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ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 5  |  Page : 460-464  

Profile of the tuberculosis patients enrolled in Nikshay portal (a web-based online portal) from Chittoor district: A monitoring tool for tuberculosis in India


1 Department of Community Medicine, ESIC Medical College, Sanath Nagar, Hyderabad Departmentof Community Medicine, Apollo Medical College, Chittoor, Andhra Pradesh, India
2 Government General Hospital, Chittoor, Andhra Pradesh, India

Date of Submission26-Jun-2019
Date of Decision17-Jan-2020
Date of Acceptance26-Jun-2020
Date of Web Publication7-Sep-2020

Correspondence Address:
K R John
Department of Community Medicine, Apollo Institute of Medical Sciences, Murukambattu, Chittoor - 517 127, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_183_19

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  Abstract 


Background: The Revised National TB Control Programme developed a case based web-based online reporting mechanism called NIKSHAY. A community-based survey conducted in 2011 reported that 46% of the tuberculosis (TB) patients in India were treated outside the public health system (private sector) and hence they are not the part of the national TB notification system. Methodology: The objective of the study was to assess the profile of the TB individuals in the Chittoor district in Andhra Pradesh, south India. A secondary data were retrieved from the district TB center NIKSHAY web-based online portal in Chittoor and analyzed using SPSS 21.0 version. Data were taken from the last 1 year (April 2017 to March 2018). Results: A total of 3952 individuals were registered in the web based online NIKSHAY portal during the study. Among them in 2918 (73.7%) were males and 1033 (26.2%) were females with the mean age of the patients was 44.6 years with a standard deviation of ± 16.3 ranges. The clinically confirmed cases were 587 patients and microbiologically positive were 2495 (79.8%) and negative were 633 (20.2%). Majority 3263 (82.5%) were had pulmonary and 452 (11.4%) had extra-pulmonary TB. Depending on the HIV-positive cases were 274 (6.9%) and 3560 (90.2%) were negative and the remaining 118 (2.9%) do not know the status of the HIV/AIDS. The CBNAAT results were 411 (10.5%) of the patients had rifampicin sensitivity and 26 (0.6%) of them were resistant. Conclusion: India had taken the nice initiative for the web-based online portal for the notification of the TB patients. Several ongoing efforts have been implemented to improve the quality of surveillance reporting. A series of trainings on quality assurance of TB data should be taken to all the field staff.

Keywords: Nikshay, notification, tuberculosis


How to cite this article:
Babu D S, John K R, Babu R. Profile of the tuberculosis patients enrolled in Nikshay portal (a web-based online portal) from Chittoor district: A monitoring tool for tuberculosis in India. Med J DY Patil Vidyapeeth 2020;13:460-4

How to cite this URL:
Babu D S, John K R, Babu R. Profile of the tuberculosis patients enrolled in Nikshay portal (a web-based online portal) from Chittoor district: A monitoring tool for tuberculosis in India. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Oct 22];13:460-4. Available from: https://www.mjdrdypv.org/text.asp?2020/13/5/460/294345




  Introduction Top


INDIA accounts for nearly a quarter of the global burden of tuberculosis (TB) cases. In 2012, the Government of India included TB in the list of notifiable diseases. Subsequent to this decision, it launched “NIKSHAY,” a web-enabled system, with the aim of increasing case notification and tracking TB cases. While NIKSHAY's implementation is still in its early days, a recent report has noted that, since its implementation, case notification from the private sector has increased from 0.2% to nearly 2.6%.[1] Across the globe, nearly three million TB cases are estimated to be missed by national notification systems, of which nearly one million are in India.[2] A community-based survey conducted in 2011 reported that 46% of the TB patients in India were treated outside the public health system (private sector) and hence are not part of the national TB notification system.[3] A diverse private health sector is known to manage over 50% of these cases, either partly or completely, 1 yet its contribution in overall case notification remains only 0.2% (3533) of 1,467,585 notified cases in 2012.[4] This observation raises questions about its operational implementation, especially considering the proportion of patients managed by the private sector. In many parts of India, including rural and tribal areas, unavailability of computers and poor internet connection remain major challenges. It is therefore imperative to design a robust and detailed electronic recording and reporting system, based on the World Health Organization guidelines.[5] Globally, one-third of the nearly 9 million people are estimated to fall ill with TB each year and many out of them could not be reached by TB program. This “missing” patient, of population over 3 million, has stubbornly remained unchanged since 2007.[6]

Objective

The objective of the study was to assess the profile of the different categories of TB patients in the Chittoor district in Andhra Pradesh, south India, who are registered in the NIKSHAY web-based online portal.


