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The roosting ecology of most waterbird species is poorly known and even less is known from southern Asia, where many species inhabit human-modified areas. Roosting ecology of the Black-headed Ibis (Threskiornis melanocephalus) was studied in urban and rural settings in southern Rajasthan, India. Analyses focused on assessing whether site characteristics varied between nest sites, urban and rural roost sites, and paired sites (i.e., a waterbird roost site near Black-headed Ibis roosts but without Black-headed Ibis). Additionally, the hypothesis that factors affecting Black-headed Ibis numbers at roosts would be similar at urban and rural sites was tested. Tree characteristics (canopy cover, girth at breast height) were different (P < 0.05) between nest and roost sites. Urban roost sites experienced 2.3 times greater disturbance than rural roost sites. Paired site characteristics were similar to urban roost sites (multi response permutation procedure, significance of δ = 0.3), but were dissimilar to rural roost sites. Co-occurring roosting bird assemblages were significantly different between roosts and paired sites (significance of δ < 0.01) in urban and rural settings. Black-headed Ibis numbers at urban roosts were influenced by multiple variables, but models showed considerable ambiguity at rural sites. Results strongly suggest that including roost sites in a species status assessment is important. [ABSTRACT FROM AUTHOR]

Sarus Cranes ( Antigone antigone) in south Asia breed during the rainy season (monsoon), with few nests initiated outside of the monsoon. Several hypothesis have been put forth to explain the unseasonal nesting outside the monsoon, but a careful evaluation of the hypotheses has been absent. Using a multi-year (2004-2017), multi-scale (four Indian states) data set, this study explored the factors potentially responsible for unseasonal nesting by Sarus Cranes. Nests outside the monsoon were very rare (0.3% of all nests) and were initiated when Sarus Crane pairs were in areas with artificial water sources (irrigation canals or reservoirs) or faced abnormal monsoonal conditions. Unseasonal nests were initiated only when breeding pairs had been unsuccessful in raising chicks in the previous primary nesting season. Altered cropping patterns associated with increased artificial irrigation and changing rainfall patterns appear responsible for unseasonal nesting in Sarus Cranes. Nesting of this species outside the monsoon may increase in response to the increasing changes in cropping patterns and changing rainfall conditions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To isolate antibacterial potential of sponge endosymbiotic bacteria from marine sponges at Lakshadweep archipelago. Also to identify the potent bacteria by 16s rDNA sequencing and determine the antibacterial activity against clinical pathogens by MIC. Methods: Sponge samples was collected from sub-tidal habitats at Kavaratti Island and identified. The endosymbiotic bacteria were isolated and selected potential bacteria which show antibacterial activity in preliminary screening against clinical pathogens Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Salmonella typhi (S. typhi), Klebsiella pneumoniea (K. pneumoniea) and Streptococcus sp. by disc diffusion assay. The crude extracts of potential bacteria LB3 was tested against clinical pathogens by MIC. The LB3 strain was identified by 16s rDNA sequencing, 1 111 bp was submitted in NCBI (HQ589912) and constructed phylogenetic tree. Results: Sponge sample was identified as Dysidea granulosa (D. granulosa) and potential bacteria LB3 identified as Enterobacter sp TTAG. Preliminary screening of sponge isolates against clinical pathogens, LB3 strain was selected as potential producer of secondary metabolites and crude extract was implies on MIC of LB3 have confirmed with lowest concentration of 5.0 mg/mL in broth medium influence of crude extract on growth inhibitory activity after 5 h of incubation period and completed the inhibitory activity at 15 h. Conclusions: The present study concluded that phylogenetic analysis of endosymbiotic bacteria Enterobacter sp from sponge D. granulosa of Lakshadweep islands showed significant antibacterial activity against clinical bacterial pathogens. [Copyright &y& Elsevier]

Background: The Government Hospital of Thoracic Medicine (GHTM), Tambaram, in Kanchipuram district (formerly known as tuberculosis [TB] sanatorium), Tamil Nadu, draws patients from all over India although RNTCP services have been in place country-wide for a number of years. Objective: To document the reasons for patients with chest symptoms attending GHTM, Tambaram. Materials and Methods: In a prospective observational study, on a simple random sample basis, TB suspects attending the out-patient department of GHTM during the period January-March, 2006, were interviewed using a semi-structured interview schedule. Information on demographic, socio-economic characteristics and reasons for attending GHTM for health care was collected. Results: A total of 2,023 respondents attended GHTM during the study period; 56% were males, 67% were aged <45 years, 63% were literates and the average annual family income was Rs 25,000. Multiple reasons for attending GHTM were given: popularity of the centre (82%), perceived availability of good treatment (52%), referral by earlier treated patients (36%), expectation of specialized care (22%), referred by treating physicians (13%), and came for inpatient care (11%). Conclusion: Despite the availability of local RNTCP health services, many patients with chest symptoms made use of GHTM services due to the reputation of the former "TB sanatorium" in the community. The findings suggest that there is a need to improve community awareness of the availability of free diagnostic and treatment facilities locally under RNTCP. [ABSTRACT FROM AUTHOR]

