DEPT OF COMMUNITY

MEDICINE.

GROUP : B
ROLL NO : 50-99

TOPIC: Socio-Clinical Profile

Of Tuberculosis Patients
Attending DOTS Clinics.
 INTRODUCTION
Tuberculosis (TB) is an infective airborne
disease whose causative organism is
Mycobacterium tuberculosis, mainly affecting
the lungs (pulmonary TB), but, it may affect
other organs also (extra-pulmonary TB). In
most cases it affects adults, with the
incidence of cases in men (90%) being
higher than that of women. One of the
challenges for the treatment of Tuberculosis is
Non-Adherence to the TB regimen, which
leads to MDR-TB as well as XDR-TB with poor
treatment outcomes, longer regimens, and is
also cost-burdening to the healthcare sector.
[1]
With the increasing rise in the incidence of
TB, it is essential to control this unjustly
stigmatized disease which is significantly
impacting the lives of people through proper
adherence to the TB regimen. According to
WHO, Medication adherence refers to
"the extent to which a person's
behavior medication, following a diet,
or executing lifestyle changes,
corresponds with agreed
recommendations from a health care
provider" [2]
WHO outlines those socio-economic factors,
healthcare system nuances, the nature of the
condition, therapy duration, and individual
patient attributes influence adherence.[3]
It has been seen that patients do not
guarantee compliance even when the
drugs are being provided free of cost or at a
minimal value at hospitals[4].
Though DOTS is now considered an effective
method to combat nonadherence, with
lifestyle changes over time, it's necessary to
recognize and address the current factors
influencing nonadherence. To combat TB and
align with WHO's initiative to "END TB by
2035," we have to start it from the tertiary
health systems and spread it to other
branches of healthcare. The research will not
only help in finding out the main factors of
nonadherence to TB medication but also help
in raising awareness and breaking down
stigma and myths surrounding TB through
AIMS AND OBJECTIVES:

1.UNDERSTANDING THE EPIDEMIOLOGY OF

TB:-
-Incidence and prevalence: Determine the
rates of new and existing TB cases in the
region served by the tertiary health care
centre of WB(RPHGMCH) in the given study
period.
- Risk factors: Identify factors that increase
the risk of TB infection, such as poverty,
malnutrition, HIV co-infection, and
overcrowding.
2. IMPROVING DIAGNOSIS AND TREATMENT:-
-Effective treatment: Optimize treatment
regimens to improve cure rates and reduce
the risk of drug resistance.
Adherence to treatment: Implement
strategies to improve patient adherence to
treatment, such as directly observed therapy
(DOTS).

3. COMMUNITY OUTREACH: Educate the public

about TB symptoms, prevention, and
treatment to promote early diagnosis and
treatment.

4.SOCIODEMOGRAPHIC PROFILE OF THE

PATIENT: To determine the sociodemographic
profile of TB patient in a tertiary health care
centre of WB(RPHGMCH) and to access the
attitude, practices regarding the disease in
them.
PREVALENCE:

INDIA

Tuberculosis (TB) is the major cause of

mortality and morbidity among the
communicable diseases.
Globally, an estimated 10 million people
develop TB and over a million deaths occur
annually India accounts for about 25% of
global TB burden, with
an estimated TB incidence of 2.77 million in
2022.(5)
WEST BENGAL

The situation is similarly concerning.

The state has reported High TB incident
rates influenced by factors like population,
density, poverty, healthcare access.
specific prevalence figures can vary in
different districts.
The prevalence of tuberculosis (TB) in West
Bengal is estimated to be 249 per 100,000
people.
THE PREVALENCE VARIES WIDELY ACROSS
THE DISTRICTS:

JALPAIGURI: The highest prevalence of TB

at 653 cases per 100,000 people

DAKSHIN DINAJPUR: 436 cases per 100,000

people.

UTTAR DINAJPUR: 376 cases per 100,000

people.

SOUTH 24 PARGANAS: The lowest

prevalence at 84 cases per 100,000 people.

HAORA: 87 cases per 100,000 people.

