TUBERCULOSIS: DPSEEA MODELBasanta Chalise

Roll no.- 01MHPE

IOM

OUTLINE OF THE PRESENTATION

• Introduction• DPSEEA Framework• Driving forces • Pressures• State• Exposure • Effects • Actions• Conclusion

INTRODUCTION

• TB is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It typically affects the lungs (pulmonary TB) but can affect other sites as well (extrapulmonary TB).

• It is transmitted by droplet infection.

DRIVING FORCES

• Rapid population growth

• Industrialization

• Rapid urbanization

• Migration (intra & inter)

• Poverty

• Poor socio economic conditions

PRESSURES• Overcrowding

• HIV/AIDS

• Poor sanitation and housing condition

• Unplanned settlement and urban slum

• Increase number of cases

• Delay diagnosis and inadequate treatment of cases

• MDR TB

STATEGLOBALTuberculosis (TB) remains one of the world’s

deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease, 360 000 of whom were HIV-positive. TB is slowly declining each year and it is estimated that 37 million lives were saved between 2000 and 2013 through effective diagnosis and treatment

STATE

SEAR

• Of the estimated 9 million people who developed TB in 2013, more than half (56%) were in the South-East Asia and Western Pacific Regions.

• India and China alone accounted for 24% and 11% of total cases, respectively.

STATENepal• Tuberculosis (TB) is a major public health

problem in Nepal.• About 45 percent of the total population is

infected with TB, of which 60 percent are adult. Every year, 45, 000 people develop active TB, out of them 20,500 have infectious pulmonary disease.

• Treatment by Directly Observed Treatment Short course (DOTS) has reduced the number of deaths; however 5,000‐7,000 people are still dying per year by TB.

EXPOSURE• Elderly• People living with HIV/AIDS (PLHIV)• Prisoners• Diabetic patients• Frequent contact with TB patients• Smokers• Urban Slums• Migrants• Poor/malnourised• Remote areas• Minorities

EFFECTS • TB kills millions people every year

• Co-infection with HIV cause increased mortality

• Multidrug-resistant TB

• Psychological effects - stigma

• High DALY lost

• Increase Poverty (The World Bank estimates that loss of productivity attributable to TB is 4 to 7 percent of some countries' GDP)

ACTIONS: GLOBAL • Millennium Development Goal (MDG)

framework includes five indicators: TB incidence, TB mortality, TB prevalence, the case detection rate for new TB cases and the treatment success rate for new TB cases.

• Global Plan to Stop TB 2011−2015 - There has been encouraging progress towards 2015 targets for TB/HIV interventions.

ACTIONS: NATIONAL

National TB Program (NTP) Goal, Strategy and Target:

• Vision: Tuberculosis free Nepal

• Goal: To reduce mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem

Objectives:• To dramatically reduce the National burden

of TB by 2015 in line with the Millennium Development Goals and the Stop TB Partnership targets

• Achieve universal access to high‐quality diagnosis and patient‐ centered treatment

• Reduce the human suffering and socioeconomic burden associated with TB

• Protect poor and vulnerable populations from TB, TB/HIV and multi‐drug‐resistant TB

Targets:• MDG 6, Target 8: ...halted by 2015 and

begun to reverse the incidence.• Targets linked to the MDGs and endorsed by

the Stop TB Partnership:– By 2005: detect 100% of new sputum smear‐

positive TB cases and cure at least 85% of these cases.

– By 2015: reduce prevalence of and death due to TB by 50% relative to 1990

– By 2050: eliminate TB as a public health problem (<1 case per million population)

Components of the Stop TB strategy1.Pursue high‐quality DOTS expansion

&enhancement2.Address TB/HIV, DR‐TB and other

challenges3.Contribute to health system strengthening4.Engage all care providers5.Empower people with TB, and communities6.Enable and promote research

Key activities of NTP are as follows:• Provide effective chemotherapy to all patients in accordance with

national treatment policies.• Promote early diagnosis of people with infectious pulmonary TB by

sputum smear examination.• Establish a network of microscopy centers and a system of quality

control of sputum smear examination.• Establish treatment centers for every 100,000 population within the

existing primary health care system.• Provide continuous drugs supply to all treatment centers. This includes

systems for procurement, storage, distribution, monitoring and quality control of drugs.

• Maintain a standard system for recording and reporting• Monitor the result of treatment and evaluate progress of the program, by

analyzing periodic treatment outcome in cohorts of patients.• Provide continuous training and supervision for all staff involved in the

NTP, at each level.• Pilot and expend health communication project to improve

communication between health workers and TB patients and to promote community awareness about TB.

• Expansion of income generation and skill development training activities to needy DRTB patients in all over the country.

CONCLUSION

• TB is a infectious disease which is major public health problem in Nepal.

• Its control depends upon multi-sectoral coordination and collaboration.

• Poverty alleviation and improved sanitation along with public health measure are essential to control TB.

REFERENCES:

• Class notes

• Global TB report (2014) – WHO

• Annual Report (070/71) – DoHS

• http://www.who.int/en/