Objective To estimate the annual risk of tuberculosis infection (ARTI) among tribal children of Madhya Pradesh, central India. Methods Community-based, cross-sectional tuberculin survey among children aged 1–9 years in the tribal population of Madhya Pradesh. Multistage stratified cluster sampling was used to select a representative random sample of villages predominated by tribal population from selected districts. A total of 4802 children were tuberculin-tested with 1TU of PPD RT 23 and the reaction sizes read after 72 h. Results A total of 3062 (64%) children had no BCG scar. The frequency distribution of children by reaction sizes indicated a fair mode at 18 mm in the right hand side of the distribution. By mirror-image technique, the prevalence of infection among children with no recognizable BCG scar was estimated as 6.8% (95% CI: 4.8–8.9%). The ARTI was computed as 1.3% (0.9–1.7%). The corresponding figures for children irrespective of scar status were 7.1% (95% CI: 5.5–8.8%) and 1.3% (1.0–1.7%) respectively. Conclusions The risk of tuberculosis infection in tribal population of Madhya Pradesh, central India is not different from other areas of the country. There is, however, a need to further intensify tuberculosis control measures on a sustained and long-term basis. [ABSTRACT FROM AUTHOR]

Recent excavations at Kadakkarappally in Kerala, south-west India, have unearthed the remains of an iron-fastened boat, believed to predate the earliest known records for the use of iron in South Asian boatbuilding. The design departs significantly from the traditional view of Indian watercraft, although the use of locally available timber and the suitability of the design for use in the backwaters that characterise the region suggest that it was built and used in India. This is the first excavation of its type to take place in Kerala and contradicts the belief, widely held in Kerala, that the survival of organic remains has been negated by the tropical climate of the region. [ABSTRACT FROM AUTHOR]

A cross sectional tuberculin survey was undertaken to estimate the Annual Risk of Tuberculosis Infection (ARTI) amongst tribal children aged 1-9 years in Jhabua district, Madhya Pradesh, India. Of the 1056 test-read children, 774 (73.3 %) had no BCG scar. The prevalence of infection was estimated as 6.3% (95% CI: 4.8-7.7) and ARTI as 1.2 % (95% CI: 0.9-1.5). The findings suggest that the tuberculosis situation in the tribal population of Jhabua district is not that different from the situation among the non-tribal population in the country. However, there is a need to further intensify tuberculosis control measures in the area. [ABSTRACT FROM AUTHOR]

Metals such as Cd, Pb, Cu and Zn were analysed in five seagrass species from five locations of the Palk Bay coast of south-eastern India. The maximum Cd concentration (2.83 ± 0.08 μg g−1) was recorded in Syringodium isoetifolium on the Mallipattinam coast in the post-monsoon season, and the Cu (29.54 ± 1.03 μg g−1) in Enhalus acoroides of the Thondi coast during monsoon season. The maximum concentrations of Pb (3.12 ± 0.14 μg g−1) and Zn (52.66 ± 0.88 μg g−1) were observed in S. isoetifolium and Cymodoceae rotundata on the Devipattinam and Karangadu coasts, respectively, during the monsoon season. The metal concentrations obtained in different seagrass species varied significantly among species, and no clear monsoon season had a clear effect on the accumulation of heavy metals in the investigated seagrass species. S. isoetifolium has higher capacity for Cd and Pb accumulation than other tested seagrass species. Unlabelled Image • Metals were analysed in different seasons from five different seagrass species using AAS. • Syringodium isoetifolium has higher bioavailability of Cd and Pb than other seagrass species. • Cu showed maximum accumulation in E. acoroides ; Cd 0.22; Cu 1.74; Zn 23.17. • S. isoetifolium showed maximum level of metals than the other tested samples of all the station. [ABSTRACT FROM AUTHOR]

The article reports on the use of BCG Vaccination to control tuberculosis disease in India. Accordingly, tuberculosis remains the major public health problem globally specifically in children. In this regard, BCG vaccination is used to control the disease as part of the government Universal Immunization Programme (UIP) that would be administered at birth.

Setting: Twenty-four districts in India., Objectives: To evaluate trends in annual risk of tuberculous infection (ARTI) in each of four geographically defined zones in the country., Study Design: Two rounds of house-based tuberculin surveys were conducted 8-9 years apart among children aged 1-9 years in statistically selected clusters during 2000-2003 and 2009-2010 (Surveys I and II). Altogether, 184,992 children were tested with 1 tuberculin unit (TU) of purified protein derivative (PPD) RT23 with Tween 80 in Survey I and 69,496 children with 2TU dose of PPD in Survey II. The maximum transverse diameter of induration was measured about 72 h after test administration. ARTI was computed from the prevalence of infection estimated using the mirror-image method., Results: Estimated ARTI rates in different zones varied between 1.1% and 1.9% in Survey I and 0.6% and 1.2% in Survey II. The ARTI declined by respectively 6.1% and 11.7% per year in the north and west zones; no decline was observed in the south and east zones. National level estimates were respectively 1.5% and 1.0%, with a decline of 4.5% per year in the intervening period., Conclusion: Although a decline in ARTI was observed in two of the four zones and at national level, the current ARTI of about 1% in three zones suggests that further intensification of TB control activities is required.

