Tuberculosis: Tuberculosis Program Principles

Tuberculosis: Tuberculosis Program Principles 2025

Although it seemed that tuberculosis was disappearing in most of the countries near the end of year 2000 despite the global increase in disease in last decade of 20th century. 




Tuberculosis history 

World health organization (W.H.O.) predicted, in 1997 there will be 7.96 million tuberculosis cases in the world (and there will be 1.9 million deaths around the world.  Tuberculosis became fifth most fatal reason death of humans though it had a single infectious agent, tubercle bacillus. Though 95% of infected cases were in Asia, Africa and Latin America, still many cases could be found around the world, Tuberculosis’ was declared as a ‘epidemic’ and a ‘national emergency’ as it was analyzed that its revival or second wave may come due to following:

  •         Poverty in poor and industrially marginalized nations.
  •      Demographic growth in tuberculosis affected countries.
  •         The acquired immunodeficiency (AIDS) epidemic in tuberculosis affected countries.

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Carelessness on part of health ministries of tuberculosis affected nation, that didn’t give tuberculosis control needed priority. According to W.H.O., there were already 8.4 million cases which could have led to 2 million deaths, so if it didn’t 80 million more cases might rise which consequently will lead to 20 million deaths— this death wave might take economy running youth (age 20–49-year-old citizen).

The countries like Benin, China, Gunia, Nicaragua, Peru and United Republic of Tanzania which were supported by W.H.O. and T. A.T. L. D (treatment against Tuberculosis and lung disease) have shown improvement. 

Types of tuberculosis found 

Tuberculosis is contagious disease caused by bacteria belonging to genus Mycobacterium, the bacterium manifest in form of different disease when it occurs in different parts of the body.

1. Pulmonary tuberculosis: 

Tuberculosis in adult initially show mild symptoms or symptoms that are generalized symptom of normal cough, cold fever, after three weeks it takes form of chronic cough which can also be confused with pre-medical conditions of person like an asthmatic person, smoker with damaged respiratory tract and worker in marble factory who has inhaled minerals.

When carefully examined in radiography, it shows cavity in pulmonary region; In such cases sputum sample must be taken two different days in two different time of day, if nothing comes out the next will be culture method.

2. Extrapulmonary tuberculosis

TB which happens outside the pulmonary region is called extrapulmonary tuberculosis which effect different parts of the organ of the body how to this diagnose the simulating tuberculosis there is an acute your classes that to the blood means that is source of the primary part affected they are factor and need immediate treatment and diagnosis  the lunch of the liver or sometimes brain abnormalities..

3. Tuberculosis lymphadenitis

In this condition the nodes enlarge leading to chronic fistulation within 7 months several dark scars appear. Tuberculin tests a usually positive or a serious indicator of culture purr if the node. If node is firm, then it's advice to surgically remove and let culture happen in it.

4, Abdominal Tuberculosis 

Tuberculosis in abdomen results collection of fluid leading to bloating-like structure with no science of hypertension aspiration of fluid will be found containing proteins, side pain exists but liver and spleen will be normal when the ultrasound. When laparoscope will be done caseation in the walls of liver or mucous in abdominal wall will be found accompanying with, swelling of mass of abdomen and obstruction on the way till mouth.

5. Spinal Tuberculosis 

In spine tuberculosis create posture deformity, chronic pains and in some cases paralysis. Lumber vertebra or lower back pains, lower back deforms, inguinal Canal swells and disc gets damaged. In joints tuberculosis cause monoarticular arthritis, imitation in movement or the large joint redness and functional deformities of joints

6. Genital tuberculosis 

It creates obstruction poses kidney failure and enlarging seminal vesicles in 50% of cases. In women obstruction in fallopian tube swells abdomen, irregular mental cycle and uterus deformation happen. In men prostate enlarges and so does seminal vesicles; there is swelling painless but thetical becomes sensitive.

7. Pericardium tuberculosis

Pericardium tuberculosis occurs in heart region at the twice heart shape and heart can be seen in form of a shadow in radiography there is also irrigation of arteries and there is a reduction in the heart sound. 

Tuberculosis in children 

Usually, sputum is not present and only way to detect the in only way to detect is loss of weight in the child and the person who was in direct contact with the child. Therefore, type of tuberculosis in child is   primary pulmonary, it is a symptom of attack producing generalizes symptoms like our cold fever and other normal symptom they excessive flow of mucus and formation of caseation in shin. Eyes also waters and is lot irritated by lights; person also develops photophobia, on radiological examination you will find formation of cavity and tuberculosis meningitis causing laziness irritation complaint about headache and vomiting and eyes there are photophobia, irritation in eyes when exposed to the light.

In radiography you may find lumbar puncture that is CSF is clear, and pressure is elevated, presence of lymphocytes, glucose level is low, and protein is elevated indicating alarming situation.

