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					T/t outcome was favorable i.e. T/t completed in 137 (82.03%)                   the students. This module makes them complete manager for
and was unfavorable in 30 patients, of which defaulted-                        the prevention and control of TB. The use of this TB module is
were15.56%, failure- nil, died ñ 2.39%.                                        recommended in other medical schools, where TB is a public
                                                                               health problem.
Of the defaults most i.e. 15 (57.6%) were in first two months
of treatment and could not be correlated with drug toxicity.                   Keywords: TB module, TB, Nepal
Conclusion: It appears though various regimens under DOTS                      13. FACTORS INFLUENCE DOT IMPLEMENTATION
are well tolerated and highly effective with favourable outcome,
                                                                                   AND ADHERENCE TO TUBERCULOSIS
the default rate is high in spite of DOTS, more efforts are
                                                                                   TREATMENT IN RAYALASEEMA, ANDHRA
needed to prevent defaults, specially address tracing and to
send the patient to his own address before starting the                            PRADESH
treatment as well as during T/t .                                              Raju M P Narasimha, Reddyn S. Krishna
Keywords: re-treatment, DOTS, TB RNTCP                                         Professor and Head

12. BPKIHS TB MODULE: AN INNOVATIVE WAY                                        Department of Sociology
    TO TEACH TUBERCULOSIS TO MEDICAL                                           Sri Venkateswara University
                                                                               Tirupati - 517502 Andhra Pradesh, India
Jha N
                                                                               Introduction: India has an estimated 5 million people with
School of Public Health & Community Medicine                                   tuberculosis (TB). Official policy is that treatment of all patients
BP Koirala Institute of Health Sciences, Dharan, Nepal                         is directly observed by health workers; completion rates are
Tel:9842039897, Fax: 025 520251                                                reported to be in reduced and drugs should be supplied for
E-mail: niljha@yahoo.com                                                       free. However, some research suggests there is a gap between
                                                                               the official policies and practice.
Introduction: Tuberculosis is a public health problem. Medical
schools must adopt and use their potential to contribute                       Methods: The study municipality is Tirupati Municipal
proactively in shaping the future of the health system. By                     Corporation, in Southern Andhra Pradesh, with a population
introducing changes in medical education, research and                         of 4 Lakhs, living in a mountainous area, with a socio-economic
delivery of care for TB control, medical schools have the unique               profile below average (BPL). The researcher purposively
opportunity to demonstrate social accountability. Medical                      selected four urban slums as representative of the study, in
school should provide every medical graduate with knowledge,                   terms of socio-economic development, geographic and
skills and attitude essential to the management of TB in the                   transportation condition. Survey of TB patients in Tirupati
patient and community as a whole. They should have an                          municipality; record assessment at one TB centre; patient and
effective educational strategy to provide such ability to their                village doctor in-depth interviews.
                                                                               Results: More than Sixteen per cent reported being directly
BP Koirala Institute of Health Sciences, Dharan, Nepal has                     observed every time they took treatment; less than one tenth
been teaching TB to medical undergraduates by using its own                    of TB patients were observed by health staff. Overall, more
module for many years.                                                         than one-tenth of the respondents reported that they had not
                                                                               taken any TB drugs in the previous week, Most TB patients
Objectives: The objective of this study was to know the                        said that they took drugs on their own at home and knew
feedback from the student about this TB module.                                nothing about the records of drug taking. Many patients
Methodology: The feedback was taken from the                                   described being treated differently by people in their immediate
undergraduate student after the modular teaching in different                  communities after getting TB. They suggested neighbours or
years.                                                                         friends did not like to talk with them, or kept a certain distance
                                                                               while talking with them for fear of infection. TB patients tended
Results: All students felt that the objective of this module is                to conceal their disease from others for fear of being isolated.
clear. Majority (more than 85 %) of the students said that                     Qualitative research indicated direct observation is neither well
content and duration student participation were adequate. The                  understood nor thought to be necessary, and that patients
visits to DOTS centre NATA were informative and useful.                        reported being charged expensive fees for ancillary treatments,
                                                                               such as liver protection drugs.
Conclusion: This TB module gives a comprehensive and
complete practical knowledge as well as skills on the diagnosis                Conclusion: The concept of free treatment has become
and management of TB with special reference to DOTS to                         blurred, with charges for additional tests and drugs. The

Abstracts-SAARC Second Conference on TB, HIV/AIDS and Respiratory Diseases – 2008, Kathmandu, Nepal ----------------------------------------------   7
government is already actively tackling these issues, and               15. CLINICAL PRESENTATION AND OUTCOME OF
involvement of health workers and others in this process will               SIX CHILDREN WITH TUBERCULAR
be helpful.                                                                 MENINGITIS IN BANGLADESH MEDICAL
                                                                            COLLEGE HOSPITAL
    INCLUDING A 5-MONTHS OLD INFANT                                     Chowdhury E U A1, Huq Md N2, Nahar K
    HAVING TUBERCULOSISñ A CASE                                         1
                                                                          MBBS, Assistant Registrar; Department of Paediatrics, Bangladesh
    REPORT -                                                            Medical College Hospital.

