INTRODUCTION

Tuberculosis is a common and deadly infectious disease caused by mycobacterium

tuberculosis. It is one of the emerging infectious diseases affecting both developed and
developing countries.
One third of the world’s current population has been infected by TB, and new
infections occur at a rate of one per second. Not every one infected develops full-
blown disease; asymptomatic, latent infection is most common. However, one in ten
latent infections will progress to active disease, which, if left untreated, kills more than
half of its victims. In 2004, mortality and morbidity statistics included 14.6 million
chronic active cases, 8.9 million new cases and 1.6 million deaths, mostly in
developing countries. [1]
The rise in HIV infections in the neglect of TB control programs has enabled a
resurgence of tuberculosis .[2] The emergence of drug resistant strains has also
contributed to this new epidemic with, from 2000 to 2004, 20% of TB cases being
resistant to standard treatments and 2% resistant to second line drugs [3]. The World
Health Organization (WHO) declared TB a global health emergency in 1993, and the
Stop TB Partnership developed a global plan to stop tuberculosis that aims to save 40
million lives between 2006 and 2015. [4]
According to WHO, 2 billion people- one third of world’s population- have been
exposed to the tuberculosis pathogen. Annually, 8 million people become ill with
tuberculosis, and 2 million people die of the disease world wide. In 2004, around 14.6
million people had active TB disease with 9 million new cases. The annual incidence
rate varies from 356/100,000 in Africa 241/100,000 in the America. TB is the world’s
greatest infectious killer of women of reproductive age and the leading cause of death
among people with HIV/AIDS. [5]
In developed countries, tuberculosis is less common and is mainly an urban disease. In
United Kingdom, TB incidences range from 40/100,000 in London to less than
5/100,000 in the rural south west of England; [6] the national average is 13/100,000.
The highest rates in Western Europe are in Portugal (42/100,000) and Spain
(20/100,000). These rates compare with 113 per 100,000 in China and 64 per 100,000
in Brazil. In the United States the over all tuberculosis case rate was 4.9/100,000
persons in 2004. [7]
The incidence of TB varies with age. In Africa, TB primarily affects adolescents and
young adults. However, in countries where TB has gone from high to low incidence,
such as the United States, TB is mainly a disease of older people. [8]
Tuberculosis is a major public health and developmental problem in Pakistan. The
country has 7th highest burden of TB among the 22 high burden tuberculosis countries
worldwide, according to the WHO Global TB report 2006. Every year, approximately
280,000 people develop TB with an incident rate of 181/100,000 and 62,000 people die
of TB in the country with a mortality rate of 37/100,000. 1 TB case is responsible for
5.1% of the total national disease burden which is 3rd largest contribution to the disease
burden in Pakistan. As in most low income developing countries there has been almost
no observable decline in TB incidence. The absolute number of cases is likely
increasing due to population growth and worsening poverty. Despite progress towards
the global target for TB control, the treatment success rate (TSR) remains around 82%
against the target of 85% and the case detection rate (CDR) remains at 37% against the
target of 70%. Pakistan adopted the WHO recommended
directly observed short course (DOTS) strategy in 1995. In 2000 thanks to a World
Bank funded scheme the program was expanded to the provinces. Since 2001 the
government has been handling TB as a national emergency. DOTS have been extended
to 34 of more then 100 districts, covering 25% of the population. More provinces will
be covered by the end of the year, and the Punjab, the most populated province, will be
covered by 2005. [9]
The justification of our study comes from the reason of up rise in TB cases during past
decade specially its prevalence in lower socio-economic environment and the
emergence of multi drug resistant cases due to inadequate surveillance and treatment
plans for TB affected areas. A number of factors prevail in the community like
ignorance, different social customs and taboos, treatment neglect especially for female
community ad above all poor compliance to the treatment because of lack of education.
In the light of above mentioned factors it is pertinent to study the current practices of
people residing in this remote study area. The data collected will help us to understand
the problem in its full magnitude and to improvise new strategies for counter acting
this ailment.
 Abstract

The survey was conducted in Jia bagga. The result of survey showed that only 3%
people were found to have tuberculosis

Most of them (59%) will receive treatment from Govt. facility and very few from
T.B clinic, private doctors and hakeems.