The figure shows TB deaths in Bengal
in past few years and yearly TB
notification for five years. (7)
CURE RATE:

CUTE RATE OF TUBERCULOSIS IN INDIA

The incidence rate in India had fallen from 237

per lakh population in 2015 to 199 per lakh
population in 2022, while the mortality rate
had declined from 28 per lakh population in
2015 to 23 per lakh population in 2022.
According to the India TB report 2024 released
by the Union Health Ministry on March 27,
stating that the country has set 2025 as the
target for eliminating the disease.(8)
The Centre added that after the COVID-19
pandemic, the National Tuberculosis
Elimination Programme (NTEP) embarked on
a journey towards accelerating TB
elimination, guided by the National Strategic
Plan(NSP) 2017-25.(9)
“The NTEP continued providing free
diagnostic services, conducting
approximately 1.89 crore sputum smear tests
and 68.3 lakh nucleic acid amplification tests
(NAAT) in 2023,” noted the report.
Direct Benefit Transfer(DBT) under the
Nikshay Poshan Yojana continued to provide
financial support to TB patients, with
approximately 2,781 crore disbursed to
approximately one crore beneficiaries,” the
report noted. (10)
CURE RATE OF TUBERCULOSIS IN WEST
BENGAL

The cure rate for tuberculosis (TB) in West

Bengal is 86.1% for patients treated by
private providers. This means that 86.1% of
patients were either cured or completed
treatment. 8.6% of patients were not
evaluated. (11)

TB is curable if treated with the approved

four drug combination for at least six months.
Patients should start feeling better within
two to four weeks of starting treatment. It is
important to complete the entire course of
antibiotics to prevent the disease from
getting worse. (12)
TUBERCULOSIS (TB) POSES SEVERAL
SIGNIFICANT PROBLEMS:

1.Public Health Threat: TB remains a leading

cause of death globally, particularly in low-
and middle-income countries (1).
2. Drug Resistance: The rise of multi-drug-
resistant (MDR) and extensively drug-
resistant (XDR) TB complicates treatment
and control efforts (2).
3. Co-infection: TB often coexists with HIV,
exacerbating health issues and complicating
treatment protocols (3).
4. Socioeconomic Factors:
Poverty, malnutrition, and lack of
access to healthcare increase
susceptibility to TB and hinder
effective treatment (4).
5. Stigma: Social stigma
surrounding TB can lead to
isolation and discourage
individuals from seeking
treatment (5).
6. Diagnosis Challenges: Delayed
diagnosis and access to lack of
resources or testing can lead to
prolonged infectious periods (1).
THE BURDEN OF TUBERCULOSIS (TB)
IN INDIA AND WEST BENGAL IS
SIGNIFICANT:
India (6)-
• Global Context: India accounts for
about 27% of the world's TB cases,
making it one of the highest-burden
countries.
• Incidence: The estimated incidence
rate is around 210 cases per 100,000
people.
• Deaths: TB remains a leading cause
of death, with hundreds of thousands
of fatalities each year.
• Challenges: Issues such as poverty,
West Bengal (7):

• Prevalence: West Bengal reports a

higher-than-average incidence of TB
compared to other states in India.
• Socioeconomic Factors: High
population density, poverty, and
health infrastructure challenges
exacerbate the situation.
• Control Measures: The state has
implemented various TB control
initiatives, focusing on awareness,
early diagnosis, and
treatment adherence.
RELEVANCE:

TB is caused by bacteria (Mycobacterium

tuberculosis) and it most often affects the lungs. TB
is spread through the air when people with lung TB
cough, sneeze or spit. A person needs to inhale only
a few germs to become infected . Every year, 10
million people fall ill with tuberculosis (8).

Despite being a preventable and curable

disease, 1.5 million people die from TB each
year - making it the world's top infectious
killer . TB is the leading cause of death of
people with HIV and also a major
contributor to antimicrobial resistance (3).
. Most of the people who fall ill with TB live in low-
and middle-income countries, but TB is present all
over the world. About half of all people with TB can
be found in 8 countries: Bangladesh, China, India,
Indonesia, Nigeria, Pakistan, Philippines and South
Africa (4).

. About a quarter of the global population is

estimated to have been infected with TB bacteria,
but most people will not go on to develop TB
disease and some will clear the infection (3).
Those who are infected but not (yet) ill
with the disease cannot transmit it .

. People infected with TB bacteria have

a 5-10% lifetime risk of falling ill with
TB. Those with compromised immune
systems, such as people living with
HIV, malnutrition or diabetes, or people
who use tobacco, have a higher
risk of falling ill.
METHODOLOGY
STUDY TYPE- OBSERVATIONAL DESCRIPTIVE
STUDY

STUDY DESIGN: CROSS-SECTIONAL

PLACE OF STUDY: RAMPURHAT GOVERNMENT

MEDICAL COLLEGE AND HOSPITAL
DURATION OF STUDY : 1 WEEK(21/10/24 to
27/10/24)

STUDY POUPULATION- PATIENT ATTENDING

THE CHEST OPD AT RAMPURHAT GOVT .
MEDICAL COLLEGE AND HOSPITAL
Inclusive criteria:-
1)Indoor patients
2)Records review (past 2 quarter records)
3)All family care givers of the patient who
gave informed consent During interview.
Exclusive criteria –
(i) All emergency severely ill patient
caretaker attending ward shortly.
(ii) who were not willing to give consent for
interview.