Chowdhury E. Ul A1, Huq Md. N2, Parveen F3                              MBBS, DTCH, FCPS, Professor & Head; Department of

                                                                        Paediatrics, Bangladesh Medical College Hospital.
MBBS, Assistant Registrar; Department of Paediatrics, Bangladesh
                                                                        MBBS, Medical Officer; Department of Paediatrics, Bangladesh

Medical College, Hospital                                               Medical College Hospital.
MBBS, DTCH, FCPS, Professor and Head; Dept. of Paediatrics,
                                                                        Department of Paediatrics, Bangladesh Medical College Hospital
Bangladesh, Medical College Hospital
                                                                        E-mail: ehsaanchowdhury@yahoo.com
MBBS, Internee Doctor; Department of Paediatrics, Bangladesh

Medical College Hospital                                                Background: Tubercular Meningitis (TBM) is a dreadful
                                                                        disease with high mortality and morbidity commonly occurring
A 5-months old male infant, immunized as per EPI schedule,              within 6 months of primary infection.
2nd issue of a nonconsanguinous parents residence at Lalbag,
Dhaka from a poor socioeconomic background was admitted                 Objectives: To see the clinical presentation, laboratory data
into the Paediatrics ward, Bangladesh Medical College                   and to observe the response to treatment.
Hospital on 11th March 2004 with fever for 1 month, dry cough           Materials and Methods: This is a prospective observational
for 21 days, loose motion and vomiting for 14 days. He was              study conducted in the Bangladesh Medical College Hospital
weaned from breast milk at 3 months of his age and there                (BMCH), Dhaka, Bangladesh from May 2003 to April 2004.
was gross malfeeding history. BCG vaccine was given at 6                Six patients aged 6 months to 10 years admitted in Paediatric
weeks. His mother had also been suffering from recurrent                ward who were clinically suspected to have TBM and
febrile illnesses and weight loss for many months. Baby was             confirmed by CSF study were included in this study.
looking ill but conscious, mildly pale, afebrile with no dyspnoea.
Z score of wt/age, lth/age, wt/lth and OFC were ñ2.9, -3.5, -           Results: There were 4 male and 2 female patients with a
0.3 and ñ0.3 respectively. Fontanel was open and normal.                mean age of 4.6 + 4.2 years. Four (66.7%) cases came from
There was no lymphadenopathy and BCG mark was present.                  outside Dhaka. Majority belonged to low-income group (83.3%)
Breath sound was vesicular with fine crepitation on right lung.         and all study children were malnourished of different grades.
He was treated initially as septicemia by combined parenteral           Mostly were admitted with 3-4 weeks (33.3%) of illness. Three
antibiotics. But response was not satisfactory. Lab data yielded        (50.0%) cases presented in stage-II and 3 (50.0%) in stage
raised ESR, eosinophillia, pyuria and haematuria with sterile           III. Fever was present in all cases followed by night sweats,
culture. Chest X ray was abnormal. MT was done and found                loss of appetite (66.7% each) and weight loss (33.3%).
strongly positive (18mm/72hrs.). Other family members were              Headache, vomiting, convulsion and loss of consciousness
immediately screened for tuberculosis and all revealed                  were present in 3 (50.0%). Fever (100.0%), meningeal signs
                                                                        (100.0%), very ill looking (50.0%), unconsciousness (50.0%)
positive. Complete Blood Count, MT and Chest X ray were
                                                                        and pallor (66.7%) were documented as physical signs. BCG
chosen as screening methods for them to diagnose
                                                                        scar mark was present in 5 (83.3%) study children. MT was
tuberculosis. We started anti tubercular therapy to all of them
                                                                        negative in all cases. CSF study revealed typical pictures of
including baby for 6 months. We also corrected the feeding
                                                                        TBM. Chest radiograph showed abnormality in 5 (83.3%)
practice of the patient and kept in close monitoring. He showed
                                                                        cases. Response to treatment was maximally observed
remarkable clinical improvement with weight gaining. We
                                                                        between 5-10 days (66.6%). Total hospital stay was variable.
discharged him as pulmonary tuberculosis with septicemia with
                                                                        Out of 6 cases five were cured without any sequelae with one
having pulmonary tuberculosis among all other family
members and advised for follow up. They all were cured. At
present, they are healthy and baby is now 4 years of age with           Conclusion:† Prognosis of TBM largely depends on stage of
good physical and mental growth.                                        presentation. Early clinical suspicion and diagnosis at
                                                                        initial stage followed by proper treatment can save the
Key words: Tuberculosis, Tuberculosis in infant, Pan family             children from its immediate and long term sequelae as well
tuberculosis.                                                           as mortality.

