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RNTCP Structure
The structure of RNTCP comprises of 5 levels
1. National
2. State
3. District
4. Sub – District
5. Peripheral health institutions

1. National: Central TB Division
• Programme Manager/DDG(TB)
• Plans/Supervises/Monitors/Evaluation
• National Committee on TB Diagnosis and Treatment
• National Laboratory Committee
• National Technical Working Group for TB/HIV
• National Institutes Etc.

• DOTS strategy had 5 main components:
1. Political will (therefore administrative commitment) (C)
2. Diagnosis by quality microscopy of sputum (M)
3. Adequate drug supply (S)
4. Directly observed treatment (O)
5. Accountability – systematic monitoring (A)
Thus RNTCP shifts the responsibility for cure from the patient to the health system
Suggested Mnemonic: SCAM – O

• The National Tuberculosis Programme of India (NTP) was initiated in 1962 and was originally designed for
– Domiciliary treatment, using self- administered standard drug regimens.
• A review of the programme in 1992 concluded that the NTP was poorly managed, inadequately funded and could not achieve TB control
– Treatment success rates was unacceptably low
– Over-reliance on X – ray for diagnosis
– frequent interrupted supplies of drugs
– Default rates remained high
– Death rates due to TB were still high

• Decades of unrestrained transmission has left hundreds of millions of Indians with latent TB infection, which may re-activate at any time.
• A significant proportion of the population is undernourished, which weakens immunity and drives TB reactivation.
• A considerable number more suffer from risk factors for tuberculosis,
– Diabetes,
– Indoor air pollution from cook stoves, or smoking.
• The dense, growing urban environment facilitates the transmission of the disease cutting across all economic strata.

Before initiating treatment for TB in women, she should be asked about current or planned pregnancy
• EXCEPT Streptomycin, all first line anti –TB drugs are safe for use in pregnancy
–Streptomycin is ototoxic to the fetus and should not be used during pregnancy

In case of MDR –TB: Test for pregnancy
• If not pregnant advised to use birth control
– OCPs should be avoided
– Use of barrier methods or IUD is recommended

• The most common causes of infant and child mortality in developing countries (including India) are:
– Acute respiratory infections
– Diarrhoea
– Malaria
– Measles and
– Malnutrition
• Making a single diagnosis may not be feasible or appropriate
– Because many children present with overlapping signs and symptoms of diseases
– Clinical outcome depends upon treating not only the immediate presenting symptom but the underlying disorders as well

Reference:
WORLD HEALTH ORGANIZATION, 2003. Review of Ethical Issues in Medical Genetics: Human Genetics Programme, Management of Non-communicable Diseases; Geneva: WHO/HGN/ETH/00.4

• Some traits like intelligence, physical ability and longevity are genetically determined but the effect of external and environmental influences are the main determinants of health and survival
• With increased control of environment, genetic makeup is becoming more important determinant of individual health
• Genetic predisposition may lead to the premature onset of common diseases of adult life such as
– Cancer
– Coronary heart disease
– Diabetes
– Hypertension and
– Mental disorders
• Cancer:

• This occurs:
– If the fetus is Rh positive and
– mother is Rh negative

• Some fetal red cells cross the placenta and enter maternal circulation in all pregnancies
– The Rh +ve fetal cells act as foreign antigen and stimulate production of Rh antibodies in the Rh negative mother

• The Rh antibodies are of two main types:
– The ‘strong’ or saline antibodies and
– The ‘weak’ or albumin antibodies: these are small 7s gamma globulins which can cross the placental barrier.