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Controlling Tuberculosis

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Save a Mother has increased tuberculosis detection rates by a factor of 10 in fifty villages where the program has been launched.Tuberculosis (TB) is a major public health problem in India. The country has the largest number of TB cases in the world with over 25% of the global TB and multidrug-resistant TB (MDR-TB) burden. Each year, more than 2 million people in India get TB, and over 300,000 people die from it. India has the greatest number of new cases of MDR-TB, with an estimated 99,000 cases in 2014.

It is estimated that before a person suffering from Tuberculosis gets treatment that individual infects 10 more people. Hence early detection and immediate initiation of treatment is critical to reducing the burden of TB.

What Drives the High TB Incidence in India?

As part of its 5 year plan 2012-2017, The Government of India instituted the Revised National Tuberculosis Program (RNTCP) aimed at achieving universal access to TB control services. The program includes a target of an 85% cure rate of all the sputum positive pulmonary TB cases and a 70% percent case detection rate.

However, as TB is a disease which spreads through droplet infection, having 70% cases detected means that there will be 30% active undetected cases with no treatment that spread the disease to others. This helps explain the exponential nature of infections in India. In addition even within the RNTCP program there are many opportunities for infected individuals to ‘drop-out’ of the system, thereby adding to the burden.

To control a disease which spreads through droplet infection, early detection rate of close to 100% will be an ideal aspirational goal. This level of early and higher detection rates is not achievable using the existing government health care infrastructure a public/private partnership is required.

What is SAM’s Impact?

The state of Uttar Pradesh is one of the most populous states in India. In 2011,
250, 000 cases of smear positive Tuberculosis disease were detected, making the State one of the largest contributors to the total people suffering from the disease in the country.

SAM Foundation conducted first pilot TB control project in 25 villages (population 74000) in Amethi district of Uttar Pradesh from March 2012 to July 2013. Thelearning from the first pilot were applied to second pilot conducted in different 44 villages (population 105,400) from December 2013 to Dec 2015.

SAM’s TB Control program in Amethi resulted in:

-As a result of the first pilot SAM detected 192 new TB cases where there were only 19 known cases before the program showing a 10 fold increase in detection.
-It is estimated SAM could reached only 35% of the population and only 50% people with symptoms went for sputum test.
-A second pilot with modified campaign strategy reached over 60% of the population and 67% people with symptoms went for sputum test.

How Does SAM Make An Impact?

As with all its projects, SAM starts with a set of clear objectives then develops a set of holistic activities that will help it achieve project goals. Additionally a framework to measure progress to goals is also implemented.

For the Amethi TB Control project, SAM’s objectives were:

-Generate awareness about TB – its symptoms and how it spreads
1. Mobilize people who have TB symptoms to undergo sputum testing
2. Track the people who have positive sputum examination test to initiate drug therapy from the DOTS center
3. Track the people who are on drug therapy to complete the drug regimen
4. Track people who have dropped out of the program to complete the drug regimen

In order to achieve its objectives, SAM initiated the following activities:

-Conducted series of community meetings in each village to generate awareness of TB, its symptoms, its cause, how it spreads & the importance of early detection & treatment.
-SAM used AV methods, flip charts, posters, people rallies, magic shows and home visits to motivate people with symptoms to go for sputum test.
-Field Facilitators (SAM employees), and trained village health volunteers (Swasthya Sakhi) mobilized people. Those who test positive are tracked down by field facilitators & treatment was initiated immediately.
-Field Facilitators tracked people undergoing treatment on an ongoing basis, they made home visits and ensured that patient completed the entire treatment.

TB Control from 2016-2019:

Starting from Jan 2016 SAM will launch TB control program in over 750 villages to cover whole Amethi district. The program will last 3 years.