The most common reason for non compliance was expensive treatment due to
limited resources. Few of them complained about the non availability of medicine.

From survey it was concluded that knowledge among people regarding treatment of
tuberculosis was very poor.

Most of the families (48%) consisted of 5-8 people.

Out of total population of 504, 275 (54.5%) are male and 229 (45.4%) are female.

57% of the women interviewed had given birth to a child in last two years.

A total of 243 children were less than 14 years of age out of which 93 (38.2%) were in
the range of 1-4 years.

Out of 243 children 134 are male and 109 are female. Out of these 138 go to school
and 105 don’t go to school.

Out of the 93 children under 5 years of age 91 are vaccinated for BCG, 90 for
DPT/Hepatitis B, 85 against Measles and all are vaccinated against Polio.

As for as the living standard of the people is concerned 40% are using the supply of
pipe water and an equal number of people are using facilities like well and handpump.
73% of houses are using flush system latrine and 21% go to the open field. Out of
hundred houses 77 are pakka and 17 are semi pakka.
 OBJECTIVES

 To know the current practices of the people living in the community regarding
the management of Tuberculosis.

 T study the socio demographic factor of the community concerned with the
practices regarding T.B

 To get baseline info regarding the current practices of T.B in the community by
this small scale study.
 Literature review

Historical aspects
Tuberculosis is an ancient disease, an evidenced the skeletal remains of Neolithic, pre-
Columbian and old kingdom Egyptians person. This disease referred to as
“consumption” in early Hindu writings and as “phthisis” by the Greeks.
Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common
and deadly infectious disease caused by mycobacterium, mainly mycobacterium
tuberculosis. One third of the world’s current population has been infected by TB, and
new infections occur at a rate of one per second. [2] Not every one infected develops the
full blown disease , asymptomatic, latent infection is most common. However, one in
ten latent infections will progress to active disease which if left untreated kills more
than half of its victims.
The study of tuberculosis dates back to THE CANON OF MEDICIN written by IBN-
A-SINA (Avicenna) in 1020’s. He was the first physician to identify pulmonary
tuberculosis as a contagious disease, the first to recognize association with diabetes,
and the first to suggest that it could spread through contact with soil and water. [10] He
developed the method of quarantine in order to limit the spread of tuberculosis. [11]
Although it was established that the pulmonary form was associated with ‘Tubercles’
by Dr. Richard Morton in 1689, [12] due to the variety of its symptoms, TB was not
identified as a single disease until the 1820’s and was not named ‘tuberculosis’ until
1839 by J. L. Schonlein. [13] During the years 1838 to 1845, Dr. John Croghan, the
owne4r of mammoth cave brought a number of tuberculosis sufferers into the cave in
the hope of curing the disease with a constant temperature and purity of the cave’s air:
they died within a year. The first TB sanitorium opened in 1859 in Gorbersdorf ,
Germany (today’s sokolowsko, Poland) by Herman Brehmer. In regard to this claim
‘THE TIMES’ for January 15, 1859 page 5 column 5 carries an advertisement seeking
funds for the Bournemouth sanatorium for consumption, referring to the balance sheet
for the past year, and offering an annual report to prospective donors, implying that this
sanatorium was in existence at least in 1858. The bacillus causing tuberculosis,
mycobacterium tuberculosis, was identified and described on march 24, 1882 by
Robert koch. He received the noble prize in physiology or medicine in 1905 for this
discovery. [14] Koch did not believe that bovine (cattle) and human tuberculosis were
similar which delayed the recognition of infected milk as a source of infection. Later
this source was eliminated by the pasteurization process. Koch announced a glycerin
extract of the tubercle bacilli as a “remedy” for tuberculosis in 1890, calling it
“TUBERCULIN”. It was not effective but was later adopted as a test for pre
symptomatic tuberculosis.[15]

TUBERCULOSIS - DEFINITION

“Tuberculosis is a chronic bacterial infection caused by mycobacterium tuberculosis

that is characterized by formation of granulomas in the infected tissues and by cell
mediated hypersensitivity. The usual site of the disease is lungs, but other organs may
be involved” [16]

TUBERCULOSIS - CLASSIFICATION
 Pulmonary tuberculosis is most common form of the disease.

