primary level care of tuberculosis
TRANSCRIPT
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PRIMARY LEVEL OF CARE OF TUBERCULOSIS
PRESENTERS: • Emmanuel Wekesa• Keagan Kirugo
SUPERVISOR• Professor Francis E. Onyango
• Dr Boniface O. Osano• Professor Ruth Nduati
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OUTLINE
Introduction Classification Magnitude of morbidity and mortality Risk factors Stop TB strategy
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INTRODUCTION 1
Causative agent-Mycobacterium genus. Species are varied but mainly Mycobacterium tuberculosis.
It is an obligate aerobe and an acid-fast bacillus. TB is a re-emerging disease of global concern. The HIV pandemic has led to a resurgence of TB in both
adults and children, The burden of TB in children depends on the burden of
the disease in the adult population. Children have an increased risk of developing primary
progressive TB because of the associated severe immune suppression resulting from their young age and HIV.
Extrapulmonary TB is seen more often in HIV-infected children.
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INTRODUCTION 2
There is a higher case fatality rate for children who are co-infected with TB and HIV.
It is important to look actively for TB in children with a chronic cough and to provide treatment as early as possible.
The highest reported sero-prevalence was reported in southern africa;10-60%, the lowest prevalence in West Africa.
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CLASSIFICATION1
It is for childhood tuberculosisA. ACCORDING TO SITE Pulmonary Extrapulmonary.B. ACCORDING TO SEVERITY, TREATMENT HISTORY
AND DRUG RESISTANCE
1Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 34
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1. Non-severe TB
2. Severe TB
3. Retreatment
4. MDR TB
•PTB without extensive parenchymal disease•TB lymphadenitis•TB pleural effusion
•PTB with extensive lung disease•Miliary TB•All other forms of extrapulmonary TB
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MAGNITUDE OF MORBIDITY AND MORTALITY 1
Globally2: 2nd to HIV/AIDS as the greatest killer due to a single infectious agent.
Amongst those sick in 2012; 530,000 were children of whom 74,000 were HIV negative.
2http://www.who.int/mediacentre/factsheet/fs104/en/ reviewed March 2014
2010 2012
Morbidity 8,800,000 8,600,000
Mortality 1,400,000 1,300,000
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MAGNITUDE OF MORBIDITY AND MORTALITY 2
TB is the leading killer in PLWHIV causing 1/5 of all deaths.
Locally3: Kenya is position 15/22 of the high TB burden countries
2012: prevalence 103,159 of which 39% were HIV infected.
3Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 9
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MAGNITUDE OF MORBIDITY AND MORTALITY 3
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RISK FACTORS4
A. Major HIV infection. Most common risk factor locally. Poorly treated previous TB Low socioeconomic statusB. Minor Non-modifiable: Age-extremes of age; Sex. M>F Immunosuppressive states: Malnutrition; Diabetes
mellitus; Immunosuppressive agents; Malignancies. Drugs: Alcoholism; Tobacco smoking Pulmonary diseases: Silicosis
4Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 3-4
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STOP TB STRATEGY5 1
A. BACKGROUND 1991: World Health Assembly recognized TB as a world health
problem. 2 targets were set up: i) Detection of 70% of new smear positive cases
ii) Cure 85% of the new cases. All these by 2005
1994: DOTS launched. Componentsi) Govt. commitment
ii) Case detection through sputum microscopyiii) Standardized short-course chemotherapy under supervision
iv) System of regular drug supplyv) Monitoring and evaluation of the programme
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STOP TB STRATEGY5 2
2003: Cure rates of the new sputum positive cases was 83%
2004: Case detection rate 53%
2006: Launching of Stop TB Strategy to run from 2006-2015
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STOP TB STRATEGY5 3
TARGETSi) MDG 66: Combat HIV/AIDS, malaria and other
diseases. Target 8: Have halted by 2015 and begun to reverse incidence of malaria and other diseases.
ii) Stop TB partnership: By 2015, the global burden of TB will be lowered by 50% relative to 1990 levels
VISIONA world free of TB GOALTo reduce dramatically the global TB burden by 2015 in
line with the MDGs and the Stop TB partnership targets and to achieve major progress in the research and development needed for TB elimination.
5WHO (2006). The Stop TB Strategy.6http://www.milleniumproject.org/goals/gti.htm/
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STOP TB STRATEGY5 4
PRINCIPAL COMPONENTS1. PURSUE HIGH-QUALITY DOTS EXPANSION AND
ENHANCEMENTa) Political commitment with increased and
sustained financingb) Case detection through quality-assured
bacteriologyc) Standardized treatment with supervision and
patient supportd) Effective drug supply and management
systeme) Monitoring and evaluation system and impact
measurement
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STOP TB STRATEGY5 5
2. ADDRESS TB/HIV, MDR-TB AND OTHER CHALLENGES
3. CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING
4. ENGAGE ALL CARE PROVIDERS5. EMPOWER PEOPLE AND
COMMUNITIES WITH TB6. ENABLE AND PROMOTE RESEARCH
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REFERENCES
Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition.
http://www.who.int/mediacentre/factsheet/fs104/en/ reviewed March 2014.
WHO (2006). The Stop TB Strategy. http://
www.milleniumproject.org/goals/gti.htm/
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THANK YOU
AHSANTE MERCI XIEXIE