Tuberculosis (TB) is a major public health problem among the Saharia, a marginalized tribal group in Madhya Pradesh state, central India. However, there is no information on the risk factors associated with the development of TB disease in this community. A cross-sectional TB prevalence survey was conducted among the Saharia residing in Sheopur district of Madhya Pradesh. Information on tobacco smoking and alcohol consumption was collected from all the individuals. Persons aged ≥45 years, males, smokers and alcohol consumers had higher risks of developing TB disease. There is an urgent need to develop and implement culturally appropriate awareness raising activities to target smoking and alcohol consumption to support the efforts to control TB in this community.

Background: There is little information on the recovery of Mycobacterium tuberculosis complex from sputum samples collected in the field for bacteriological examination., Setting: Tribal areas in the State of Madhya Pradesh, in central India., Methods: Sputum specimens collected from subjects with chest symptoms in a disease prevalence survey were refrigerated until transportation to the laboratory. The specimens were processed for microscopy and culture. The samples were grouped based on the delay in processing for culture from the day of collection into three groups: 0-3, 4-7 and ≥8 days, and the recovery of M. tuberculosis complex in these groups was analysed. The statistical analysis was performed using χ(2) test., Results: Of the 3651 processed specimens, 114 were positive for M. tuberculosis complex by culture and 96 by smear microscopy. The differences in the proportion of 'smear-positive, culture-positive', 'smear-positive, culture-negative' and 'smear-negative, culture-positive' samples between the three groups were not significant., Conclusion: In difficult-to-reach areas with limited resources, refrigeration of sputum specimens until they are transported for processing at a reference laboratory for culture seems not to significantly affect the recovery of M. tuberculosis complex isolates.

Background: A community-based cross-sectional tuberculosis (TB) disease prevalence survey was undertaken amongst the Baiga primitive tribal community of Baiga Chak in central India., Material and Methods: A population of 2,359 was covered under the study. Sputum samples were collected from chest symptomatics and examined for smear microscopy and culture., Results: Overall prevalence of PTB was 146 (95% C.I: 0-318) per 100,000 population., Conclusion: The findings suggest that TB is not a major public health problem amongst this tribal group. However, there is still the need to maintain and further strengthen TB control measures on a sustained and long term basis in the area.

A cross-sectional survey was undertaken to estimate the prevalence of pulmonary tuberculosis (TB) among the primitive Bharia tribe of Madhya Pradesh, India. Virtually the entire community in Patalkot valley of Chhindwara District was covered. Individuals aged > or =15 years were questioned about chest symptoms relating to TB. Sputum samples were collected and examined by smear microscopy and culture. The overall prevalence of pulmonary TB was found to be 432 per 100 000 population-not dissimilar to that seen in the wider population in India. There is, however, an urgent need to strengthen TB services in the area to improve access for this group.

Background: Innovative schemes to ensure the participation of private practitioners (PPs) in the Revised National Tuberculosis Control Programme (RNTCP) are necessary to identify and treat all patients with tuberculosis (TB). We developed a novel public-private mix (PPM) model to encourage PPs to practise DOTS and participate in the RNTCP while retaining their patients., Methods: The Resource Group for Education and Advocacy for Community Health (REACH) developed and implemented the programme in partnership with the Chennai local health authority and the Tuberculosis Research Centre, Chennai, India. PPs were sensitised to the RNTCP and DOTS through a one-to-one approach or group meetings, and were assisted in referring patients. Surveys were carried out at baseline and at the completion of the study to assess changes in attitudes and practices., Results: Six hundred PPs underwent sensitisation about the RNTCP, after which the proportion of PPs adopting DOTS increased significantly (P < 0.001), and the majority (72.8%) used sputum testing for diagnosing TB. The proportion of PPs who used X-ray alone for diagnosis declined to 16.0% from a baseline of 45.4%., Conclusions: This PPM model, which emphasises sustained advocacy for DOTS and allows PPs to retain private patients, looks promising and needs to be tested at other sites.

Unlabelled: SET UP: One Tuberculosis Unit (TU) in Tiruvallur district, Tamil Nadu, India where Tuberculosis (TB) patients treated under Directly Observed Treatment Short Course (DOTS) programme., Objective: To identify the effects of weight gain among TB patients at the end of treatment on different factors such as socio-economic and demographic characteristics, smoking and drinking habits, treatment under supervision, the type of DOTS centres and problems in taking drugs., Methods: TB patients registered between May 1999 and December 2004 formed the study population. Multiple regression method was used for the analysis., Results: Among 1557 smear-positive TB patients registered under DOTS programme, the changes in weight ranged from a loss of 4 kgs to a gain of 20 kgs at the end of TB treatment; the average change in weight was 3.22 kgs. The gain in weight at the end of treatment was associated with age (<45 years), DOT at government centres, no problems in taking drugs as reported by patients and cure rate., Conclusion: The findings showed that there is an association between gain in weight with DOT at government centres and cure of patients.

