TB: way ahead

DOTS (directly observed treatment, short-course), is the name given to the  control strategy that combines five components:World Health Organization-recommended tuberculosis

• Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
• Case detection by sputum smear microscopy
• Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
• A regular drug supply
• A standardized recording and reporting system that allows assessment of treatment results

·         WHO’s directly observed treatment shortcourse strategy aims at reducing TB incidence by 2015

DOTS IN INDIA

• Lack of political commitment has hampered its impact
• Poor supply of anti TB medicines

HOW WEST TACKLED TB?

• TB in western world dropped drastically without any major anti TB meciation
• This was possible through following steps
• Adequate housing
• Reduction in overcrowding
• Improved nutrition
• Better work environment
• India should learn lesson from this
• For long India has focused exclusively on medical inteventions and neglected socio envirnmental interventions

UNIQUE PROBLEMS IN INDIA

• DOTS involves provision of foced dose combination recommendation of medication
• In India most of poor are under nourished
• These doses of medicines may cause side effects on the undernourished people
• Also for lack of time/money many leave the medication course midway leading to increased susceptibility to multi drug resistant TB

THE FLAWED NUTRITION POLICY

• Our national nutrition policy focuses on provision of calories through carbohydrates to the poor while neglecting other essential components that make up a balanced diet
• This leads to lowered immunity

WAY AHEAD

• Educate general population
• Provide good housing
• Develop new diagnostic tests to replace smear tests