	TB claims a life every minutes in India; Every day 40 indivuduals die due to TB in Jharkhand ; this is truly tragic since it’s a nearly 100% curable disease.
	Each Year, nearly 2 million people in India develop TB , 1 million of them highly infectious sputum positive cases who spread the infection in the community. Each sputum positive case can infect 10 – 15 individuals in an year.

Social burden of TB in India

Economic burden of TB in India

	TB kills more women than all causes of maternal mortality combined.
	More than 100,000 women are rejected by their families on account of TB.
	More than 300,000 children leave school to work as a result of parental TB.

	TB affects the most productive age group of 15 – 54 years and hence is a major barrier to economic development; costing India 12,000 crore a year.
	100 million productive work day are lost in our country due to TB.

Poverty and TB

HIV and TB

	Poverty and TB form a vicious circle; TB decreases a persons capacity to work and adds the burden of treatment expenses.
	The poor seek and receive inadequate health care that often inhibits the detection of TB and adds to the impact of the disease.

In India, there are an estimated 3.97 million people living with HIV. Amongst AIDS cases, it is estimated that approximately 605 have TB disease. The potential, social and economic burden of TB of the TB and HIV co – epidemic could overwhelm the resources of a developing country such as India.

Scenario Jharkhand

What is TB?

The State of Jharkhand with a population of approximately 2.69 crores will have approximately 53,800 60,000 TB patients every year. About 13,000 people die of TB every year in the State of Jharkhand i.e. more than 35 people every day.

TB is disease caused by the bacillus Mycobacterium Tuberculosis. In over 80% of the cases, TB affects the lungs; it can also affect any other part of body.

The important symptoms of TB are

The core principles of DOTS are

	Cough for more than three weeks
	Evening rise of temperature
	Weight loss
	Breathlessness
	Chest Pain
	Blood in sputum
	Night sweat
	Loss of appetite

The basic principles are diagnosing TB, especially the infective cases through smear Microscopy followed by treatment with a course of anti – TB medicines given for 6-8 months with constant monitoring of each patient. The widespread application of the DOTS strategy is the cornerstone of TB control DOTS was formally launched as a strategy of the Revised National Tuberculosis Control Programme ( RNTCP ) in 1993 as a poilot . In Jharkhand, the programme has Started service delivery in the districts of Ranchi, Palamau and Latehar since 2000, in Hazaribagh and Chatra in 2002, in Deoghar and Dhanbad in 2003. All the other district. of the State are in the preparatory stage and shall start service delivery in the year 2004.

	Early detection of all suspected cases.
	A speedy and correct diagnosis.
	Effective treatment with quality drugs.
	Constant supervision and motivation of each patient of ensure completion of treatment.
	Monitoring and evaluation to assure quality of services.

Benefits of DOTS

	DOTS more than doubles the accuracy of TB diagnosis.
	DOT results in success rates of up to 90%.
	DOTS prevents the spread of tuberculosis bacilli, thus reducing the incidence and prevalence of TB.
	DOTS helps in alleviating poverty by saving lives, reducing the duration of illness and preventing new infections cases; thus, losing fewer years of employment.
	DOT improves the quality of life and overcomes stigma.
	DOTS prevents treatment failure and the emergence of MDR- TB ensuring patient adherence and an uninterrupted supply of anti – drugs.
	DOTS lends credence to TB control efforts.
	DOTS provides a model for strengthening health services.
	Every patient with cough for more than 3 weeks should have 3 sputum smears examined in a competent laboratory. No patient should start treatment for pulmonary TB without 3 sputum tests.
	All tuberculosis patients must be effectively treated, most importantly the smear positive (infectious) cases. Only observed treatment with proven regimens can ensure cure.
	The public system has a responsibility to monitor the diagnosis and treatment of every tuberculosis patient, most importantly the smear – positive (infectious) cases.