 Extra pulmonary is tuberculosis affecting organs other than the lungs, most
commonly pleura, lymph nodes, spine, joints, genitourinary tract, nervous
system or abdomen. Tuberculosis may affect any part of the body. [17]

TUBERCULOSIS - GLOBAL BURDEN

According to WHO, 2 billion people- one third of world’s population- have been
exposed to the tuberculosis pathogen . Annually, 8 million people become ill with
tuberculosis, and 2 million people die of the disease world wide. In 2004, around
14.6 million people had active TB disease with 9 million new cases. The annual
incidence rate varies from 356/100,000 in Africa 241/100,000 in the America. TB
is the world’s greatest infectious killer of women of reproductive age and the
leading cause of death among people with HIV/AIDS. [2]
In 2005 the country with the highest estimated incidence of TB was Swaziland,
with 1262 cases per 100,000 people. India has the largest number of infections,
with over 1.8 million cases. [18] In developed countries, tuberculosis is less common
and is mainly an urban disease. In United Kingdom, TB incidences range from
40/100,000 in London to less than 5/100,000 in the rural south west of England; the
national average is 13/100,000. The highest rates in Western Europe are in Portugal
(42/100,000) and Spain (20/100,000). These rates compare with 113 per 100,000 in
China and 64 per 100,000 in Brazil. In the United States the over all tuberculosis
case rate was 4.9/100,000 persons in 2004. [18]
The incidence of TB varies with age. In Africa, TB primarily affects adolescents
and young adults. However, in countries where TB has gone from high to low
incidence, such as the United States, TB is mainly a disease of older people.

TUBERCULOSIS - NATIONAL BURDEN

Tuberculosis is a major public health and developmental problem in Pakistan. The

country has 7th highest burden of TB among the 22 high burden tuberculosis
countries worldwide, according to the WHO Global TB report 2006. Every year,
approximately 280,000 people develop TB with an incident rate of 181/100,000
and 62,000 people die of TB in the country with a mortality rate of 37/100,000. [2] 1
TB case is responsible for 5.1% of the total national disease burden which is 3rd
largest contribution to the disease burden in Pakistan.

TUBERCULOSIS - MODE OF TRANSMISSION

The microorganisms usually enter the body by inhalation through the lungs. They
spread from the initial location of the lungs to other parts of body via the blood
stream, the lymphatic system, the airways or by direct extension to other organs. [17]

TUBERCULOSIS - ETIOLOGY

Mycobacterium tuberculosis , is the causative organism. Along with the closely

related M. bovis, it causes tuberculosis. Mycobacterium is distinguished by their
surface lipids which render them acid fast so that they can not be decolorized with
acid alcohol. [18]

TUBERCULOSIS - PATHOGENESIS

The tuberculosis is spread principally by inhalation of expectorated droplet nuclei

containing bacilli. Rarely, infection is acquired by drinking milk containing M.
bovis or by traumatic inoculation into the skin. Depending upon the pathology
tuberculosis is divided into primary and post primary tuberculosis.