SAMPLING TECHNIQUE:
PURPOSIVE SAMPLING

SAMPLE SIZE : 65
STUDY TOOLS:

1) Questionnaire/proforma(validated)
2) Stethoscope
3)Weight machine
4)Pulse oximeter
5)Measuring tape
6)Pen/pencil
Scoring System:
We ask the ТВ patients 3 questions test their knowledge, 3 questions
to test their attitude towards therapy, and 6 questions to test their
practice. We give (+1) score for each correct answer and zero for
wrong answer, or noresponse
If for knowledge: Score 3 = Good knowledge
2 = Intermediate knowledge
1 = Poor knowledge
 For attitude towards TB therapy,
Positive directed questions are taken as -
For negative directed questions –
Scoring system will be as: (-6 to 0) – Unfavorable
(1-6) – Favorable

+2 +1 0 -1 -2

Strongly agree Agree Neutral Disagree Strongly disagree

-2 -1 0 +1 +2
For practice, If score( 3) – Unfavorable
(4-5) – Favorable
We take into account the socio-demographic
factors of the patients ---- their Socio-economic
status based on updated BG Prasad2024 scale,
Socio-cultural problem in family, and distance
from the TB clinic, as it would give us the
present scenario, if TB is still majorly affecting
the poor or has it changed. It will also help us to
see if distance is being a factor in non-adherence
of TB treatment.
We also note the presenting symptoms
during admission, investigations done to
diagnose the case the current NTEP regimen
Plan of analysis of data: Data will be entered in Microsoft
office Excel 2010. It will be represented as bar graphs of pie
charts. Variables such as Socio-economic status, Occupation,
knowledge, Attitude, Practice, Current regimen followed, Co-
morbidity expressed as frequencies and percentages, 10 be the
trends.

Confidentiality: The identification of the patient will be kept

confidential. Only NIKSHAY ID of the patient will be used.

Ethical Consideration: The study will be conducted ethically

as per National Ethical Guidelines for Biomedical and Health
Research Involving Human Participants, ICMR 2017, and
under current Good Clinical Practice (GCP) guidelines
Time schedule:
1.Preparatory phase (1st Week)
Selection of titles
Setting objective
Permissions from authority
Preparation of study tool
Pretesting of questionnaire
Collection and finalization of questionnaire
2.Data collection phase (2nd week)
Interview of TB patients attending DOTS clinic in the given
study period
3.Data entered in Excel sheet and analysis of data (3rd week)
4.Data presenting and report writing (4th week)
RESULTS
 3%

INFERENCE-- 30.8% of study population wee illiterate and 3%of

them were Graduates.
INFERENCE-- 38.5% of study population belongs to LOWER MIDDLE CLASS and
10.8% belongs to UPPER CLASS
INFERENCE-- 47.7% Of study population had sedentary
occupation
INFERENCE- Distance from the tb clinic of 58.5% study population were
above 5km
INFERENCE- Place of residence of most of the study population were urban
INFERENCE- Most of the study population presented
with Cough ,Fever , chest pain during admissions
 INFERENCE- 84.6% of Study population were
New
INFERENCE- Most of the study population about 78.5 were
Study Population
INFERENCE- 61.5% of study population were in
Intensive phase and rest were in continuous phase
INFERENCE- 90.8% of study population had good
Relationship with Healthcare providers
INFERENCE- 69.2% of study population were addicted
( out of that maximum had addiction of BIDI smoking
and consumption of Alcohol ) .
Rest 30.8% were non smoker
SUMMARY
Approximately 29-2% of the
patients were neutral about the
fact of taking a punishment to
them, but almost 26.2%- were in
favour of this fact depicting
their better knowledge about
being diseased which can't be
Ignored.
> et majority of the population
under study about 69•27% felt
depressed of their current status
of being diseased; shouting the
After studying 43 study population data, we have nded the
following findings:-

① Majerity of study population belongs to age range of 40-60

years

2 Majarity Estudy population [67.7%] were male.

③ Most of the study population belongs to rural area

Approx 30.87. of study population was found to be illiterate

Approx 6469. of study population have 5-6 family members

47.77. of study population leads moderate lifestyle

Socio-economic status 38.5%. belongs to lower-middle class

according to trepted updated BG Prasad Scale
> 69.24 patient were an addict;
mostly Tobacco

> almost 90% of deceased patient

under study continued smoking after
they were aware, about humbeing
discared;

Majority of the people catre in

around 938, were in favour of
completing their whole treatment ;
depicting theads kuyhad hosting
sound Rroulledge about the fact that
the disease could be curable on
complete treatment
CONCLUSION

Lack of awareness in than leads to further

transmission of disease of poor treatment
outcome which increases the prevalence.

