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TITLE:

DIFFERENTIAL MORBIDITY AND MORTALITY PATTERNS


OF PULMONARY T.B

INVESTIGATOR:
Niqad Ahamd (2nd Year),
Zia-ud-Din (2nd Year),
Nasir Iqbal (2nd Year),
Zain-ul-Abideen (3rd Year).

INSTITUTE:
PESHAWAR MEDICAL COLLEGE
PESHAWAR (NWFP)
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ABSTRACT:
Objective: To assess the KAP of community towards T.B to estimate morbidity and
mortality of pulmonary T.B.
Study Design: Cross sectional KAP survey.
Methods and Materials: The study was carried out in the village Mathra New Tehsil,
ShabQadar (Charsadda) from 4th march 2008 to 8th April 2008. The designed
questionnaires were administered to 100 persons of each family. These 100 people have
197 childrens & about 1245 relatives. The Morbidity of TB found is from 2006 to2008.
Result: After collecting data, it was found that 73.83 % of the community people know
about the T.B; (Signs, Symptoms, Effects and Treatment) and 26.17% don’t know about
TB. 26. 5 % had BCG vaccines (67.93 % adults and 32.07 % children).9% doesn’t know
which type of vaccine they have been given. 64. 5 % have not been given the BCG
vaccines. (35.66% adults and 64.34%children). Morbidity of T.B found 6.92 %(
individual person = 6.38 %, children = 19.15%, relative 74.47%). Mortality of T.B =
26.59%, (children of the interviewed persons = 20%, Relative= 80%). Co morbidity of
other diseases = 66.66 %( diabetes 25 %, and other = 75%).
Conclusion:
The Persons in Pakistan suffer from TB are about 0.156% per year. Out of which 24% of
the people died per year (4).The percentage of T.B in our village was found to be 6.92%
&the Mortality is 26.59% which is more because of the unhygienic condition of the
village & unwell developed arranged program of the health for the awareness of the TB
as well as BCG Vaccines. The morbidity found per year was 3.46% and mortality found
was 13.49%.

Key Words: PULMONARY TB, MORBIDITY, MORTILITY, CO- MORBIDITIES.


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INTRODUCTION:

RATIONALE:
TB is one of the most dangerous diseases in the world. We choose this topic because
nowadays TB is an international issue. Every person related to any race suffers from this
fatal disease especially the poorest one due to their deficient balanced diet and
unhygienic condition.
BACKGROUND:
The alternative name of TB is tuberculosis. Tuberculosis (TB) is an infectious disease
caused by bacteria whose scientific name is Mycobacterium tuberculosis. It was first
isolated in 1882 by a German physician named Robert Koch who received the Nobel
Prize for this discovery. TB most commonly affects the lungs but also can involve almost
any organ of the body. Many years ago, this disease was referred to as "consumption"
because without effective treatment, these patients often would waste away. Today, of
course, tuberculosis usually can be treated successfully with antibiotics. (1)
A person can become infected with tuberculosis bacteria when he or she inhales
minute particles of infected sputum from the air. The bacteria get into the air when
someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is
common in some cultures). People who are nearby can then possibly breathe the bacteria
into their lungs. (1)
Tuberculosis (TB) is a life-threatening infection that primarily affects your lungs. Every
year, tuberculosis kills nearly 2 million people worldwide. The infection is common —
about one-third of the human population is infected with TB, with one new infection
occurring every second diagnosis. The most commonly used diagnostic tool for TB is a
simple skin test. Although there are two methods, doctors consider the Mantoux test the
more accurate. Chest X-ray. Culture tests. (2)
17 March 2008 – Geneva – The World Health Organization (WHO) report, Global
Tuberculosis Control 2008, released today, finds that the pace of the progress to control
the tuberculosis (TB) epidemic slowed slightly in 2006, the most recent year for which
data were available. The new information documents a slowdown in progress on
diagnosing people with TB. Between 2001 to 2005, the average rate at which new TB
cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate
of increase was cut in half, to 3 %. (6)
More than 4,000 people died daily from TB-related illnesses in 2005. TB is a major
cause of childhood morbidity and mortality in these developing countries, and there is an
urgent need for rapid and definitive modalities for mycobacterial diagnosis in children. (3)
Over one-third of the world's population has been exposed to the TB bacterium, and new
infections occur at a rate of one per second. In 2004, mortality and morbidity statistics
included 14.6 million chronic active TB cases, 8.9 million new cases, and 1.6 million
deaths, mostly in developing countries.(5)
In Pakistan it has around 1.5 million TB patients, while every year 250,000new person
develops the disease. Every year, about 60,000 patients died of TB in Pakistan. (4)
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AIMS AND OBJECTIVES:

AIM:
To assess the Knowledge of rural people about TB and Mortality and Morbidity
Related to TB

OBJECTIVES:
• To assess the KAP of general community toward TB.
• To make a community based estimate of mortality related to Pulmonary TB.
• To analyze co-morbidities in patients with pulmonary TB.

