Tuberculosis situation among tribal population of Car Nicobar, India, 15 years after intensive tuberculosis control project and implementation of a national tuberculosis programme

• Published in: Bulletin of the World Health Organization Vol. 82; no. 11; pp. 836 - 843
• Main Authors: MURHEKAR, M. V, KOLAPPAN, C, GOPI, P. G, CHAKRABORTY, A. K, SEHGAL, S. C
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01-11-2004; World Health Organization; The World Health Organization
• Subjects: Adolescent; Area sin atención médica; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Communicable Disease Control - organization & administration; Cooperation; Development and progression; Diseases; Epidemics; Ethnic groups; Geografía; Government programmes; Grupos étnicos; Health aspects; Health care; Health conditions; Health Policy & Services; Health Surveys; Houses; Human bacterial diseases; Humans; India; India - epidemiology; Indigenous populations; Infant; Infant, Newborn; Infections; Infectious diseases; Islands; Medical sciences; Medically Underserved Area; Medicine, Preventive; National Health Programs - organization & administration; Pneumology; Population; Prevalence; Prevention; Program Evaluation; Programas nacionales de salud; Public health; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; TB pulmonar; Tribes; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - ethnology; Tuberculosis, Pulmonary - prevention & control; Asia; India; Human; Respiratory disease; Scar; Lung; BCG; Check; Mycobacterial infection; Method; Respiratory system; Epidemiology; Hemorrhage; Fever; Implementation; Cough; Infection; Prevention; Survey; Hemoptysis; Pain; Tuberculosis; Bacteriosis; Smear; Child; Géographie; Inde; TB, Pulmonary; Area sin atención médica; Medically underserved area; Geografía; TB pulmonar; India; Tuberculose pulmonaire; Groupes ethniques; Ethnic groups; Grupos étnicos; Programme national santé; Zone sous-équipement médical; National health programs; Programas nacionales de salud
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862004001100008

To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986.
The entire population of Car Nicobar was enumerated through a house-to-house survey. Children aged <14 years were tuberculin tested and read for reaction sizes. Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms. Sputum samples were examined for presence of acid-fast bacilli.
Among the 4,543 children enumerated, 4,351 (95.8%) were tuberculin tested and read. Of the 981 children without bacille Calmette-Guerin scars, 161 (16.4%) were infected with TB. A total of 77 cases who were smear-positive for TB were detected from among 10,570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100,000. The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100,000, respectively.
The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002. Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community. The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures. High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures.