Bridging Gaps in Revised National Tuberculosis Control Program at Bankura District, West Bengal State, India

Background: Tuberculosis distresses economically productive age groups and emerged as a noteworthy reason of global burden. Objectives: The study was undertaken to find the gaps at the level of patients, or health providers in implementing RNTCP and also find out the reasons therein. Methods: This study was carried out among all patients enrolled as pulmonary tuberculosis cases in DOTs register of Tuberculosis Unit (TU) of a tertiary care teaching institute in eastern India in the third quarter of the year 2011. Results: Majority of cases (56.61%) belonged to 35-54 years age group, male (75.47%), from rural areas (64.15%), literacy up to primary (47.18%). Sputum was examined in 75.47 percent cases within 2-3 weeks after onset of cough and 89.62 percent were found sputum positive. DOTs providers completed initial home visit up to 70.75 percent cases; 71.70 percent initiated treatment within seven days after diagnosis. Initial defaulter was in 28.30 percent of cases; Literacy status showed significant difference in timing of diagnosis, initiation of treatment. Significance of difference with and without BPL Card was noted in delay of diagnosis and initiation of treatment. Literacy status was significantly associated with both timing of diagnosis and initiation of treatment. Socio economic status was also found significantly associated with delay in diagnosis and initiation of treatment. First contact with unqualified local practitioner with delay in advising sputum examination in Government health facility, long distances from facility, non-availability of drugs and staffs with refusal to supply drug, inconvenient timing of clinic, fear from social stigma and fear of side effects of drugs with long duration of treatment were cited as negative issues in treatment. Conclusion: Initiation and continuation of treatment of TB is related with socio-demographic correlates that needs counselling & motivation for early intervention.