METHODS AND MATERIALS:


This is a cross-sectional KAP survey done in the Village Mathra New P.O & Tehsil
Shabqader Distt: Charsada (NWFP Peshawar) from 4th march to 8th April 2008. The
designed and approved (by supervisor) questioners were administered to 100 responsible
subjects of the family. These subjects have 197 children and 1247 relatives. The
morbidity found is from 2006 to 2008.
MS excel software is used for data analysis
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TABULATED RESULT OF TB.


GENDER M=82(82%) F=18(18%)
AGE AGE A=10(10%) B=5(5%) C=18(18%) D=7(7%) E=60(60%)
MARTIAL A=78(78%) B=19(19%) C=3(3%)
EDUCATION A=60(60%) B=15(15%) C=15(15%) D=5(5%) E=2(2%) F=3(3%)
Q3.HEAR TB Y=97(97%) N=3(3%)
Q4.WHAT IS TB A=86(86%) B=1(1%) C=5(5%) D=8(8%)
Q5.TB TRANSFER Y=85(85%) N=15(15%)
Q6.IF Y,HOW TRAN A=43(50.6%) B=38(44.7%) C=3(3.53%) D=0(0%) E=1(1.2%)
Q7.TB FATAL Y=74(74%) N=23(23%) DK=3(3%)
Q8.TB TREATABLE Y=98(98%) N=2(2%)
Q9.HOW TREATED A=93(94.9%) B=2(2.04%) C=0(0%) D=3(3.06%)
Q10.ORGAN BRAIN EYE LUNG HEART INTESTIN KIDNEY BONE SKIN
EFFECT E
Y=65% Y=71(71%) Y=97(97%) Y=86(86%) Y=85(85%) Y=79(79%) Y=90(90%) Y=73(73%)
N=35% N=29(29%) N=3(3%) N=14(14%) N=15(15%) N=21(21%) N=10(10%) N=27(27%)
Q11.TB LEAD INFER Y=29(29%) N=53(53%) DK=18(18%)
Q12.MOST EFFECT A=33(33%) B=30(30%) C=10(10%) D=27(27%)
Q13.YOU HAD BCG Y=36(36%) N=46(46%) DK=18(18%)
Q14.POSSIBLE CURE Y=95(95%) N=1(1%) DK=4(4%)
Q15.TREAT DURATN A=32(32%) B=11(11%) C=0(0%) D=16(16%) E=41(41%)
Q16.CAUSE DISBLTY A=2(2%) B=2(2%) C=1(1%) D=0(0%) E=1(1%) F=15(15%) G=79(79%)
Q17.HIV EFFECT Y=16(16%) N=84(84%)
Q18.SMOKE CAUSE Y=87(87%) N=13(13%)
Q19.UNPESTUR MILK Y=65(65%) N=14(14%) DK=21(21%)
Q20.GVT FREE TRT Y=92(92%) N=8(8%)
Q22.SUFER FROM TB Y=6(6%) N=94(94%)
Q23.BODY PART A=0(0%) B=0(0%) C=0(0%) D=6(100%)
INFECT
Q24.YEARS AGO TB A=0(0%) B=3(50%) C=0(0%) D=3(50%)
Q25.HOW INFECT A=2(33.3%) B=2(33.3%) C=2(33.3%)
Q26.TB DIAGNOSE Y=6(6%) N=94(94%)
Q27.WHICH TYPE A=1(16.6%) B=5(83.4%) C=0(0%) D=0(0%)
DIAGNOSE
Q28.SUFER FRM Y=4(66%) N=2(34%)
OTHER DISEASE
Q29.WHICH TYPE DSE A=1(16%) B=0(0%) C=0(0%) D=3(84%)
Q30.DO YOU SMOKE Y=16(16%) N=84(84%)
Q31.FAMLY MEMBER Y=45(45%) N=55(55%)
COUGH
Q32.WHERE THEY GO A=43(95%) B=2(5%) C=0(0%)
Q33.CDS HAVE TB 18/197=
9.13%
Q34.CDS HAD BCG Y=17(17%) N=83(83%)
Q35.DEATH OF CDS 5/18=27.77%
Q36.TYPE OF TB CDS A=0(0%) B=17(94.44% C=1(5.5%)
)
Q37.CONSULT DOCTR Y=93(93%) N=7(7%)
Q38.FAMLY TB Y=34(34%) N=64(64%)
Q39.NO OF RELATION 70/1245=
5.62%
Q40.RELATION DIED 20/70=
28.57%
Q41.RELATION A=15(65%) B=4(20%) C=3(15%)
90.00%
80.00% individual
80.00%
70.00% person
children
70.00%
60.00%
60.00%
mortality
their children 6
50.00%
120.00%
50.00% relitive mortality
40.00%
100.00%
40.00% their community
relatives know
30.00%
30.00%
20.00%
80.00%
20.00%
10.00%
GRAPHtotalWISE
community
RESULTS:
total mortalityTB
morbidity dont
about

10.00%
60.00%
0.00%
0.00% Comparison ofknowcommunity known and unknown persons towards TB (signs,
individual

relatives
40.00%
effect, symptoms and treatment):
mortality

mortality
children
person

total
their
total

20.00%
0.00%
community

total
about TB
know

Community community total


know about Don’t know
TB
73.83% 26.17% 1
00%

MORBIDITY:

Individua Their Their Total


l children relative morbidit
person s y
6.38% 19.15% 74.47% 6.92%

Mortality:

Children Relative Total


mortalit mortalit mortalit
y y y
20% 80% 28.40%
80.00%
60.00% co morbidity 7
40.00% diabetes
20.00% others
0.00%
ty

es

rs
di

he
et
bi

ab

ot
or

di
m
co

Co morbidities:
Co morbidity diabetes Others
66.66% 25% 75%
DISCUSSION:

Discussion:
Although considered a historic disease and almost eradicated in most of the developed
world, TB remains one of the leading causes of premature morbidity and mortality in
Pakistan. Common reasons quoted for this problem are poverty and crowded living
conditions leading to poor immunity and easy transmission, respectively. Government of
Pakistan has several TB surveillance programs in concert with WHO and free medicines
are provided at district level. It is indeed enlightening to note the level of knowledge
related to TB among rural dwellers.
According to WHO Between 2001 to 2005, the average rate at which new TB cases were
detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase
was cut in half, to 3 %.(6)
This decline in the pulmonary TB frequency was achieved through well developed
programmed for TB vaccination (BCG) and DOTS
WHO is working to dramatically reduce the burden of TB, and halve TB deaths and
prevalence by 2015, through its Stop TB Strategy and supporting the Global Plan to Stop
TB? (6)
Current study shows that the level of knowledge about TB in the village under study is
alarmingly low. There is no program for BCG vaccination or if it is in place, villagers are
mostly unaware of it.
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REFERNCES
1. http//www.medicinenet.com
2. Mayo Foundation for Medical Education and Research (MFMER)
3. Diagn Cytopathol. 2008 Apr; 36(4):245-51
PMID: 18335554 [PubMed - in process)
4. JCPSP2004, Vol.14 (7):419-422 (page 419)
5. http//en,wikepedia.org/wiki/tuberclosis
6. http//www.who.int/tb/e
7. Division of Tuberculosis Elimination National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention.
8. http//www.merck.com
9. J Indian Med Assoc. 2007 Aug; 105(8):432, 436, 438-9.
10. PMID: 18236905 [PubMed - indexed for MEDLINE
11. Int J Chron Obstruct Pulmon Dis. 2007;2(3):263-72
12. PMID: 18229564 [PubMed - indexed for MEDLINE Tuberculosis (Nemours
Foundation)

ACKNOWLEGMENT:
The investigators thank specially to Sajjad Ahmad (for great support in the village) as
well as to Zaid Ahmad (for helping in administering questioners to females).The
investigators also thank the inhibitors of the Mathra New Village for their co-operation.

SUPERVISER:
DR.AFSAN ZAHID KHAN