nene key operations (Table 5). Some of them have been already at hand, or almost so in Nepal, but many remain to be fulfilled. Among others, for example, #8.
Supervision at the district and health station level is an urgent issue.
Table 5 Key Operations of a National TB Programme (WHO)
1) Establish an NTP with a Central Unit
2) Prepare a programme manual
3) Establish the recording and reporting system
4) Initiate a training programme
5) Establish a microscopy service with QC of smear microscopy, training and supervision
6) Establish treatment services
7) Secure a regular supply of drugs and diagnostic material
8) Design a plan of supervision of the key operations
9) Prepare a project development plan for the NTP
National Tuberculosis Seminar, Hanoi, Vietnam February,1997
Global Tuberculosis Epidemiology and Vital components in NTP
Toru Mori, M.D (Research Institute of Tuberculosis)
1. Global burden of tuberculosis
〇 Annual Risk of Infection
〇 Prevalence of Infection, age specific
〇 Age-composition of the infected persons in the population
〇 Age-composition of new tuberculosis patients
〇 Economic and sociological impact
〇 Prediction of tuberculosis cases and deaths
〇 Impact of HIV epidemics
〇 Causes causing "Global TB Crisis (WHO)"
Table 2 Factors causing the "Global Crisis" (WHO)
- Neglect of TB by the government
- Poorly managed and incorrectly conceptualized control program causing failures
- Demographic factors
- HIV epidemics
2. TB Control concept viewed from an Epidemilogy Model
a) A Model of Natural History of Tuberculosis
〇 Pool of Infection -Clinical breakdown
〇 Cases-Average duration of disease (Fate of case; Death & Cure)
〇 New infection -Infectivity
b) Intervention with control measures
〇 BCG vaccination
〇 chemoprophylaxix
〇 Case-finding and Chemotherapy, Case-lading/Motivation
〇 Isolation(?)
c) Importance of successful treatment services
Table 3 Targets for Global TB Control (WHO)
to cure 85% of the new smear positive TB cases, and
to detect 70% of exciting cases by the year 2000
N.B Do not produce MDR TB by giving priority to case/finding before achieving good treatment programme.
