Evaluation of ‘Referral for Treatment’ System under RNTCP in a Hospital at Kolkata, India
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.