A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1-9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72 h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11 mm and a mode at 18 mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2-22.5%) and the ARTI was 3.9% (95% CI 3.5-4.3%). The corresponding figures were 21.1% (95% CI 18.3-23.8%) and 3.9% (95% CI 3.4-4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4-22.5%) and 4.0% (95% CI 3.2-4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area.

We report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village.

Setting: Tiruvallur District in Tamilnadu, South India, where the World Health Organization-recommended DOTS strategy was implemented as a tuberculosis (TB) control measure in 1999., Objective: To assess the epidemiological impact of the DOTS strategy on the prevalence of pulmonary tuberculosis (PTB)., Design: 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., Results: 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., Conclusion: 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.

Aim: To study the proportion of children infected with Mycobacterium Tuberculosis in Chennai city., Methodology: A cluster sampling methodology was adopted to select an estimated sample size of 7000 children from five corporation zones selected systematically from ten zones of the city. A total of 7098 children aged 1-9 years were subjected to Mantoux and test read; 1897 (27%) from slum area and 5201 (73%) from non-slum area., Results: The prevalence of infection among children without BCG scar was estimated to be 10.5 % (ARTI of 2.0%) and was similar to that among children irrespective of scar status. The prevalence of infection was higher among children in slum areas (11.1%; ARTI 2.1%) compared to non-slum areas (8.9%; ARTI 1.7%); but the difference was not statistically different., Conclusion: The tuberculosis situation in Chennai as measured by risk of infection was higher in urban city area than rural areas and comparable to that found in other cities as reported from earlier studies. This information can be used as baseline information for monitoring the epidemiological trends in Chennai city in future.

Background: Prevalence of tuberculosis (TB) is an important epidemiological index to measure the load of the disease in a community. A series of disease surveys were undertaken in rural community in Tiruvallur district in Tamilnadu, south India, Objective: To investigate the yield of pulmonary tuberculosis (TB) cases by different symptoms status and suggest predominant symptoms for detection of cases in the community based surveys., Methods: Three disease surveys were conducted during 1999-2006, in a random sample of 82,000 adults aged > or = 15 years to estimate the prevalence and incidence of pulmonary TB. All subjects were screened for chest symptoms and chest radiography. Sputum examination was done among those who were either symptomatic or abnormal on X-ray or both. Cases observed through symptom inquiry were included for analysis., Results: In survey-I, 65.6% had cough of > or = 14 days and yielded 79.1% of the total cases. In surveys II and III, symptomatic subjects with cough contributed 69.5% and 69.2% of the cases respectively. In survey I, 26.8% had symptoms without cough but with at least chest pain > or = 1 month contributed 8.4% of total cases. The corresponding proportions in subsequent surveys were 29.3, 11.5%; and 23.4, 11.2% respectively. The number of symptomatics without cough and chest pain but with fever > or = 1 month was negligible., Conclusion: The relative importance of cough as a predominant symptom was reiterated. The yield of pulmonary TB cases from symptomatics having fever of > or = 1 month was negligible. Fever may be excluded from the definition of symptomatics for screening the population in community surveys.

Objective: To estimate survival probabilities and identify risk factors for death of tuberculosis (TB) patients during treatment period., Methods: TB patients registered during May 1999 to December 2004 from a rural TB unit (TU) with a population of 580,000 in Tiruvallur district, South India, formed study population. Life table and Cox's regression methods were used., Results: Of the 3818 TB patients who were initiated on treatment, 96, 94 and 97% of category--I, II and III respectively, were surviving after completion of treatment. Higher death rates were independently associated with patient's age (45 years), previous history of treatment, alcoholism and initial body weight (<35 kgs)., Conclusion: The survival probability was found to be similar in all patients irrespective of categorization. Necessary actions need to be initiated in the programme to improve body weight and abstain from alcoholism.

Objective: To study the impact of improved treatment outcome of a cohort of patients treated under DOTS strategy on the prevalence of pulmonary tuberculosis (TB) in the community., Design: The data from TB register of one Tuberculosis Unit (TU) in Tiruvallur district of Tamilnadu, and two TB disease surveys conducted in the same area during 1999-2003 were analysed. The successful treatment outcome was compared to the prevalence of TB in the subsequent cohort., Results: The proportion of patients who completed treatment successfully was 75.3% in the first cohort period. This higher proportion of treatment success among patients treated under DOTS in the first cohort period (1999-2001) compared to the 51-55% reported during SCC, resulted in a lower prevalence of smear-positive cases, irrespective of culture results observed in the survey conducted during 2001-2003 compared to that in the survey conducted during 1999-2001 (252 vs. 323 per 100,000; annual decline of 9%). Similarly, a decline in culture-positive cases, irrespective of smear results, was also observed (443 vs. 605; annual decline 11%)., Conclusion: The higher proportion of successful completion of treatment after DOTS implementation was associated with a substantial decline in the prevalence of TB. These findings showed that we are in the direction towards achieving the Millennium Development Goals (MDGs).

