C Kolappan

National Institute of Research in Tuberculosis

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R Subramani

Christ University

Narayanan Parameswaran

Jawaharlal Institute of Post Graduate Medical Education and Research

P G Gopi

Sound Health Options

T Santha

National Institute of Research in Tuberculosis

N Selvakumar

Anna University, Chennai

V. Kumaraswami

National Institute of Epidemiology

Thomas B. Nutman

National Institutes of Health

D. Baskaran

National Institute of Research in Tuberculosis

Soumya Swaminathan

M S Swaminathan Research Foundation

Thomas R. Frieden

Save the Children

Cooperative Institutions

National Institute of Research in Tuberculosis

Indian Council of Medical Research

National Institutes of Health

National Institute of Allergy and Infectious Diseases

National Tuberculosis Institute

International Centers for Excellence in Research

Ministry of Health and Family Welfare

National Institute of Epidemiology

Jawaharlal Institute of Post Graduate Medical Education and Research

Regional Medical Research Centre

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Estimation of annual risk of tuberculosis infection among children irrespective of BCG scar in the south zone of India.

Indian Journal of Tuberculosis (2006)

P G Gopi R Subramani C Kolappan V Venkatesh Prasad P R Narayanan

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Citations (15)

Association between biomass fuel and pulmonary tuberculosis: a nested case-control study

Thorax (2009)

C Kolappan R Subramani

Objective:

To quantify the association between biomass fuel usage and sputum-positive pulmonary tuberculosis.

Methodology:

A tuberculosis prevalence survey was conducted in a random sample of 50 rural units (villages) and three urban units in the Tiruvallur district of Tamilnadu, India during the period 2001–2003. Additional data regarding exposure to tobacco smoking, alcohol consumption, biomass fuel usage and Standard of Living Index (SLI) were also collected from the study participants. A nested case–control study was carried out in this population. Cases are defined as bacteriological-positive cases diagnosed by either sputum smear or culture examination. For each case, five age- (within ±5 years of age) and sex-matched controls were selected randomly from the non-cases residing in the same village/unit. Thus, 255 cases and 1275 controls were included in this study.

Results:

The unadjusted OR measured from univariate analysis for biomass fuel is 2.9 (95% CI 1.8 to 4.7). The adjusted OR measured from multivariate analysis using Cox regression is 1.7 (95% CI 1.0 to 2.9). Thirty-six percent of cases are attributable to biomass fuel usage.

Conclusion:

The findings from this case–control study add to the evidence for an independent association between biomass smoke and pulmonary tuberculosis. Improvement in standards of living brought about by economic development will lead to more people using cleaner fuels for cooking than biomass fuel which in turn will lead to a reduction in the occurrence of pulmonary tuberculosis in the community.

Nested case-control study

10.1136/thx.2008.109405

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Citations (84)

Could repeated prevalence surveys lead to decreasing tuberculosis prevalence in a community?

The International Journal of Tuberculosis and Lung Disease (2015)

R Subramani C Kolappan Venkatesh Chandrasekaran N Selvakumar Fraser Wares

Tiruvallur District, South India, where one baseline tuberculosis (TB) disease prevalence survey followed by three repeat prevalence surveys were conducted every 2.5 years between 1999 and 2008, and where the DOTS strategy was implemented in 1999.To rule out the possibility that the observed decline in TB prevalence was influenced by conducting repeat prevalence surveys, we compared the findings from two surveys: the third repeat survey conducted in 2006-2008 and an independent single survey in a neighbouring area conducted in 2008-2009.An independent survey was conducted to estimate the prevalence of TB in the same district in 2008-2009 using a different set of villages and employing repeat survey methodology. The independent survey findings were compared with those of the third repeat survey.The estimated prevalence rate of culture- and smear-positive TB was respectively 401 per 100,000 and 186 per 100,000 population in the third repeat survey area. The corresponding rates were 340 and 184/100,000 in the independent survey area. The difference in prevalence was not significant (culture P = 0.09; smear P = 0.93).The estimated prevalence rates in the two different sample survey areas were comparable, indicating that the repeated prevalence surveys in the study area did not influence the observed decline in TB disease prevalence.

Prevalence

Survey research

Survey Methodology

10.5588/ijtld.14.0562

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Tuberculosis mortality in a rural population from South India

Indian Journal of Tuberculosis (2016)

C Kolappan R Subramani Soumya Swaminathan

Verbal autopsy

Standardized mortality ratio

10.1016/j.ijtb.2015.07.005

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Citations (5)

Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India.

PubMed (2008)

R Subramani S. Radhakrishna Thomas R. Frieden C Kolappan P G Gopi

Tiruvallur District in Tamilnadu, South India, where the World Health Organization-recommended DOTS strategy was implemented as a tuberculosis (TB) control measure in 1999.To assess the epidemiological impact of the DOTS strategy on the prevalence of pulmonary tuberculosis (PTB).Surveys of PTB were undertaken on representative population samples aged > or =15 years (n = 83000-90000), before and at 2.5 and 5 years after the implementation of the DOTS strategy. The prevalence of PTB (smear-positive/culture-positive) was estimated.TB prevalence declined by about 50% in 5 years, from 609 to 311 per 100000 population for culture-positive TB and from 326 to 169/100000 for smear-positive TB. The annual rate of decline was 12.6% (95%CI 11.2-14.0) for culture-positive TB and 12.3% (95%CI 8.6-15.8) for smear-positive TB. The decline was similar at all ages and for both sexes.With an efficient case detection programme and the DOTS strategy, it is feasible to bring about a substantial reduction in the burden of TB in the community.

