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Indian Journal of Community Medicine

Assessment of One Year of RNTCP

Author(s): S.S. Aggarwal, N.S. Aggarwal, S.S. Nagar, B.K. Makadia

Vol. 29, No. 4 (2004-10 - 2004-12)


Objective: 1) To analyze critical indicators of case finding and management in RNTCP. 2) To compare the Revised National Strategy with Previous Strategy in National Tuberculosis Control Programme (NTCP).

Design: Retro prospective.

Setting: Jamnagar District with its 3 Tuberculosis Units (TU) namely Jamnagar, Khambhalia and Kalavad.

Participants: All registered patients of tuberculosis receiving or had received treatment for tuberculosis.

Statistical analysis: Chi square test.

Results: There is significant increase in cure rate with DOTS therapy (82%) as compared to previous startegy (35%). Defaulter rate is significantly reduced with introduction of DOTS therapy in RNTCP.

Key Words: Case detection in NTCP, Sputum conversion, Cure rate, Defaulter rate


India accounts 28% of global burden of TB and every day in India more than 20,000 people become infected, more than 5,000 develop the disease and more than 1,000 die from TB1. Treatment completion rate was about 30% in National tuberculosis control programme2 because of non adherence to treatment (of patients), even if medications are available. This has resulted in increase in TB load and also emergence of multi drug resistant TB.

Current management of TB in many parts of the world and India is perhaps the worst example. The patient with disease is put on treatment without sufficient bacteriological testing. The drugs may be bought in from the market and are of poor quality. The regimen prescribed may be non-standard. There will be virtually no supervision of the patients to ensure compliance. The result is that the patients are not cured of disease and another half treated patients burden the community3.

The latest appraisal of performance of the NTP with previous strategy adopted by Government of India is frustrating. The programme by the government run machinery could take care of only about 30% of the patients of which only 30% again could complete the treatment. It means that only about 10% of our tuberculosis population completed treatment under government care. And, unfortunately there has been hardly any data regarding the rest 70% of our tuberculosis patients that were treated outside the tuberculosis control programme4.

In 1992 Government of India appointed a review committee of National and International experts and they evolved a revised strategy. This revised strategy was pilot tested in 1993 and shown that diagnostic practices improved with effective use of quality sputum microscopy, and cure rates doubled as compared to those achieved with conventional treatment. The goal of the RNTCP is to cure at least 85% of all new sputum smear positive patients detected, and to detect at least 70% of all such patients after the goal for cure rate has been mat. One component or RNTCP is DOTS. In DOTS treatment is taken under observaton by health worker or community leader or volunteer or social worker, household members of the patients are not accepted for this purpose.

Present study analyzes the critical indicators of case finding and management in RNTCP and also gives a chance to compare revised national strategy with previous strategy in NTCP.

Material and Methods

The study was done in Jamnagar District with mid-year population of 1,705,626 (1991 census). For every 5 lacks population there is one Tuberculosis Unit (TU). Jamnagar district has 3 tuberculosis units given along with their respective population as :

Jamnagar TU 553,175,
Khambhalia TU 525,643,
Kalavad TU 484,800

Each TU is staffed with senior TB laboratory supervisor (STLS) and senior treatment supervisor (STS). Functions of TU are to implement, monitor and supervise TB control activities in designated geographical area. One medical officer TB control (MO-TC) is responsible for TB work of the particular TU. The diagnostic component (Microscopy Centre) which is attached with these TU is taken for study results. Retrospective study was done in which previous records were checked for NTCP (Previous strategy) from Oct. 97 to Sept. 98, these were analyzed retrospectively, from this point with start of revised strategy, activities were checked prospectively every 15 days and is followed for the period from Oct. 98 to Sept. 99 (4 quarters)

Data obtained from district tuberculosis registers from previous strategy were compared with data obtained on revised strategy from patient treatment sheets, microscopy diagnostic results are checked. Various quality indiators as advised in operational guidlines for TB control are compared to get the results.


There is significant improvement in case detection activity under RNTCP with improvement in ratio of sputum positive to sputum negative (Table I). 3 months conversion, from sputum positive to sputum negative is approximately 80% with DOTS therapy as shown in table II. There is significant increase in cure rate with DOTS therapy as shown in table III. Defaulter rate is significantly reduced with introduction of DOTS therapy.

Table I : Comparison of Critical Indicator of Case Detection in Jamnagar District Under RNTCP 98-99 with Previous Strategy 97-98.

Year of Study Strategy Proportion of Chest Symptomatic but not TB Sputum Positive Sputum Negative Ratio
1997 - 1998 NTP (previous) 7,523/11,590 66.0% 990/11,590 8.5% 3,077/11,590 26.5% 1:3
1998 - 1999 RNTCP 7,306/9,989 73.2% 1,032/9,989 16.5% 1,651/9,989 16.5% 1:1.6
x2 = 316, df = 2, p<0.001

Table II: Conversion Report of Sputum Positive Case Under RNTCP.