  Methodology Top


It is a descriptive retrospective study was done from the data retrieved from the NIKSHAY portal of District Tuberculosis Centre, Chittoor. The secondary data of the Nikhay online portal under RNTCP were analyzed to enumerate all the variables in the web-based portal. The data retrieved from April 1, 2017, to March 31, 2018 from the portal. NIKSHAY was launched in India[7] on June 4, 2012 by the government of India. As of now more than 3.6 lakh TB patients have been registered. Details of 34,261 Designated Microscopic Centres/Peripheral Health Institutions, 2268 TB units, 629 District Tuberculosis Office (DTO) and 53 STO are available. Notification means reporting about information on diagnosis and/or treatment of TB cases to the nodal Public Health Authority (for this purpose) or officials designated by them for this purpose. Every health-care providers meaning clinical establishments run or managed by the government (including local authorities), private, or NGO sectors and/or individual practitioners.[4] The NIKSHAY portal was started in May 2017 in the DTO in Chittoor district. We had taken permission from the DTO before retrieving the data from the data entry operator. Since this study was a review of reports pulled from the “Nikshay” database and did not involve patient interaction, individual patient consent was deemed unnecessary. Data retrieved electronically in Microsoft-Excel and analysis was done using IBM SPSS Statistics 21.0 version (Armonk, NY: IBM Corp). The data were expressed in frequency and proportions and mean distribution of all types of TB patients.


  Results Top


A total of 3952 individuals were registered in the web-based online NIKSHAY portal during the study by different health personnel from different villages and mandals of Chittoor district. Among them, in [Figure 1] [Table 1], 2918 (73.7%) were male and 1033 (26.2%) were female and only one individual was transgender, respectively. The mean age of the patients was 44.6 years with a standard deviation of ± 16.3 ranges from 2 to 95 years. More than half 1611 (52.0%) of the patients were between the ages 36–60 years. Only 0.9% of them were <10 years and 7.1% of them were adolescence age group and 562 (17.6%) of them were belongs to geriatric, i.e., more than 60 years of age group.
Table 1: Distribution of tuberculosis patients according to the age

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Figure 1: Distribution of tuberculosis patients according to the age

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[Table 2] shows that TB cases confirmed clinically were 587 patients and microscopy positive were 2495 (79.8%) and negative were 633 (20.2%) and unknown results were 237 (5.9%). Those who underwent new sputum smear microscopy; the conversion rate was 2495 (79.8%). More than three-fourth 3021 (76.5%) of the patients were new cases, 335 (8.4%) were recurrent cases, 85 (2.5%) were failure cases, 121 (3.1%) were lost to follow-up and 3.9% were others and 5.9% were waiting for the report, respectively. Among them, majority 3263 (82.5%) were had pulmonary TB and 452 (11.4%) had extra-pulmonary TB and the remaining 237 (6%) of them were not mentioned any out of the two. Among registered cases HIV-positive status was 274 (6.9%) and 3560 (90.2%) were negative and the remaining 118 (2.9%) do not know the status. The other associated comorbid condition status [Table 3] 206 (5.2%) of the patients were confirmed cases of diabetes and 1805 (45.6%) of them was nondiabetic and 1608 (40.6%) of them do not know the status of the diabetes. The rifampicin sensitivity and resistance was done with the help of the CBNAAT, out of them 411 (10.5%) of the patients had rifampicin sensitivity and 26 (0.6%) of them were rifampicin resistant and remaining 88.9% of them not underwent the test. Details regarding the treatment outcome only 66 (1.6%) of them were cured, 46 (1.1%) were treatment completed and majority 3817 (96.8%) were undergoing treatment.
Table 2: Distribution of tuberculosis cases according to the type of diagnosis (n=3952)