PRIMARY TUBERCULOSIS

The initial lesion of tuberculosis develops before specific cell mediated immune
reaction develop to contain the infection.
A peripheral lesion with enlarged hilar lymph nodes on the chest radiology is
diagnostic for primary complex. Tuberculin conversion usually occurs 3-8 weeks
from the time of infection. Bacteriological confirmation by gastric washing,
laryngeal swab or bronchoscopy may yield the diagnosis.
The initial infection, whether, or not it causes overt disease, may resolve
completely by or merely progress to post primary disease in some time in future. [17]
 POST PRIMARY TUBERCULOSIS

It occurs in the previously infected, usually tuberculin positive, person as a result

of endogenous reactivation of a dormant infection or of exogenous re-infection. For
unknown reasons, lesion usually develops in the upper part of the lung. Necrosis is
prominent, resulting in large solid lesions (tuberculoma) and cavities. The local
lymph nodes are not usually involved and hematogenous dissemination is rare,
except in the immunocompromised. [17]

EXTRA PULMONARY TUBERCULOSIS

Extra pulmonary is tuberculosis affecting organs other than the lungs, most
commonly pleura, lymph nodes, spine, joints, genitourinary tract, nervous system
or abdomen. Tuberculosis may affect any part of the body.

TUBERCULOSIS - DIAGNOSIS

HISTORY

 Persistent cough for three weeks or more

 Sputum production which may be blood stained (haemoptosis), shortness of
breath and chest pain.
 Fatigue, loss of appetite and loss of weight, night sweats and fever.

BACTERIOLOGICAL EXAMINATION OF SPUTUM

When ever tuberculosis is suspected three specimens must be collected for examination
by microscopy. When ever possible, they should be obtained within 24 hours as
follows:
First Specimen
At the first interview with the patient a spot specimen is collected; this specimen is
obtained on the spot, after coughing and clearing the back of the throat, under
supervision of a staff member, in a well ventilated area.
Second Specimen
The patient is then given a sputum container for collection of an early morning
specimen before the second interview, which should be on the next working day.
Third Specimen
At the second interview with the patient, the collection specimen is brought by the
patient and a further spot specimen is obtained.
Should the first spot specimen be positive and should the patient not return for the
second interview, an immediate search must be made to find the patient in order to
prevent transmission of microorganisms in the community and deterioration in the
patient’s conditions.
Sputum for Culture
Sputum can also be cultured for mycobacterium tuberculosis but it takes about six
weeks.

TUBERCULIN SKIN TEST

It can be used in individual patients to detect TB infection as well as in screening of

high risk population to guide TB control efforts. The tuberculin skin test is a very safe,
inexpensive, and readily available but only a crude indicator of delayed
hypersensitivity following infection by mycobacteria. A positive tuberculin test
indicates an intact cell mediated immunity and consists of an infiltration with CD4+T
lymphocytes, macrophages and local edema after injection of tuberculin protein. The
most accurate tuberculin test is the ‘Montoux test’ on the volar aspect of the fore arm.
After strictly intradermal injection of 0.1ml tuberculin solution with single use syringes
an in duration can be detected within 48 to 72 hours.
False negative tuberculin tests, defined as indurations equal or smaller than 10mm, or
found in 15 to 25% of patients with active tuberculosis. False negative test are caused
by older age, lower serum protein (malnutrition or alcoholism), concomitant illness
such as viral infection, HIV or sarcoidosis and over whelming TB disease and
Technical reasons.

Effective TB Control (DOTS)

The WHO-recommended treatment strategy for detection and cure of TB is "Directly

Observed Treatment, Short-course" (DOTS). DOTS combines five elements: political
commitment, microscopy services, drug supplies, surveillance and monitoring systems
and use of highly efficacious regimes with direct observation of treatment. [19]

Once patients with infectious TB (bacilli visible in a sputum smear) have been
identified using microscopy services, health and community workers and trained
volunteers observe and record patients swallowing the full course of the correct dosage
of anti-TB medicines (treatment lasts six to eight months). The most common anti-TB
[20]
drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.

Sputum smear testing is repeated after two months, to check progress, and again at the
end of treatment. A recording and reporting system documents patients' progress
throughout, and the final outcome of treatment.

• DOTS produces cure rates of up to 95 percent even in the poorest countries.

• DOTS prevents new infections by curing infectious patients.
• DOTS prevents the development of MDR-TB by ensuring the full course of
treatment is followed.
• DOTS strategy as one of the "most cost-effective of all health interventions."