Period Total Sputum Positive 3 Months Conversion
Sputum Positive
to Sputum
4th Quarter 47 42 89
1st Quarter 126 117 93
2nd Quarter 176 151 86
3rd Quarter 214 179 84
Average NA NA 87

Table III : Comparison of Outcome of Treatment of Sputum Positive TB patient between RNTCP and Previous strategy.

Strategy Sputum Positive put on Treatment Cure Rate Failure Rate Defaulter Rate Death Rate
NTP (previous) 818 287 (35.3%) 38 (4.6%) 471 (57.5%) 22 (2.6%)
RNTCP 564 492 (87.3%) 6 (1.0%) 62 (11.0%) 4 (0.7%)
x2 = 364.07, df = 3, p<0.001


Ministry of health and family welfare, India in 1997 recommended that the topmost priority should be given to diagnosing and curing patients with sputum positive tuberculosis as these patients are the source of infection in their community5.

One of the improvement guiding criteria for judging performance of RNTCP is that the new smear positive cases should be equal to that of new smear negative patients. This is also evident from report of Dr. Khatri, Deputy Director General (TB) that the ratio of sputum positive to sputum negative cases in the country has improved from 1:3 in NTCP era to 1:0.8 in RNTCP6. Case detection activity under RNTCP in DTC. Jamnagar shows that in comparison to new smear positive cases new smear negative cases were approximately equal 564: 498 (Table I). Ratio of sputum positive to sputum negative cases also improved from 1:3 to 1:1.6 with RNTCP (Table III).

The conversion of sputum smear from positive to negative is the best indicator that the intensive phase of chemotherapy has been regular and effective. After 2 months of chemotherapy more than 80% of new pulumonary smear positive cases should be smear negative, and after 3 months the rate should increase to more than 90%8. In the study conversion rate is approximately 84% and 88% at 2 months and 3 months respectively. This shows the performance of RNTCP in Jamnagar is good as per guidelines of tuberculosis control.

Two other guiding parameters given by experts for tuberculosis control are, cure rate should be more than 85% and defaulter rate should not be more than 5% for proper functioning of RNTCP8. These two criteria's are very well met by DTC, Jamnagar as cure rate and defaulter rate were 87% and 11% respectively. Defaulter rate is slightly higher because all those whose results are not available are added as defaulters.

In spite of availability of DOTS in RNTCP, if we fail in correctly implementing NTCP, consequences of failure will be increase in TB case load, Increase in number of deaths due to TB, Increase in cases of multi drug resistant TB and Conversion of treatable epidemic of TB in untreatable epidemic.

Thus phased and effective implementation of the RNTCP is best strategy, and perhaps the only chance of controlling TB in India.

Conclusion and Recommendation

Ensuring diagnosis and cure of TB case by RNTCP policies is the only effective way to stop the spread of TB in India, thus also reduces source of infection to the community. DOTS in RNTCP is effective and all health professionals in public and private sectors should extend their full cooperation in implementation of RNTCP more widely in India.

Abbreviations: DTC - District TB Centre, DOTS - Directly observed treatment shortcourse. RNTCP: Revised National TB control programme, NTCP - National TB control programme, TU - Tuberculosis Unit, STLS-Senior TB laboratory supervisor, STS - Senior treatment supervisor, MO-TC - Medial officer TB control.


Authors acknowledge Dr. S.R. Nagar, CDHO, District Jamnagar and staff members of DTC, Jamnagar for their help in comparative study. Authors also thank Mr. B.D. Karia, Statistical Assistant for providing valuable data. Authors also wish to acknowledge Dr. S.B. Saxena, Dr. K.J. Mathai and Dr. P.B. Verma for critical appraisal of this manuscript.


  1. TB in India 2001 : DGHS, Ministry of health and family welfare, India 2001:6.
  2. Gajera MK. CME for Doctors : "Stop TB at the source DTC, Rajkot". 2.
  3. Davis PDO. Tuberculosis, the Global Epidemic : JIMA 2000; 98(3):101.
  4. Parthsarthi Bhattarcharya : Current recommendations of chemotherapy drugs : JIMA 2000;98(5) : 120.
  5. DGHS, Ministry of health and family welfare : Recommendations of national consequences confernce of tuberculosis control, 1997:14.
  6. Medical Times. DOTS achieves 85% cure rate in TB patients. 2000;XXX(1) : 1.
  7. DGHS. Operational guidelines for TB control, 1999 third printing : 25.

1. Department of Community Medicine,
2. Deptt. of Paediatrics, M.P. Shah Medical College and Guru Gobind Singh Hospital, Jamnagar(Gujarat)

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