Post-pulmonary tuberculosis

Material examination is potential enough to detect tuberculosis post pulmonary tuberculosis occurs when person is reinfected which is mostly due to Malnutrition or suffering from HIV due to history of the contacts with the pulmonary tuberculous effects WBC come in blood.

Tuberculosis in HIV patient

 A person is HIV positive because he has, he is following characteristics:

  1. 1 month prolonged cough
  2. Pruritic dermatitis 
  3. Pain in swallowing
  4. Burning sensation in feet
  5. Neurological abnormality

In case of tuberculosis the HIV patient is at the risk come becoming drug dependent. All exudes on serenas membrane must be taken seriously. in case of tuberculosis meningitis your she maybe suspected immediately after cryptococcal meningitis is disapproved. The process of tuberculosis is same as a saving negative person.

Treatment of Tuberculosis

appropriate treatment or tuberculosis is chemotherapy with anti-tuberculosis drug they are five prominent tuberculosis drugs: 

  • Isoniazid
  • Rifampicin
  • Pyrazinamide
  • Streptomycin
  • Ethambutol

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 Action of first line anti-tuberculosis

 drug metabolically active replicating bacteria are blocked by lack of oxygen and I said pH of macrophages cytoplasm but some of bacilli remain dormant do metabolically inactive have ability to multiply most effective on bacteria is  and rifampicin that are the games metabolically active metabolically and antibacterial both Isoniazid and  rifampicin—it act faster so it's better, but they can't go intercellular wall , so to attack on intercellular bacteria Pyrazinamide is recommended and streptomycin is capable of killing extracellular bacteria.

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 All the four medicines recommended to be taken with chemotherapy. No drug should be given alone, it risks resistant immunity of TB bacteria against anti-tuberculosis drug; according to National tuberculosis program standard practice is recommended according to which some cases are recommend different regime.

Women receiving chemotherapy who are breastfeeding is allowed to receive chemotherapy, but the child has to be given to rifampicin and vaccinated BCG. The pregnant Women are not given streptomycin and women using contraceptive asked to use higher dose of rifampicin else would be infective in the case of Kidney failure Paradoxcyne must be prescribe and patient. 

Prevention of tuberculosis

main risk group case is family in which tuberculosis patient is held institutes citizen a marginalization refuges Nd infected marginalization or from infected marginalized nation and person whose untreated prevention measures for to be taken it immediate detection and reporting out the same positive case preventive prevent infections or tuberculosis caused by good ventilation of Laboratories and I see you so that it allows the sunlight to come and kill bacteria.

For BCG, bacteria pass through glyceride potato making it lose its potential to cause illness this is affection should be given after the birth, and injecting vaccine should be from injection after applying antiseptic on skin.

 It is instructed that it is to be applied after birth and after 2 months vaccine can be applied polio vaccination s and after 9 months can be applied with measles reaction on the body after BCG vaccine is a small rate after 2- or 3-weeks car is form with the last diameter light and protection from BCG vaccine is out 10 to 15 years and effective a long term not for instant action.

Tuberculosis affecting community

According to the classes mortality of death definition or tuberculosis number by unit per time the information is not reliable collected most countries of the world in 1997 who is the mated more than 1.9 million due to triple classes the more than 1 million in southeast countries in 2000 cause that in individual countries other in different countries tuberculous estimated 2.8 caused that's in the world in all is groups 26% of avoidable these Individual countries Motability has two main indices

The disease presence number of diseases present in the community at a given time in the pre unit of population it can be determine only by survey conducted on the representative sample of general Population on the representative sample of general population survey are costly difficult and conductors in some part of the country of the world.

Disease incidence the new cases are to be not a file and to be put against the population in 1 million multiples to get how many numbers of people infected the in high income country is the disease notification date I was more than case in in the poor countries and the notification rate and was 30 per 100000 and 1980 tuberculosis was considered natural after that measure after every natural vaccine and number was 3 million in South west Asia which amount to 40 percent of world population.

Infectious percentage was as follows 25% in South West Asia 22% in China 10% in best Pacific 7% in Latin America and rep person and Eastern Mediterranean effector the treatment in rich countries the improvement was 5 to 10% which after medication increase to 4 to 5% and after the full treatment was done it increase to 14 to 18% in poor country also recover but not HIV patients affected with tuberculosis in African Saharanpur

Tuberculosis Program Principles launched 

The main objective of global tuberculosis control is to reduce of Transmission of disease and hence lower the death rate due to disease. The specific objective for tuberculosis control established by WHO under "National Tuberculosis Program (NTP) are:

  • To diagnose at least 70% of cases.
  • To cure 85% of at least positive cases diagnosed.

This main objective of NTP should be reached before expanding case-finding.

New WHO strategy

It is based on new absolute priority: ensure all sputum complete full course of standardization by observation during treatment. As the cure of currently cases is the best mean to prevent furthermore case-finding of tuberculosis.