Since DOTS was introduced on a global scale, millions of infectious patients have
received effective DOTS treatment. In half of China, cure rates among new cases are
96 percent. In Peru, widespread use of DOTS for more than five years has led to the
successful treatment of 91 percent of cases.
By the end of 1998, all 22 of the high burden countries which bear 80% of the
estimated incident cases had adopted DOTS. 43 percent of the global population had
access to DOTS, double the fraction reported in 1995. In the same year, 21 percent of
estimated TB patients received treatment under DOTS, also double the fraction
reported in 1995. [21]

MATERIALS AND METHODS

Study design

It is descriptive cross sectional study.

Study universe

The study was conducted in village Jia bagga, UC 147 Lahore, 40 km from Raiwind.
It was a rural area with one BHU facility and the total population was about 50000.

Duration of study

The study was conducted from 10-03-08 to 17-03-08

Study population

Consisted of all the households sampled in the study

Sample size

A sample of 100 households was selected for the study.

Study tool

A questionnaire booklet consisting of all variables was designed.

Sample technique

It was a simple random sampling.

Data collection

The data was collected with the help of a semi structured questionnaire by the students
of 4th year SIMS. The local community authority was informed about the education of
study and so the data collection was done after their consent’s group of supervisors and
LHV’s also accompanied the students to ensure the quality of data. So finally the data
was collected after taking consent from the head of family of household fulfilling the
ethical consideration.

Data analysis
Responses were added in the captor by using Microsoft Excel and Microsoft Word
program, all the responses were entered, data was cleaned and finally data was
analyzed to obtain the results by frequencies tables and charts.

Ethical considerations

Consent was taken and the respondents were assured of full confidentiality.

Results
CHARACTERESTICS OF PERSONS IN THE SURVEY
It was noted that out of 100 families included in the study 43 families had population
range between (1-4) years (43%) 48 families had population range between (5-8) years
(48%) and 9 families had population range between (9-12) years (9%).

Out of 504 persons 275 (54.5%) were males and 229 (45.4%) were females.

The distribution according to material status of females in jia bagga showed that out of
100 females 94 (94%) were married, 3 (3%) were widow, 2 (2%) divorced and 1 (1%)
was separated.

In study out of 100 mothers 57 had child birth in last two years and 43 (didn’t)

The study of household showed that of 243 children less than 4 years of age, 93 were
in range of 1-4 years, 83 were in range of 5-8 years, 63 were in range of 5-12 years

Of 243 children 134 were males and 109 were females.

Out of 138 school going children students who were in 1st class were 27, in 2nd class
were 25, in 3rd class were 13, in 4th class were 15, in 5th class 21, in 6th class 10, 7th class
15, 8th class 12.

Vaccination status of child under 5 years of age showed that 91, were vaccinated
against BCG, 90 were against DPT and hepatitis B, 93 against polio and 85 against
measles.

In survey 34 were radios, 97 were T.V, 67 refrigerators, 72 bicycles, 43 motorcycles,

15 light vehicles.

In survey 3% were tuberculosis and rest were not.

Of 100 people most common practice of people 59 regarding treatment of tuberculosis

is govt. health facility, 19 people approach tuberculosis clinic, 13 use private doctor
facility,9 go to hakeem.
Reason for non compliance by 65 people was expensive treatment, 27 said about non
availability of medicine. Health facility is not accessible by 2, non availability of staff
by 3.

As regards to keeping live stocks, 79 had dairy animals. 43 had weight bearing
animals, 31 had egg laying birds, 7 had none.

40 use pipe water as source of water supply, 40 used mixed (well and hand pump) and
20 use hand pump.

Latrine system used by 73 was flush, 21 used open field, 5 used bucket, 1 used pit.

77 houses were pacca, 17 were semi pacca and 6 were katcha.

Discussion
It is apparent from the study that almost 5-12 persons are residing in 56% of the
households. as we know that T.B is an air borne disease having transmission from one
person to another specially in closed atmosphere so in these households having more
persons the chances of T.B are likely to be more as compared to the household with
less no. of persons. It is very distressing that 43% of children in the study area are not
attending the school as we know that education imparts a lot of things to the students
about their healthy way of life so the children depriving of education are unable to
conceive these healthy ideas and are ultimately at more risk of developing different
ailments.