Objective: To describe the status of cases 2-3 years after the initiation of treatment under DOTS., Setting: After DOTS implementation in Tiruvallur district, south India, we followed up a cohort of smear-positive TB patients registered during 2002-03 after initiation of treatment., Results: The overall mortality rate was 15.0% and among the remaining 18.6% had active disease. In multivariate analysis, a higher mortality rate was independently associated with age, sex, occupation, treatment outcome and initial body weight of patients., Conclusion: The mortality and morbidity rates are still high during follow-up and needs to be curtailed by addressing these issues effectively in TB control programme.

Objectives: To measure the independent association of risk factors age, sex, smoking and alcoholism with pulmonary tuberculosis (TB) in terms of prevalence odds ratio (POR)., Method: A community-based cross-sectional survey was conducted from June 2001 to December 2003. A total of 93945 individuals aged > or = 15 years selected from a random sample of villages in a district from South India were screened for pulmonary TB by chest symptoms and chest X-ray (MMR). Two sputum samples were collected (one spot and one early morning) from patients with chest symptoms and those with abnormal X-rays for examination by microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis. Bacillary cases are bacteriologically positive cases diagnosed by either sputum smear or culture examination. In addition, data on exposure to tobacco smoking and alcohol consumption were collected from the male population only. All females were considered non-smokers and non-alcoholics., Results: A total of 429 bacteriologically positive cases were detected during the survey. The adjusted PORs (with 95%CI) for age, sex, smoking and alcoholism were 3.3 (2.7-4.1), 2.5 (1.9-3.3), 2.1 (1.7-2.7) and 1.5 (1.2-2.0), respectively., Conclusion: Risk factors such as age, sex, smoking and alcoholism are independently associated with pulmonary TB. Risk factors age and sex show a stronger association than smoking and alcoholism.

A cross-sectional socio-economic survey to assess the standard of living index (SLI) of a rural population in South India was undertaken along with a tuberculosis (TB) prevalence survey during 2004-2006. Of 32,780 households, the SLI was low, medium and high in 22%, 36% and 42%, and TB prevalence was 343, 169 and 92 per 100,000 population, respectively, a significant decrease in trend (P < 0.001); 57% of the TB patients had a low SLI and the prevalence of TB was higher amongst the landless (P < 0.001), those living below the poverty line (P < 0.01) and in katcha houses (P < 0.001), suggesting that TB disproportionately affects those with a low SLI.

Setting: A rural population in Tiruvallur district, south India., Objective: To study the variability of skin test reaction sizes between 48 and 72 hours., Methods: A tuberculin test survey was conducted among children aged less than 10 years. The reaction sizes were read by the same reader at 48 hours and 72 hours independently. The results of the tuberculin test were compared., Results: Of 957 children aged below 10 years were included in the study; the male and female ratio was 1: 1.1. There were no significant differences between the readings of reaction size at 48 and 72 hours., Conclusion: The tuberculin test results can be read either at 48 hours or 72 hours without compromising the validity.

Background: Tuberculosis is curable, but community surveys documenting epidemiological impact of the WHO-recommended DOTS strategy on tuberculosis prevalence have not been published. We used active community surveillance to compare the impact of DOTS with earlier programmes., Methods: We conducted tuberculosis disease surveys using random cluster sampling of a rural population in South India approximately every 2.5 years from 1968 to 1986, using radiography as a screening tool for sputum examination. In 1999, DOTS was implemented in the area. Prevalence surveys using radiography and symptom screening were conducted at the start of DOTS implementation and after 2.5 years., Results: From 1968 to 1999, culture-positive and smear-positive tuberculosis declined by 2.3 and 2.5% per annum compared with 11.9 and 5.6% after DOTS implementation. The 2.5 year period of DOTS implementation accounted for one-fourth of the decline in prevalence of culture-positive tuberculosis over 33 years. Multivariate analysis showed that prevalence of culture-positive tuberculosis decreased substantially (10.0% per annum, 95% CI: 2.8-16.6%) owing to DOTS after only slight declines related to temporal trends (2.1% annual decline, 95% CI: 1.1-3.2%) and short-course chemotherapy (1.5% annual decline, 95% CI: -9.7% to 11.5%). Under DOTS, the proportion of total cases identified through clinical care increased from 81 to 92%., Conclusions: Following DOTS implementation, prevalence of culture-positive tuberculosis decreased rapidly following a gradual decline for the previous 30 years. In the absence of a large HIV epidemic and with relatively low levels of rifampicin resistance, DOTS was associated with rapid reduction of tuberculosis prevalence.

Objective: To identify risk factors for non-adherence of tuberculosis (TB) patients to DOT., Methods: Retrospective study of TB patients by logistic regression analysis to identify risk factors for non-adherence., Results: Of the 1666 patients interviewed, 1108 (67%) adhered and 558 (33%) did not adhere to DOT. Of 558 patients, the risk factors associated with non-adherence were illiteracy (39%), difficulty in accessing health facility (57%), and non-government DOT centre (43%)., Conclusion: Patients should be educated about tuberculosis and importance of DOT. All DOT centres, including Non-government DOT centres, should be made more accessible and patient-friendly.