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A baseline survey of the prevalence of tuberculosis in a community in south India at the commencement of a DOTS programme.

PubMed (2003)

P G Gopi R Subramani S. Radhakrishna C Kolappan Kesavan Sadacharam

To determine the baseline prevalence of culture-positive and smear-positive tuberculosis and the annual risk of tuberculous infection (ARTI) in a community in south India where DOTS is being implemented.Using cluster sampling, 50 rural panchayats (villages) and three urban units in Tiruvallur district were selected randomly. All adults aged > or = 15 years underwent symptom and radiographic examination, and those with abnormal shadows and/or chest symptoms had sputum smear and culture examination. In another cluster sample of 73 villages and three urban units, all children aged < 10 years were tuberculin tested.The prevalence of culture-positive and smear-positive tuberculosis was respectively 605 and 323/100,000. Both increased appreciably with age, and were substantially higher in males than in females at all ages; the overall male:female ratio was 5.5 for culture-positive and 6.5 for smear-positive tuberculosis. The ARTI in children aged under 10 years was 1.6%, and was unaffected by sex. Over three decades there was an overall decline of 1.8% per annum in the prevalence of culture-positive and 2.1% for smear-positive tuberculosis.Tuberculosis is a major problem in this rural community in south India, with a prevalence of 605/100,000 for culture-positive tuberculosis and 323/100,000 for smear-positive tuberculosis.

Sputum culture

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Repeatability of nerve thickness assessment in the clinical examination for leprosy

Leprosy Review (1995)

C Kolappan Rajalakshmi Selvaraj ABDUL KHUDOOS B. N. APPE GOWDA Manjula Datta

The assessment of the thickness of the superficial peripheral nerve trunks to document nerve involvement is an important aspect of clinical examination in case finding for leprosy, and is usually done by trained paramedical workers (PMWs). This assessment is subject to variability and has implications on the outcome of the survey. The present study proposes to quantify this variability. In this study, 242 individuals, consisting of 50 neuritic cases, 143 nonneuritic cases of leprosy and 49 normal controls, selected from the records of the trial of BCG prophylaxis in leprosy in South India, were examined by a doctor and paramedical workers. Repeatability of nerve thickness assessment for ulnar and popliteal nerves between the medical officer (MO) and the PMWs was quantified using Kappa statistics. The Kappa values for repeatability between the MO and the PMWs ranged from 0.45 to 0.54 and 0.52 to 0.69 for ulnar and popliteal nerves, respectively. The implications of the variability in nerve assessment are discussed.

Repeatability

Kappa

Cohen's kappa

10.5935/0305-7518.19950025

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Citations (8)

Comparison of tuberculin reaction sizes at 48 and 72 hours among children in Tiruvallur district, south India.

Indian Journal of Tuberculosis (2007)

P G Gopi M Vasantha C Kolappan Narayanan Parameswaran

Tuberculin test

Skin test

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Sub-national TB prevalence surveys in India, 2006-2012: Results of uniformly conducted data analysis

PLoS ONE (2019)

V. K. Chadha S.M. Anjinappa Paresh Dave Kiran Rade D. Baskaran

Setting Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006–2012 Objective To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB. Methods Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB. Results Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4–428.1, 147.9–429.8 and 170.8–528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7–377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas. Conclusion TB burden continues to be high in India suggesting further strengthening of TB control activities.

Prevalence

10.1371/journal.pone.0212264

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Citations (27)

Excess mortality and risk factors for mortality among a cohort of TB patients from rural south India.

PubMed (2008)

C Kolappan R Subramani V. Kumaraswami T Santha Narayanan Parameswaran

To estimate the excess general mortality among tuberculosis (TB) patients in a rural area (Tiruvallur) and identify risk factors for TB-related mortality.The study population consisted of all TB patients aged >or=15 years who were registered under the Revised National Tuberculosis Control Programme (RNTCP) during the years 2000 to 2003 at Velliyur TB unit (TU) in south India.This is a retrospective cohort study of 3405 patients treated under the DOTS strategy, followed up from the date of start of treatment till the date of interview (for the survivors) or the date of death (for those who died).There were 2710 (79.6%) survivors and 695 (20.4%) deaths. The excess general mortalities for the cohort, expressed as standardised mortality ratio (SMR), was 4.2 (95%CI 3.9-4.5). High SMR values were obtained for patients belonging to the 15-44 years age group (12.1), patients on Category II regimen (9.3), treatment failures (9.1) and defaulters (7.8). The adjusted hazards ratios (aHR) were high for patients aged 45-59 years (1.9), >or=60 years (3.1) and with incomplete treatment due to default or failure (6.4).TB is one of the main causes of mortality in the younger age group. Among TB patients, the major risk factors for mortality are old age (>or=45 years) and incomplete treatment.

Excess mortality

Regimen

Standardized mortality ratio

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Citations (59)