It is very encouraging that immigration status of the children in the study area is up to
the mark although the BCG coverage is 98% in the community and same has been
reported from different parts of the country but in spite of this the new emerging cases
of T.B puts a question mark on the efficiency of BCG which has been documented in
different studies from 0 to 80%.this situation demands careful evaluation of the
efficiency of BCG vaccine. So in future a better plan can be done to curtail the
emergence of new T.B cases.

Regarding the distribution of livestock almost 79% of the households are having one or
other type of dairy animals. In most of the places the human beings and the animals are
residing under the same roof. these households are also involved in the handling of
these dairy animals like milking etc so increasing the risk of development of bovine
T.B in these individuals. 23% of the household resides in katcha or semi pakka houses
as we know that the tuberculosis organisms develop in the damp atmosphere so these
houses are excellent places of breading of these bacilli and putting these households to
catch these infections especially in closed atmosphere.

Although it is a small scale study with a small sample size however it is very
encouraging that only 3% of the study population is suffering from T.B.

This may probably be their 100% claimed for complete compliance for T.B treatment
so preventing the emergence of secondary cases. Secondly it may be because of the
high coverage of BCG vaccination which is a corner stone for the prevention of T.B in
the community. Thirdly most of the people are residing in the pakka houses so limiting
the flourishing of this bug.
The study revealed that more than 80% household consult govt. health facility for their
T.B patients. This is probably because of the establishments of DOTS corners at govt.
hospitals from where they could receive medicines regularly free of cost which is
regarded as heart of the clot’s strategy.

Although dots corners have been established at almost every Govt. health facility still
27% o0f households claimed the non availability of the centers. This situation demands
immediate consideration and needs to be rectified.

65% of households gave the lame excuse of expensiveness of treatment because dots
centers provide free and regular media. Any how these people need to be imparted
health education regarding the free media availability at these dots centers.

The presence of staff at dots centers need to be assured so that patients can get
medicine at the given time regularly.

Conclusion
It is apparent from the study that most of the household consult govt. health facilities
for treatment of T.B. however 2% of the household claimed non availability of drugs
while 65% of the household had poor complaints because of expensive medicine.3% of
the household were not getting medicine because of non availability of staff.

Recommendations and suggestions

 Health education should be imparted to remove any myths from the
community and to explain the importance of treatment.

 Public should be educated about the importance of immunization. Anti-

tuberculosis treatment and the disease it self by electronic media.

 Stock of anti tuberculosis medicines should be surplus and easily available at

BHU and RHC.

 LHVs should provide health education to all the people in the community.

 More research should be conducted in rural areas like Jia bagga.

 National policies, programmes and legislations should be established for

awareness about the treatment of tuberculosis.

 DOTS program should be made available in all the health facilities in rural
areas.

Table no. 1
Frequency distribution of house hold according to person
living
(n = 100)

Population Range
Frequency Percentage (%)
(people)
1-4 43 43

5-8 48 48

9-12 09 09

Total 100 100

Frequency

50
40
30 1-4
43 48
20 5-8
9-12
10
9
0
1-4 5-8 9-12
Frequency 43 48 9

Table no. 2
Frequency distribution of household according to sex

(n = 100)

Sex Frequency Percentage (%)

Male 275 54.5

Female 229 45.4

Total 504 100

Table no. 3
Frequency distribution of Household according to marital
status of women

(n = 100)

Marital Status Frequency Percentage (%)

Married 94 94

Widow 3 03

Divorced 2 02

Separated 1 01

Total 100 100

Table no. 4
Frequency distribution of mothers having childbirth in
last 2 years

(n = 100)

Having Child
birth in last 2 Frequency Percentage (%)
years
Yes 57 57

No 43 43

Total 100 100

Table no. 5
Frequency distribution of household according to children
less than 14 years of age in the house
(n = 100)