8    ---------------------------------- Abstracts-SAARC Second Conference on TB, HIV/AIDS and Respiratory Diseases – 2008, Kathmandu, Nepal
16. AN UNUSUAL PRESENTATION OF                                                 Objectives: To involve the community, enhance awareness
    PULMONARY TUBERCULOSIS IN A CHILD                                          on TB and generate support at policy level that will lead to
    SYNDROME                                                                   diagnosis and treatment adherence; and thus, increase overall
                                                                               case detection rate and sustain high cure rates.
Huq Md. N1, Momen S N2
                                                                               Methodology: Female community health volunteers known
    Professor of Pediatrics, Bangladesh Medical College, Dhaka
                                                                               as Shasthya Shebika disseminate information on TB through
    Medical Officer, Dept. of Pediatrics, Bangladesh Medical College           their regular visits at household level. Orientation with different
Department of Pediatrics, Bangladesh Medical College                           stakeholders was conducted to raise awareness and enhance
Dhaka, Bangladesh, Tel: 880 1819218953                                         mass involvement in programme. Interaction with policy
                                                                               makers, professionals and media personnel were done
Case summary: Hridoy, 7-year old boy, only child of non-
                                                                               through round table meetings, workshops and talk shows in
consanguineous poor parents, immunized against all EPI
                                                                               TV channels. Social communication events like street drama
target diseases, coming from Pabna, Bangladesh; presented
                                                                               and folk song on TB messages performed by local groups in
with huge generalized edema, scanty urine, cough and
                                                                               remote areas. Features and articles on TB were published in
shortness of breathing for 6 days. He had no fever, cough or
                                                                               newspaper. Leaflets, posters, stickers and billboards were
breathlessness before. He suffered from steroid responsive
                                                                               developed as awareness raising materials.
nephrotic syndrome 4 times earlier. This is the 4th relapse of
nephritic syndrome but this time with additional cough and                     Result: In 2007, total 18,674 opinion leaders; 2,565 scouts &
shortness of breathing. Physically the child was very ill looking              girlsí guide; and 19,099 cured TB patients were oriented on
with fast breathing and moist chest. Treatment was                             TB. 1,146 social communication events (street drama & folk
immediately started with ceftriaxone, gentamicin, oxygen and                   songs) were held. Total 37 round-table meetings were
nebulised salbutamol and ipratropium. Diuretic was added to                    conducted with policy makers, professionals, media personnel,
combat huge edema. CBC showed normal white cell count                          implementers and civil society at different level. Besides airing
with eosinophilia (14%). ESR was 80 mm in the first hour.                      of TV and radio spots, 117 TB related news telecasted on
Chest x-ray showed a huge mass extending upward from the                       different TV channels. 115 articles and 334 TB event related
diaphragmatic margin with well defined borders and evenly                      news published in newspapers.
opaque field mimicking large mediastinal mass, occupying the
most of the right chest beside the paracardiac region.                         Conclusion: ACSM activities involve different segments of
Tuberculin skin test was negative. CT suggested pulmonary                      the society and bring changes in the service seeking of the
tuberculosis with endobronchial spread. Anti-tubercular                        people and thus enhance referral to service points. Community
therapy was instituted and the mass rapidly regressed with                     involvement at grass root level is effective to reach higher
dramatic improvement in his general condition. Follow up chest                 number of people.
x-ray Edema responded to oral prednisolone in nephrotic
dosage. After remission of edema the boy weighed 13 kg                         Keywords: ACSM, Community participation, Tuberculosis
(61%).                                                                         control

17. ACSM IN TB CONTROL: EXPERIENCE OF                                          18. ENGAGING ALL CARE PROVIDERS: BRAC
    BRAC                                                                           EXPERIENCE IN TB CONTROL

Das B K, Sultana A, Rashid S M J B, Islam M A, Ahmed F                         Siddiquea B. N., Islam M A, Islam M N

BRAC Health Programme, BRAC                                                    BRAC Health Programme,,BRAC Center ,
BRAC Center                                                                    75 – Mohakhali, Dhaka – 1212, Bangladesh
75, Mohakhali, Dhaka – 1212                                                    Tel: (88-02)-9881265, Fax: (88-02)-8823614
Bangladesh                                                                     E-mail: rifat.m@brac.net
Tel: (88-02)-9881265, Fax: (88-02)-8823614                                     Introduction: BRAC an NGO working in collaboration with
E-mail: rifat.m@brac.net                                                       National TB Control Programme. Main approach of BRAC is
                                                                               the community based service provision by involving
Introduction: BRAC an NGO, in collaboration with NTP
                                                                               community. BRAC is engaging different care providers to
providing TB services to major part of Bangladesh covering
                                                                               enhance the TB Control.
approximately 88 million population. Advocacy, communication
and social mobilization (ACSM) component is an integral part                   Objectives: To enhance the involvement of different care
of BRACís community based TB programme focusing                                providers including workplaces and thus to increase their
enhanced community involvement and its strengthening.                          participation in referral of TB suspects, raising awareness on

Abstracts-SAARC Second Conference on TB, HIV/AIDS and Respiratory Diseases – 2008, Kathmandu, Nepal ----------------------------------------------   9

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