Majority of population approx 67%% have

average regarding TB cases But 14 hand
poor knowledge have be neglected. which
cannot

Approx 60.46% of study population have

unfavorable attitude regarding TB.

Approx 49% of study population have

favorable response regarding practice for
IEC activities for Tuberculosis

IEC (Intemation, Education and Communicati

activities for Tubinculosis (78) aim to raise
Bwareness promete prevention, and improve
treatment adherence Here we some exomple

• Awarenen Campaigns We should conduct

community outreach to educate the public about
to symptoms and prevision

•Educational materials. Distribute Poster,

Pamphlets and Brochures with information on tb
transmission and treatment.

Helpline: Expand the helpline fon patients and

providers

Media Engagement utilise local ratio television

and social media platforms to Share To related
information and Succes Stories
Actions to Reduce Stigma in TB Patients Promote understanding and
empathy

Challenge stereotypes and misinformation Encourage open

communication and support Implement patient-centered can

care

Protect patient confidentiality.

Advocate for non-discriminatory policies

Raise awareness through campaigns and education

Involve affected communities in decision-making

Provide psychosocial support to patients and families

Administrative Level:

Strong leadership and commitment

Comprehensive TB control program

Adequate funding

Effective surveillance and reporting Collaboration and partnerships

RECOMMENDATION
Advice To The Family Members
Of The Patient Regarding TB
Management

Family members should be

educated about

✔ Symptoms

Mode of transmission

✔Method of prevention
They should be aware of the bad
behaviour towards the cases including the
consequences of the TB cases in their
area

• They should be well known to the

preventive measures of TB infection.

• Counselling regarding stigmas:

A. Acknowledge Emotions:

Validate feelings like fear, shame, and

frustration.
B. Educate the patient:

TB is curable; not spread through casual

contact.

Emphasise treatment adherence and

correct myths.

C. Build Resilience:

Encourage self-esteem and positive

coping

strategies. Connect with supportive

people or groups.
D. Disclosure Guidance:

Help decide when and how to disclose

the diagnosis. Practice handling negative

reactions calmly.

E. Support Treatment & Reintegration:

Monitor progress and encourage treatment

completion

Address stigma post-treatment.

F. Referral to Services:

Provide access to psychological or social

 Referances
[1] Jain A, Dixit P. Multidrug resistant to
extensively drug resistant tuberculosis:
What is next? J Biosci. 2008;33:605-16.

Krasniqi S, Jakupi A, Daci A, Tigani B,

Jupolli-Krasniqi N, Pira M, Zhjeqi V,
Neziri B. Treatment adherence of
patients in Kosovo. Hindawi
Tuberculosis Research and Treatment,
2017; 2017.
https://doi.org/10.1155/2017/4850324
2]WHO. Adherence to long-term
therapies: evidence for Action, 2003.
http://apps.who.int/medicinedocs/en/d/J
s4883e/6.html

[3]World Health Organisation.

Adherence to Long-Term Therapies.
(World Health Organisation 2003).

[4] Maria Belen Herrerro, Slvina Ramos,

Silvina Arrossi. Determinants of non-
adherence to tuberculosis treatment in
Argentina: barriers related to access to
treatment
[5] Prevalence and factors associated with
tuberculosis infection in India - ScienceDirect
https://www.sciencedirect.com/science/article/pii/
S1876034123003362#bib1

(6)https://link.springer.com/chapter/10.1007/978-
3-031-40128-2_24

(7)https://images.app.goo.gl/
xE59BmHbxRc36BFe6

(8,9,10)

India achieves 16% decline in new TB cases, 18%

reduction in mortality since 2015: report - The
Hindu
https://www.thehindu.com/sci-tech/health/india-
achieves-16-decline-in-new-tb-cases-18-
11)https://pubmed.ncbi.nlm.nih.gov/33550792/

(12)https://www.medicinenet.com/
can_tuberculosis_be_cured/article.htm

1)https://jyoungphram.com

(2)https://www.mdpi.com

(3)https://www.who.int

(4)https://pmc.ncbi.nlm.nic.gov

(5)https://www.tandfonline.com

(6)https://ntep.in

(7)https://wbhealth.gov.in
 ACKNOWLEDGMENT
We are grateful to our respected HOD
sir Dr. Debasish Sinha and our other
professors of community medicine
department Dr. Bisanka Biswas, Dr.
Aritra Bhattacharjee , Dr. Kakoli
Boral , Dr. Somenath Ghosh , Dr.
Soma Chatterjee, Dr. Suman
Chatterjee , Dr. Nivedita Ma’am , Dr.
Shinjini Ghosh and Dr. S Mahmood for
guiding us throughout the
assignment .