No. of children
(less than 14 Frequency Percentage (%)
years)
1-4 93 38.2

5-8 87 35.8

9-14 63 25.9

Total 243 100

Frequency

100
80
60 1-4
40 5-8
20 9-14

0
1-4 5-8 9-14
Frequency 93 87 63

Table no. 6
Frequency distribution of household according to sex of
children

(n = 100)

Sex of Child Frequency Percentage (%)

Male 134 55.2

Female 109 44.8

Total 243 100

Table no. 7
Frequency distribution of household according to school
status of children

(n = 100)

School going
Status of Frequency Percentage
children
Yes 138 56.7

No 105 43.3

Total 243 100

Table no.8
Frequency distribution of household according to class
status of children
(n = 100)

Class status of
Frequency Percentage (%)
child
1st 27 19.4
2nd 25 17.9
3rd 13 9.3
4th 15 10.7
5th 21 15.1
6th 10 7.1
7th 15 10.7
8th 12 8.6
Total 138 100

Table no. 9
 Frequency distribution of household according to the
vaccination status of children under 5 years of age

(n = 93)

Vaccination Status Frequency Percentage (%)

BCG 91 98
DPT-Hepatitis B 90 97
Polio 93 100
Measles 85 91.3

Table no. 10

Frequency distribution of household according to

household amenities
 (n = 100)

Household
Frequency Percentage (%)
Amenities
Radio 34 34

Television 97 97

Refrigerator 67 67

Bicycle 72 72

Motorcycle 43 43

Light Vehicles 15 15

Total 328 100

Table no. 11

Frequency distribution of household according to live

stock
 (n = 100)

Live Stock Number Percentage

Weight bearing animals 43 43%
Dairy Animals 79 79%
Egg Laying Birds 31 31%
None 7 7%
Total 100 100%

Table no. 12

Frequency distribution of household according to Source

of water supply
 (n = 100)

SOURCE NUMBER PERCENTAGE

Piped water 40 40%
Mixed(Well + Hand
40 40%
pump)
Hand pump 20 20%

Table no. 13
Frequency distribution of household according to the
latrine System
(n = 100)
Latrine system NUMBER PERCENTAGE %

FLUSH 73 73

BUCKET 05 05

PIT 01 01

OPEN FIELD 21 21

Total 100 100%

 Table no. 14
Frequency distribution of household according to the
House Structure
(n = 100)
House Structure Number Percentage
Kacha 06 6%

Semi pacca 17 17%

pacca 77 77%

Total 100 100%

Table no 15
Frequency distribution of house hold according to T.B
cases

(n = 100)

TB status Frequency Percentage (%)

Yes 03 03

No 97 97

Total 100 100

Table no. 16
Frequency distribution of household according to the
practice of the people regarding treatment of TB
(n = 100)

Treatment source
Frequency Percentage (%)
options
Govt. health facility 59 59

TB clinic/Hospital/DOTS 19 19

Private doctor 13 13

Homeopathic/Hakim 9 09

Total 100 100

Table no. 17
 Frequency distribution of household according to non-
compliance regarding TB
(n = 100)

Reasons for Non Frequency Percentage (%)

compliance
Medicine not available 27 27
Treatment too Expensive 65 65
Side effects of medicine 02 02
Health facility not accessible 02 02
Staff not available 03 03
Don’t Know 01 01
Total 100 100

