Global Journal of Medical Research, K: Interdisciplinary, Volume 22 Issue 4

Evaluation of ‘Referral for Treatment’ System under RNTCP in a Hospital at Kolkata, India Dr. Sampa Mitra Abstract- To handle the problem of tuberculosis (TB), Government of India started the Revised National TB Control Programme (RNTCP) in 1993, whereby Directly Observed Treatment, Short-course (DOTS) was officially adopted as the strategy in 1997. The medical colleges, involved in the RNTCP programme, refer the patients to the DOTS centres near their homes, after assigning the treatment categories. This study attempts to evaluate this ‘referral for treatment’ system during the second phase of RNTCP (RNTCP-II). To achieve this objective, pertinent data regarding 758 patients referred from RG Kar Medical College, Kolkata, to various DOTS centres in West Bengal, between 01.10.2006 and 30.09.2007, were collected from the said medical college, the relevant DOTS centres, the patients themselves, using a suitable questionnaire, and also the family members and the neighbours of some patients. Chi-square test at 5% level of significance was used as an analysis tool. The study displays some serious drawbacks in the system of ‘referral for treatment’ in West Bengal viz., non-registration at the DOTS centre after referral, inadequacy of previous TB treatment method (indicating the shortcomings in the referral system going on since 2003), regarding which, the urban-rural divide is significant, low conversion rate from sputum positive to sputum negative patients after 2-3 months of treatment, and possibility of unfavourable outcome (which includes death) following treatment, which is significantly dependent on the type of patient, i.e., whether seriously ill or not. Besides, this work shows a high prevalence of TB in the productive age group i.e., 15-44 years. I. I ntroduction o tackle the heavy burden of tuberculosis (TB) and improve the quality of treatment, Government of India, in 1993, revitalized its National TB Programme (NTP) as Revised National TB Control Programme (RNTCP). In 1997, Directly Observed Treatment, Short-course (DOTS) was officially adopted as the strategy of RNTCP. By the end of 2005, the whole of India was covered under this programme (i.e., RNTCP). During the second phase of RNTCP i.e., RNTCP-II, which was started in 2006, there was an improvement in the quality and reach of service. Since 2003, the medical colleges have been involved in the RNTCP programme. Here, the treatment categories are assigned to the patients, after diagnosis. Author: Director Professor, Department of Epidemiology, All India Institute of Hygiene and Public Health (AIIH & PH), Kolkata, India (currently retired). e-mail: sampamitra2003@yahoo.co.in Next, they are referred to DOTS centres situated within short distances from their residences. There, the actual treatment is done. This is the system of ‘referral for treatment’. The objective of this paper is to judge how the technique of ‘referral for treatment’ worked under RNTCP-II. To achieve this objective, this study was conducted between 01.09.2007 and 31.08.2008, on the TB patients referred from RG Kar Medical College to various DOTS centres in West Bengal (India). Before undertaking the study, a brief literature survey was performed, but no work dealing with the appraisal of the system of ‘referral for treatment’ in West Bengal, was found. II. M ethodology In this work, the details regarding the 758 patients (the study population), referred from this college between 01.10.2006 and 30.09.2007, were recorded. The referrals had been classified into two categories viz., inside district (i.e., DOTS centres inside the Kolkata (metropolis) district), and outside district (i.e., DOTS centres outside Kolkata). The data regarding the fate of patients, after their referrals, were also collected. To understand whether there is a significant association between the area of referral and the registration status (at the DOTS centre), between the area of referral and the disease status, between the area of referral and the conversion status of new sputum positive cases, and between the type of patient and the outcome of the treatment after referral, the chi-square tests were done at 5% level of significance, in all the cases. The formula for chi-square ( χ 2 ) is given by equation (1): (1) where, O = each observed value in any one of tables- 2 to 5, E = each expected value in the same table = (row total X column total / grand total) corresponding to each value in that table, p = p-value (calculated using relevant software system) corresponding to the chi-square value with 1 degree of freedom. T 21 Year 2022 Global Journal of Medical Research Volume XXII Issue IV Version I ( D ) K © 2022 Global Journals χ 2 = ∑ (O−E) 2 E Keywords: referral, DOTS, RNTCP, RG Kar Medical College, chi-square test.