Background: Although case detection is above 70% in Tamil Nadu after DOTS implementation, an assessment of the timeliness of patient diagnosis and treatment is still needed., Objective: To study the health-seeking behaviour of new smear-positive pulmonary tuberculosis (PTB) patients treated at government facilities., Methods: New smear-positive patients diagnosed and treated between January and March 2003 in government facilities of randomly selected blocks in Tamil Nadu were interviewed using a semi-structured interview schedule., Results: Of 601 patients interviewed, 65% contacted a provider within 28 days. The first contact was governmental for 47% and non-governmental for 53%. Median total, patient and provider delays were respectively 62, 28 and 28 days; provider delay was 9 days with government and 50 with private provider. In multivariate analysis, patient delay was significantly associated with smoking (P < 0.001) and mode of travel (P < 0.01), and provider delay with first consultation with a private provider (P < 0.001) and distance > 5 km from the health facility (P < 0.01). Twenty-five per cent of patients took more than two actions before diagnosis., Conclusion: Community awareness of TB needs to be increased. Greater private sector involvement in the Revised National Tuberculosis Control Programme is essential to reduce provider delay. Referral and sputum transportation to the diagnostic facility should be given priority.

Objective: To assess the proportion of patients re-registered after default, failure or successful treatment, completion and evaluate their treatment outcome., Setting: Tuberculosis patients diagnosed were registered for treatment under DOTS in rural area, South India. Patients reregistered during 1999-2004 identified from the TB register were considered for analysis., Results: Among 273 Category-I patients 'defaulted' 23% and among 112 'failure' cases 68% were re-registered. After 'successful treatment completion' of 1796 cases 6.5% were re-registered as relapse. Corresponding figures for Category II were 20% of 281 defaulters; 23% of 60 failures; 12.9% of 302 'successful treatment completion' patients. Among patients re-registered as 'default', subsequent default was also high (57% vs 37%). Failure in Category II treatment was similar among patients who were re-registered for Category II and initially registered in it for treatment. Median delay for reregistration was >200 days for 'defaulters' and 18 days for 'failures'., Conclusion: Our findings emphasise the need for continuing motivation and prompt defaulter retrieval action to reduce default at all stages of treatment. 'Defaulters' need to be contacted so that they can be started on treatment without delay. Patients declared as 'successful treatment completion' should be encouraged to report if chest symptoms recur.

Background and Objectives: Annual risk of tuberculosis infection (ARTI) computed from prevalence of infection measures the extent of tuberculosis transmission in the community and it is used to monitor the tuberculosis control programme. This is usually derived from tuberculin surveys among children not vaccinated with BCG. This study explores whether the estimated ARTI among BCG vaccinated children is comparable to that of unvaccinated children., Methods: Three tuberculin surveys were undertaken among children aged >10 yr as part of assessing the impact of DOTS implemented in Tiruvallur district, south India. The prevalence of infection was estimated using the anti-mode method among vaccinated and unvaccinated children. The ARTI was computed separately and compared in all the three surveys., Results: The prevalence of infection among unvaccinated and vaccinated children in the first survey were 7.8 per cent (95% CI: 7.1-8.6) and 7.9 per cent (95% CI: 7.1-8.8) respectively (ARTI was estimated to be 1.6 per cent in both groups) and the difference was not statistically significant. The corresponding figures for children test read in the second and third surveys were 6.9 per cent (95% CI: 6.2-7.6) and 6.8 per cent (6.0-7.5) and; 6.0 per cent (5.2-6.7) and 6.0 per cent (5.5-6.5) respectively. The computed ARTI was respectively 1.4 and 1.2 per cent among unvaccinated children in the second and third surveys; and 1.4 and 1.2 per cent among vaccinated children in the second and third rounds., Interpretation and Conclusion: There was no difference in the infection with Mycobacterium tuberculosis among vaccinated and unvaccinated children. BCG vaccinated children may thus be included for estimation of infection to assess the extent of transmission in the community as well as for monitoring purpose.

The prevalence of helminth and tuberculosis infections is high in South India, whereas Bacille-Calmette-Guerin (BCG) vaccine efficacy is low. Our aim was to determine whether concurrent helminth infection alters the ability to mount a delayed-type hypersensitivity response to tuberculin. In a cross-sectional study in southern India, individuals 6-65 years of age were screened for intestinal helminths, circulating filarial antigenemia, tuberculin reactivity, active tuberculosis, and history of BCG vaccination; 54% were purified protein derivative (PPD) positive, 32% had intestinal helminth infection, 9% were circulating filarial antigen positive, and 0.5% had culture-confirmed active tuberculosis. Only age and BCG vaccination were significantly associated with PPD reactivity; however, BCG vaccination was associated with a lower prevalence of hookworm infection relative to those without prior BCG vaccination. Neither intestinal helminth infection nor filarial infection was associated with diminished frequencies of PPD positivity. Our findings suggest that preceding helminth infection does not influence significantly the delayed-type hypersensitivity response to tuberculin.

