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

It is evident from table-4 that the number of sputum positive patients who were not converted into sputum negative ones in 2-3 months, is substantial (62 among 200 i.e., 31%). The reason for this should be investigated. However, the chi-square test shows that the association between the area of referral and the conversion status is not significant at 5% level (p- value=0.13333>0.05; degree of freedom=1). Thus, there is no significant urban-rural divide in case of conversion of sputum positive patients; rather the conversion rate is better for patients attending DOTS centres outside Kolkata, than for the ones attached to DOTS centres within Kolkata. Anyway, competent authorities should find out ways to ensure 100% or near 100% conversion rate after 2-3 months of treatment, instead of 69%, as shown in table-4. Table-5 presents how many of the patients who registered at the DOTS centres, got positive/favourable result after treatment. In this table, (i.e., table-5), “favourable outcome” implies any one of the following: Table-5: Distribution of registered patients according to outcome of treatment Type of patient Outcome of treatment Total Favourable outcome Unfavourable outcome Seriously ill (categories- I and II) 416 76 492 Not seriously ill (category-III) 167 3 170 Total 583 79 662 24 Year 2022 Global Journal of Medical Research Volume XXII Issue IV Version I ( D ) K © 2022 Global Journals Evaluation of ‘Referral for Treatment’ System under RNTCP in a Hospital at Kolkata, India • the patient was cured, and • the patient’s treatment was completed, but it was not ascertained whether the patient was ultimately cured or not (i.e., -ve sputum was found at the end of initial phase of treatment, but sputum was not tested at the end of the final phase), and “unfavourable outcome” indicates any one of the following: • the patient died during treatment, irrespective of the cause, • the patient defaulted (i.e., at any time after registration, the patient did not continue the treatment for 2 months or more consecutively), • the patient was transferred to another area, and • the patient’s treatment failed (i.e., +ve sputum was found after ≥5 months of treatment), but the patient was not dead (when the data were collected). Table - 5 indicates that the number of patients for whom the outcome of the treatment was unfavourable (unfavourable outcome includes death, as already indicated), is considerable (79 among 662 i.e., nearly 12%). This matter needs urgent attention of the pertinent authorities. Moreover, the chi-square test shows that the association between the type of patient (seriously ill/not seriously ill) and the outcome of treatment is significant at 5% level (p-value=0.00001<0.05; degree of freedom=1). This is also a cause of worry. It may be mentioned here that in table-5, patients with category-I treatment regimen are the new sputum positive pulmonary TB cases, the new sputum negative pulmonary TB cases, who are seriously ill, the new cases of extra-pulmonary tuberculosis, who are seriously ill, and all the new TB cases with known HIV positive status (Central TB Division (under Directorate General of Health Services of Government of India) 2005). Patients with category-II treatment regimen, in table-5, are the sputum positive relapse cases, the sputum positive failure cases, the sputum positive default cases currently under treatment, and the others i.e., extrapulmonary relapse or failure cases (Central TB Division (under Directorate General of Health Services of Government of India) 2005). And, in the same table, i.e., table-5, the patients with category-III treatment regimen are the new sputum negative pulmonary TB cases, who are not seriously ill, and the new extra-pulmonary TB cases, who are not seriously ill (Central TB Division (under Directorate General of Health Services of Government of India) 2005). Further, in table-5, the total number of registered patients is shown as 662, while it is mentioned as 663 in table-2. Actually, for one of these 663 registered patients, the mode of treatment was other than DOTS; hence, the outcome of treatment he/she received is not relevant to this study, and his/her case has not been included in table-5. Thus, this study shows that there are certain serious lacunae in the system of ‘referral for treatment’ in West Bengal, which should be urgently looked into. These are: • the problem of not registering at the DOTS centre after referral, • the problem of inadequacy of previous TB treatment method (indicating the drawbacks of the ‘referral for treatment’ system (which includes the drug treatment) going on since 2003), and the urban-rural divide with regard to this, • the problem of low rate of conversion from sputum positive to sputum negative patients after 2-3 months of treatment, and