A STUDY ON EXCLUSION GROUP FROM THE INITIATION OF DOTS UNDER REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME IN WEST BENGAL, INDIA

Background: Revised National Tuberculosis Control Program (RNTCP) in on from 1990s. But outcome is not satisfactory in many states including West Bengal. Our objective is to profile people coming at microscopy centre for sputum examination early and late. It tries to identify factors adversely influencing early sputum examination and causes of exclusion from initiation of Directly Observed Treatment Short Course (DOTS) therapy. Methods: Survey was conducted on 577 persons with cough for minimum two weeks from 36 microscopy centres. Important variables explored were sputum positivity level, a proxy indicator of delay in seeking services and initiation of DOTS. Apart that, information on poverty level, religion, caste, mode of journey to facility was also captured. Results: Patients coming late in the microscopy centre were expected to be high positive and those came earlier to be low positive. For both sex, late diagnosis (88.24% and 81.58%) was much more than early diagnosis (11.76% and 18.42%). Across all religions, late diagnosis was much higher than early diagnosis (Hindu 83.05%, Muslim 88.89% and others 100.0% for late diagnosis). Variables significantly influencing initial default of DOTS are age, sex, caste, religion, education, employment status, access to facility and service providers. Upper caste and above poverty line people are more complaint to DOTS. Conclusion: Present study recommends developing an overall community mobilization strategy so that TB suspects reach facilities for early diagnosis and start DOTS. Stigma reduction strategy may be developed so that community does not hesitate to access the existing microscopy health care services.