References
1. World Health Organization (WHO). Tuberculosis Fact sheet N°104 - Global
and regional incidence. March 2006, Retrieved on 6 October 2006.
2. Griffith D, Kerr C (1996). "Tuberculosis: disease of the past, disease of the
present". J Perianesth Nurs 11 (4): 240–5. doi:10.1016/S1089-9472(96)80023-
2. PMID 8964016.
3. Herrmann J, Lagrange P (2005). "Dendritic cells and Mycobacterium
tuberculosis: which is the Trojan horse?". Pathol Biol (Paris) 53 (1): 35–40.
PMID 15620608.
4. Disseminated tuberculosis NIH Medical Encyclopedia. Accessed 9 October
2006
5. Rudy's List of Archaic Medical Terms English Glossary of Archaic Medical
Terms, Diseases and Causes of Death. Accessed 9 October 2006
6. Centers for Disease Control and Prevention (CDC), Division of Tuberculosis
Elimination. Core Curriculum on Tuberculosis: What the Clinician Should
Know. 4th edition (2000). Updated August 2003.
7. Gutierrez MC, Brisse S, Brosch R, et al (September 2005). "Ancient origin and
gene mosaicism of the progenitor of Mycobacterium tuberculosis". PLoS
Pathog. 1 (1): e5. doi:10.1371/journal.ppat.0010005. PMID 16201017.
PMC:1238740.
8. Cole E, Cook C (1998). "Characterization of infectious aerosols in health care
facilities: an aid to effective engineering controls and preventive strategies".
Am J Infect Control 26 (4): 453–64. doi:10.1016/S0196-6553(98)70046-X.
PMID 9721404.
9. Nicas M, Nazaroff WW, Hubbard A (2005). "Toward understanding the risk of
secondary airborne infection: emission of respirable pathogens". J Occup
Environ Hyg 2 (3): 143–54. doi:10.1080/15459620590918466. PMID
15764538.
10. "Causes of Tuberculosis". Mayo Clinic (2006-12-21). Retrieved on 2007-10-19.
11. Herrmann J, Lagrange P (2005). "Dendritic cells and Mycobacterium
tuberculosis: which is the Trojan horse?". Pathol Biol (Paris) 53 (1): 35–40.
PMID 15620608.
12. Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D (2005). "Tuberculous
dilated cardiomyopathy: an under-recognized entity?". BMC Infect Dis 5 (1):
29. doi:10.1186/1471-2334-5-29. PMID 15857515.
13. Kaufmann S (2002). "Protection against tuberculosis: cytokines, T cells, and
macrophages". Ann Rheum Dis 61 Suppl 2: ii54–8. PMID 12379623.
14. Grosset J (2003). "Mycobacterium tuberculosis in the extracellular
compartment: an underestimated adversary". Antimicrob Agents Chemother 47
(3): 833–6. doi:10.1128/AAC.47.3.833-836.2003. PMID 12604509.
15. Kim J, Park Y, Kim Y, Kang S, Shin J, Park I, Choi B (2003). "Miliary
tuberculosis and acute respiratory distress syndrome". Int J Tuberc Lung Dis 7
(4): 359–64. PMID 12733492.
16. "Update: adverse event data and revised American Thoracic Society/CDC
recommendations against the use of rifampin and pyrazinamide for treatment of
latent tuberculosis infection—United States, 2003" (2003). MMWR Morb
Mortal Wkly Rep 52 (31): 735–9. PMID 12904741.
17. Rothel J, Andersen P (2005). "Diagnosis of latent Mycobacterium tuberculosis
infection: is the demise of the Mantoux test imminent?". Expert Rev Anti Infect
Ther 3 (6): 981–93. doi:10.1586/14787210.3.6.981. PMID 16307510.
18. Nahid P, Pai M, Hopewell P (2006). "Advances in the diagnosis and treatment
of tuberculosis". Proc Am Thorac Soc 3 (1): 103–10. doi:10.1513/pats.200511-
119JH. PMID 16493157.
19. Pai M, Zwerling A, Menzies D (June 2008). "Systematic Review: T-Cell-Based
Assays for the Diagnosis of Latent Tuberculosis Infection: An Update". Ann.
Intern. Med. 149 (3): 1–9. PMID 18593687.
20. O'Brien R (1994). "Drug-resistant tuberculosis: etiology, management and
prevention". Semin Respir Infect 9 (2): 104–12. PMID 7973169.
21. Madison B (2001). "Application of stains in clinical microbiology". Biotech
Histochem 76 (3): 119–25. doi:10.1080/714028138. PMID 11475314