre staff. The treatment has been standardised since 1970 and is carried out at every health facility in the country. While all drugs are easily available and treatment is free, there still remains the perennial problem of treatment defaulters. Only 52% of the sputum positive cases registered in Negri Sembilan in 1970 completed treatment. This improved to 70.5% in the 1973 cohort. At the national level, only 69% of the 1973 cohort completed treatment while 17% died or abandoned treatment before their sputum vas converted to direct smear negative. The National Tuberculosis Control Programme has made satisfactory progress since 1961 but there is still room for improvement as not all the objectives set have been achieved. It is in the field of case-finding and treatment that greater efforts will be required to bring about early detection of infectious cases and the rendering of them non-infectious with effective treatment. There will probably be a significant epidemiological impact on the tuberculosis problem only after all the three objectives of the programme are achieved and sustained.
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@mastersthesis{RN158u,
title = {A Study of the National Tuberculosis Control Programme in the State of Negri Sembilan, 1961-1975},
author = {Amar Singh Gill},
year = {1977},
date = {1977-01-01},
urldate = {1977-01-01},
school = {Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya},
abstract = {The National Tuberculosis Control Programme was launched in 1961 and has three components \textendash training, BCG vaccination and Case-finding (including treatment). The three objectives of the programme are: (i) Protection of at 1east 75% of the susceptible population with BCG vaccination. (ii) Identify at least two-thirds of the infectious cases prevalent in the community. (iii) Render 95% of those infections identified non-infectious with effective treatment. The training programme provides the various categories of skilled and trained personnel required for the proper organization and implementation of the programme. By the end of 1975, more than 5,000 people had beam trained in various aspects of the programme. No formal training in done in any of the states but the State Tuberculosis managerial Teams do give technical advice when required. The BCG vaccination programme is undoubtedly the most successful component of the programme. By the end of 1975 more than five million primary vaccinations had been performed in the country while more than 240,000 had been performed in the state of Negri Sembilan. By 1972, the target of vaccinating 75% of the eligible population had been achieved and by 1975, the programme was close to achieving the upper level (70 \textendash 90%) of the suggestion of the 9th W.H.O. expert Committee on Tuberculosis. At the national level 88.3% of the eligible population had been vaccinated as compared to 86% at the state level. Since 1973, the State has also done very well in achieving a BCG vaccination of more than 90% coverage of all newborns. The success of this programme (and its benefits) Is seen by the decline in the number of cases of childhood tuberculosis and of tuberculosis of the meninges and the central nervous system admitted to government hospitals in the country, particularly after 1969. The case-finding programme was launched in 1963 with mass miniature radiography as the main case-finding tool. As this was found to be uneconomical and the yield relatively poor, a change to direct microscopy of sputum from respiratory symptomatics was made in 1969. The National Tuberculosis Centre estimates that only about 40% of the infectious sources prevalent in the country have been discovered. Since 1974 the State of Negri Sembilan has been discovering more sputum positive cases than its estimated annual incidence but the nation as a whole falls short of this target. Unfortunately, cases are still detected in the far advanced stage (about 40% of all cases), resulting in about 10% of all sputum positive cases dying, usually within the first month of diagnosis. It was also seen that most of the cases were diagnosed by urban health facilities indicating relatively poor awareness of the disease among health centre staff. The treatment has been standardised since 1970 and is carried out at every health facility in the country. While all drugs are easily available and treatment is free, there still remains the perennial problem of treatment defaulters. Only 52% of the sputum positive cases registered in Negri Sembilan in 1970 completed treatment. This improved to 70.5% in the 1973 cohort. At the national level, only 69% of the 1973 cohort completed treatment while 17% died or abandoned treatment before their sputum vas converted to direct smear negative. The National Tuberculosis Control Programme has made satisfactory progress since 1961 but there is still room for improvement as not all the objectives set have been achieved. It is in the field of case-finding and treatment that greater efforts will be required to bring about early detection of infectious cases and the rendering of them non-infectious with effective treatment. There will probably be a significant epidemiological impact on the tuberculosis problem only after all the three objectives of the programme are achieved and sustained.},
note = {Master of Public Health},
keywords = {},
pubstate = {published},
tppubtype = {mastersthesis}
}