We report the status of bacillary tuberculosis (TB) cases identified in community surveys undertaken at 2.5-year intervals. We observed three cohort periods to represent the different TB control programmes, namely 12-18 months of treatment (pre-short-course chemotherapy [pre-SCC]), 6-8 months SCC and DOTS in the area. There was a significant reduction in deaths from 23% to 17%, and an increase in the proportion of cases negative by smear and/or culture for Mycobacterium tuberculosis, from 54% to 58% in the pre-SCC and SCC cohorts to 80% in the DOTS cohort. These findings suggest that the DOTS strategy could have a significant influence on TB epidemiology.

Objective: To estimate the risk of tuberculosis (TB) infection among children <10 years and assess the impact of a DOTS-based programme., Setting: After DOTS implementation in Tiruvallur district, south India, we undertook three tuberculin surveys and estimated the ARTI among children aged <10 years., Results: The ARTI estimates in the three tuberculin surveys were 1.6%, 1.4% and 1.2%, respectively. There was a significant decline in the trend of TB infection (P < 0.001). The annual decline estimated from the first to the third survey was 6%., Conclusion: DOTS implementation was associated with a substantial reduction in the risk of TB infection among children.

Objective: To validate the currently used empirical relationship between annual risk of tuberculous infection (ARTI) and incidence and prevalence of smear-positive cases., Setting: Two disease surveys to estimate the prevalence and incidence of tuberculosis (TB) among adults in Tiruvallur district, south India, and a tuberculin survey to estimate the ARTI among children., Results: The incidence of TB was estimated to be 82 and prevalence 210 per 100,000 population and ARTI 1.6%. We estimated that 1% ARTI corresponded to 51 new and 131 prevalent cases., Conclusion: The currently used empirical relationship between ARTI and incidence can be used by programme managers as an effective monitoring tool.

Background and Objective: Data on the burden of tuberculosis (TB) in India are vital for programme planners to plan the resource requirements and for monitoring the nation-wide TB control programme. There was a need to revise the earlier estimate on the burden of TB in India based on the increase in population and current epidemiological data. This study estimates the burden of disease for the year 2000 based on recent prevalence of TB and annual risk of tuberculosis infection (ARTI) estimates., Methods: Data on prevalence generated among adults by the Tuberculosis Research Centre (TRC), Chennai, among children by National Tuberculosis Institute (NTI), Bangalore, and the ARTI estimates from the nation-wide sample survey by NTI and TRC were used for the estimation. The prevalence of disease corresponding to 1 per cent ARTI was extrapolated to different parts of the country using the estimates of ARTI and the population in those areas and added together to get the total cases. Abacillary cases that required treatment were estimated from X-ray abnormals. The estimates of bacillary, abacillary and extrapulmonary cases were then combined to get the national burden., Results: The estimated number of bacillary cases was 3.8 million (95% CI: 2.8-4.7). The number of abacillary cases was estimated to be 3.9 million and that for extrapulmonary cases was 0.8 million giving a total burden of 8.5 million (95% CI: 6.3-10.4) for 2000., Interpretation and Conclusion: The present estimate differs from the earlier estimates because we have included the disease burden of X-ray cases that are likely to breakdown to bacillary cases in a one year period, and extrapulmonary TB cases. The current estimates provided baseline information for advocacy and planning resource allocation for TB control activities. Also, these estimates can be compared with that in future years to measure the long term impact of TB control activities in India.

Objective: To identify risk factors associated with relapse among cured tuberculosis (TB) patients in a DOTS programme in South India., Design: Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion., Results: Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95% CI 1.4-4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95% CI 2.0-11.6) and smoking (aOR 3.1; 95% CI 1.6-6.0). The relapse rate among non-smoking, treatment adherent patients with drug-sensitive organisms was 4.8%., Conclusions: The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking.

Setting: Twenty-six selected districts in India., Objectives: To estimate the average annual risk of tuberculous infection (ARTI) in four defined zones in the country., Study Design: A tuberculin survey was conducted in selected clusters of 26 districts in four defined zones of India. Children 1-9 years of age were subjected to tuberculin testing with ITU PPD RT23 with Tween 80, and the maximum transverse diameter of induration was measured 72 h later. Prevalence of infection was estimated using the cut-off point method (Method I) and the mirror-image technique (Method II) among children without bacille Calmette-Guérin scar. Results from individual zones have been reported earlier, and the results from all four zones are presented here as a consolidated summary., Results: The ARTI computed from estimated prevalence was found to be lowest in the southern zone (Method I: 1.1%, Method II: 1.0%). It was higher in the eastern zone (1.3% by both methods) and highest in the western (Method I: 1.8%, Method II: 1.6%) and northern zones (1.9% by both methods). The proportion of infected children was found to be significantly higher in urban than in rural areas in all zones., Conclusion: The intensified tuberculosis control efforts need to be sustained for many years.

