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

25 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 problem of unfavourable outcome (which includes death) following treatment, and its dependence on the type of patient (i.e., whether he is seriously ill or not). Further, this study indicates a high prevalence of TB among the patients of productive age group viz., 15-44 years; this matter also needs urgent attention. Before concluding this section, it will be prudent to have a quick look at the findings of some of the other researchers working in this field. Kondapaka et al. found that among the patients admitted to Government General and Chest Hospital, Hyderabad (India), between 1st January, 2010 and 30th June, 2010, for treatment of TB, 921 were ultimately referred to peripheral centres, but formal feedback was received for only 682 of them, indicating deficiencies in the system of referral for treatment and feedback (Kondapaka et al. 2012). Bharaswadkar et al. studied the role of Private Practitioners (PPs) in RNTCP in Pune (India) in 2010, and observed that though many PPs worked as referral centres, a considerable number of them were not adhering to the standard international guidelines for the treatment of TB (Bharaswadkar et al. 2014). Jayabal et al. noted that for a considerable number of TB patients, referred within and outside the Chennai district (India) by some Tuberculosis Units of Chennai Municipal Corporation, between January 1, 2014 and June 30, 2014, either no further information was available or treatment was not initiated (Jayabal et al. 2017). Thomas et al. conducted research, in 2015-16, on some TB patients of Chennai (India) who stopped following up the treatment process either during diagnosis, or at the time of referral/hospital admission, or when the official RNTCP registration process was to be done, and discussed various possible reasons for this behaviour of the patients (Thomas et al. 2020). Stalin et al. devised an intervention package to reduce the number of those TB patients of the Puducherry district (India), who were referred for treatment by four medical colleges in the district, but for whom no feedback was available (Stalin et al. 2020). They (i.e., Stalin and his group) observed that before using the package, the percentage of such patients was 54 (in the 3rd and the 4th quarters of 2016), and after applying the package, it became 34 (in the 2nd quarter of 2017) (Stalin et al. 2020). Arora et al. found that among the 4395 TB patients, handled by Maulana Azad Medical College, Delhi (India), and its associated hospitals, between July 2018 and March 2019, 3315 were referred out, but feedback was received for only 797 of them (Arora et al. 2021). Thus, these studies point out the drawbacks in the system of ‘referral for treatment’, in various parts of India, other than West Bengal. IV. C onclusions This study evaluated the system of ‘referral for treatment’ in West Bengal, in 2007-08, and found certain serious shortcomings in this technique, with regard to percentage of registration at DOTS centre, adequacy of previous TB treatment method (which gives an idea about the performance of the ‘referral for treatment’ system going on since 2003), rate of conversion from sputum positive to sputum negative patients after 2-3 months of treatment, and chance of overall positive result following treatment. Also, this work shows a high occurrence of TB among the patients of productive age group i.e., 15-44 years. A more comprehensive study needs to be done to judge the strengths and the weaknesses of not only the system of ‘referral for treatment’ but also the RNTCP programme, considering the fact that the problem of TB in India should be handled effectively and urgently. This task may be taken up in future, if possible. A cknowledgements The author acknowledges her indebtedness to Dr. Debasish Sinha, student of MD (Community Medicine) (session: 2007-09), Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, who sincerely collected and analyzed the data, used in this work, under her guidance. The author is thankful to Dr. Malay Kumar Maitra, Coordinator, RNTCP and Medical Colleges, West Bengal, for his help, cooperation and advice with regard to this study. The author expresses her gratitude to the pertinent staff members of RG Kar Medical College, Kolkata, and the relevant DOTS centres, for their cooperation, help and assistance in obtaining important patient data. Also, the author is indebted to the patients involved in this study, and their family members and neighbours, for their help and cooperation in the data collection process. R eferences R éférences R eferencias 1. Arora R, Khanna A, Sharma N, et al (2021) Early Implementation Challenges in Electronic Referral and Feedback Mechanism for Patients with Tuberculosis Using Nikshay -- A Mixed-Methods Study from a Medical College TB Referral Unit of Delhi, India. J Fam Med Prim Care 10: 1678–1686. 2. Bharaswadkar S, Kanchar A, Thakur N, et al (2014) Tuberculosis Management Practices of Private Practitioners in Pune Municipal Corporation, India. PLoS One 9: 3. Central TB Division (under Directorate General of Health Services of Government of India) (2005)