The components of Effective Tuberculosis control

Overall are five public health principles where success of program depends:

  1. Public commitment by the government
  2. Diagnosis and monitoring on tuberculosis bacteria with good system of quality assurance.
  3. Treatment using short-course Chemotherapy
  4. Uninterrupted supplies of drugs
  5. Regular evaluation of the program activities using a permanent recording and reporting system.

Implement of the program

Number of activities are needed to be implemented for success of program which includes:

  • Preparation of program manual.
  • Proper plan of program development.
  •  Creation of reference Laboratory as well as develop laboratory networks capable to perform tuberculosis microscopy on average of 1 00 000 population units in rural or 3 00 000 in urban areas. 
  • Implement of Training plans for patients’ management to nurse, doctor, supervisor and Microscopists.

The program must be integrated with prioritizing task as per level of intervention:

1. The Peripheral Level: The basic management unit the part of minimum package of health activities is applied at the level and on an average population of 1 00 000 is served includes basis activities performed targeted identifying tuberculosis patients, providing treatment; BCG vaccination is arranged by team of Expanded Program of Immunization and NTP activities are carried out by basic management unit. Organization of the basic management unit includes:

  • Unit coordinator who is trained to ensure quality of diagnosis and treatment of patient and is responsible for supervision of staff.
  • Registered laboratory with trained examiners of Microscopists
  • A system record included report of patients kept into records.

The health staff of health service institutions participating for tuberculosis control serve At Community Level, Village Level, First Level of Health Centre depending on the covering of population.

2. The Intermediate Level: It includes 8 to 10 basic management units. The clinical responsibilities for Tuberculosis control program at Intermediate Level are to Supervising the control activities to the basic management units; Intermediate Level Laboratory for providing training to Microscopists with general region as well as coordinating with reference laboratory as well as Coordination with other national programs like leprosy, acute respiratory infection and AIDS.

3. The Central Level: It is National Level scale for control tuberculosis. Its structure involves Central Unit; works under ministry of health ensuring responsibilities of delivering of medical reagents, laboratory reagents; receiving reports as well as provide training to basic management units. The National reference Laboratory include diagnosis and susceptibility testing for epidemiological surveillance as well The University hospital treat patients referred by Intermediate Level. The specialist development develops and applies technical guidance and supervising health personnel.

4. Organization of Treatment: -The basic management unit is responsible for organizing the treatment for tuberculosis generally located in the main center of district.

5. During Initial Phase: Patient needed to take drug daily during the initial stage of treatment, which contains rifampicin. The regular and systematic visit must be made to the heath post by the unit coordinator. Out-Patient should be hospitalized during the whole of initial phase of treatment, if patient requires it. However, Systematic Hospitalization of the patient during initial phase of treatment is difficult due to lack of hospital beds and even not reasonable furthermore extremely costly.

Thats why tuberculosis patients only hospitalized only in following situations:

  •  Serve deterioration of the patient's general state makes outpatient treatment difficult.
  • Complications like massive Hemoptysis, pneumothorax as well as major side effects such as jaundice, purpura or skin allergic
  •  Patient with concomitant disease such as unstable diabetes, kidney failure or stomach ulcer

The period often less than 2 weeks all varies depending upon the causes: 

1. During the Continuation Phase: In continual phase of treatment, a supply of fixed dose combinations is given to the patient at regular intervals every day and the interval jointly set by patient and health worker depends on ease of access of health center. The patients who are drug alcoholic or behavioral problems; the organization of follow-up aims for supervised intermittent treatment and health staff should try to make more available to these patients.

2. to improve treatment compliances:

  • In order to improve compliances, it is necessary to:
  • Enhance patients access to the health services:
  • The treatment center responsible for treatment located main center of population. Other health Institutions can provide directly observed treatment where center is difficult to accessible
  • Patients are registered by treatment unit are sent to control center for bacteriological tests till at the end of treatment until it cures and is recorded by basic management unit.
  • Improve the organization of the treatment centers
  • Apart from every day, the centers should open during lunch breaks and the patient appointment should be made in planned way to reduce unnecessary waiting.

3. Communicate with the patient:

How to diagnose other cases of pulmonary tuberculosis. While diagnosing if a smear negative case is to be recommended treatment, then his at least six smears should come positive else a positive culture should be found. A proper radiological x-ray should be done to find existence of disease, and radiological examination should be done i96n proper health institute

Fact about tuberculosis

  • Mycobacterium tuberculosis which is isolated or found by Robert Koch also known as Koch bacterium
  • Mycobacterium atrium is one found in west Africa and is often resistant to thioacetazone
  • Mycobacterium Bovis is found in wild and domestic animals like cow. Drinking unpasteurized milk of infected cow can give you tuberculosis Bovis
  • Non-typical bacteria are indirectly responsible to cause tuberculosis.

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