Objective: To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986., Methods: The entire population of Car Nicobar was enumerated through a house-to-house survey. Children aged <14 years were tuberculin tested and read for reaction sizes. Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms. Sputum samples were examined for presence of acid-fast bacilli., Findings: Among the 4,543 children enumerated, 4,351 (95.8%) were tuberculin tested and read. Of the 981 children without bacille Calmette-Guerin scars, 161 (16.4%) were infected with TB. A total of 77 cases who were smear-positive for TB were detected from among 10,570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100,000. The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100,000, respectively., Conclusion: The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002. Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community. The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures. High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures.

Settings: A general hospital and three peripheral health institutions (PHI) in Tiruvallur District, south India., Objective: To validate the case detection strategy for diagnosis of pulmonary tuberculosis by smear microscopy of two sputum specimens versus three., Methods: In the Revised National Tuberculosis Control Programme (RNTCP), three smears from every symptomatic patient attending the PHI were examined for acid-fast bacilli (AFB) by Ziehl-Neelsen (ZN) microscopy. The data from the Tuberculosis Laboratory Registers from the above centres were analysed., Results: Of 7843 chest symptomatics who had provided three sputum specimens for examination, 895 (11.4%) were smear-positive on at least two specimens. Examination of two specimens--first spot and early morning specimens (837, 93.5%) or early morning and second spot specimens (843, 94.2%)--yielded the highest number of cases., Conclusion: The examination of two sputum smears (one spot and an early morning) is as effective as examination of three smears.

Objective: To estimate the annual risk of tuberculosis infection (ARTI) among children aged 1-9 years in the south zone of India., Setting: The survey was carried out in a representative sample of villages and census enumeration blocks of towns in four south Indian states, as a part of a nationwide tuberculin survey., Design: Six districts were selected through systematic random sampling. Four hundred and twenty rural clusters and 180 urban clusters were selected from these districts on the basis of the rural-urban ratio in the entire zone. To obtain the required sample of 12,000 children without bacille Calmette-Guérin (BCG) vaccination, 51,000 had to be covered. Eighty-five children from each cluster were tuberculin tested and read for reaction sizes. The ARTI was computed from the estimated prevalence of TB infection among children without a BCG scar., Result: Among 52,951 children registered for the study, 50,846 (96%) had a tuberculin test result. The BCG coverage for the study population was about 65%. Among 17,811 children without a BCG scar, the prevalence of infection was 5.9% (95%CI 4.0-7.7%); the corresponding ARTI was 1.0% (95%CI 0.7-1.4%) [correction]., Conclusion: The estimated ARTI for the south zone is 1.0%, as compared to the national average of 1.7% used for programme evaluation. This baseline information should be useful for the assessment of future trends.

Setting: Tiruvallur District, south India., Objectives: To examine gender differences in tuberculosis among adults aged >14 years with respect to infection and disease prevalence, health care service access, care seeking behaviour, diagnostic delay, convenience of directly observed treatment (DOT), stigma and treatment adherence., Methods: Data were collected from 1) community survey, 2) self-referred out-patients seeking care at governmental primary health institutions (PHIs), 3) tuberculosis suspects referred for sputum microscopy at PHIs, and 4) tuberculosis patients notified under DOTS. Community survey results were compared with those for patients notified at PHIs., Results: In the community, 66% of males and 57% of females had tuberculosis infection. The prevalence of smear-positive tuberculosis was 568 and 87/100,000, respectively, among males and females. Fewer males than females attended PHIs (68 men for every 100 women). Females constituted 13% of all smear-positive patients detected in the community survey, and 20% of those detected at PHIs (P < 0.05). The probability of notification decreased significantly with age among both males and females. Significantly more females than males felt inhibited discussing their illness with family (21% vs. 14%) and needed to be accompanied for DOT (11% vs. 6%). Males had twice the risk of treatment default than females (19% vs. 8%; P < 0.01)., Conclusions: Despite facing greater stigma and inconvenience, women were more likely than men to access health services, be notified under DOTS and adhere to treatment. Men and elderly patients need additional support to access diagnostic and DOT services.

Objective: 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., Methods: 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., Results: 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., Conclusion: 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.

Background: In Tiruvallur District, South India, tuberculosis cases are detected at health facilities (HF) as part of a DOTS programme, and by screening adults through community survey (CS) as part of ongoing epidemiological research., Objective: To compare socio-demographic, clinical and bacteriological characteristics and treatment outcomes of all patients detected at HF with those of all patients detected by CS during a 12-month period., Results: Of 32,663 adults surveyed, 100 had smear-positive and 116 had smear-negative tuberculosis; of 65 smear-positive patients who began treatment, 44 were cured. Compared to HF patients, CS patients were significantly more likely to be older (AOR = 1.9), male (AOR = 2.7), non-literate (AOR = 1.7), and living in poor quality housing (AOR = 2.0), and were less likely to have cough >3 weeks (AOR = 3.4) or smear-positive tuberculosis (AOR = 4.2). Of 61 new smear-positive CS patients, 40 reported chest symptoms; of these, 32 (80%) had already consulted a health-care provider, but remained undiagnosed., Conclusions: The community survey was of little value in tuberculosis case detection even in this high-prevalence setting. Patients identified by the survey were less symptomatic and less infectious, and less than half were cured. Diagnostic services should be made more accessible to the elderly, the non-literate and men.