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Table 3: Distribution of participants according to the diabetic status, site, CBNAAT results and treatment outcome

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  Discussion Top


The present study illustrates the diagnostic, treatment, and supportive services provided in TB management by retrieving the patient information as reported in Nikshay portal. In order to ensure proper TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of drug resistance-TB, it is essential to have complete information of all TB cases.[7] Although active state level initiatives have led to increase in TB case notification, not much improvement is seen in number of PPs notifying the cases. Lack of regulatory measures at policy level and lack of awareness among private health care providers are major challenges in TB notification implementation.[8] Public health efforts thus need to be aligned through a framework of complementary measures, both regulatory and enabling, that promote an adequate level of vigilance.[9] Previous studies have looked into the causes of delay and programmatic challenges related to knowledge assessment and gaps of private health care providers on notification.[10],[11],[12] However, there is limited information on the utility of existing TB notification mechanisms through ICT-based applications for improving TB notification.

The present study shows that the district has nearly achieved the targets of the RNTCP with respect to cure rate (80%) in the year 2017. However, the district is still lagging behind in new sputum-positive case detection rate (79%) for the year 2017–2018. All patients diagnosed and put on daily regimen in public sector since October 30, 2017 throughout the country. As at the field level, the implementation of this newer initiative calls for increasing the human resource base of the program; hence, a separate cadre of qualified paramedical staff in urban areas who would regularly visit the practitioners, support them in collecting data, facilitate the diagnosis and treatment of TB patients for at least the next 5 years poses to be the pragmatic solution. The program needs to develop simple user friendly mechanism to report TB notification.[7]

Providing free anti-TB drugs to practitioners for the patients will be a good approach promoting both notification and rational treatment while reducing out of pocket expenditure of the patient. Notification should not be a one way process and there should be a process of acknowledging and providing necessary feedback to the notifying practitioner, which does not currently happen.

According to the annual TB report India 2018, the incentives of Rs. 1000 will be provided for the notification of TB patients. This will be given at Rs. 500 at notification and Rs. 500 for reporting provided on notification in the TB reporting software, i.e., Nikshay through a smooth and transparent manner by direct benefit transfer mechanism.

Considering the extent of changes the US TB Surveillance System[13] underwent in 2009, TB surveillance data have maintained a high level of completeness, with most data elements showing the same levels of completeness after 2009. New data elements, for which collection and reporting began in 2009 for most reporting jurisdictions, have varied completeness but show an overall improvement from 2009 to 2012. Some new data elements are taking longer to reach a high percentage of completeness at the state and local levels, or are less complete or less concordant in 2012 than they were in 2009. Similarly, in India, the chances of missing data were also present in the Nikshay portal entered by the STS and STLS and other field staff.

The National Notifiable Diseases Surveillance System (NNDSS)[14] is a nationwide collaboration that enables all levels of public health - local, state, territorial, federal, and international - to share notifiable disease-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions and outbreaks. NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels. NEDSS standards help connect the health-care system to public health departments and those health departments to CDC by ƒ defining the content (i.e., disease diagnosis, risk factor information, laboratory confirmation results, and patient demographics) of messages sent using the Health Level Seven messaging standard.

Conclusion:

India had taken the nice initiative for the web-based online portal for the notification of the TB patients. Several ongoing efforts have been implemented to improve the quality of surveillance reporting. A series of trainings on quality assurance of TB data should be taken to all the field staff.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Government of India. TB India 2014. Revised National TB Control Program Annual Status Report 2014. New Delhi, India: Government of India; 2014.  Back to cited text no. 1
    
2.
Satyanarayana S, Nair SA, Chadha SS, Shivashankar R, Sharma G, Yadav S, et al. From where are tuberculosis patients accessing treatment in India? Results from a cross-sectional community based survey of 30 districts. PLoS One 2011;6:e24160.  Back to cited text no. 2
    
3.
Ministry of Health and Family Welfare. Central - TB Division, Annual Status Report-TB India; 2014.  Back to cited text no. 3
    
4.
Uplekar M, Pathania V, Raviglione M. Private practitioners and public health: Weak links in tuberculosis control. Lancet 2001;358:912-6.  Back to cited text no. 4
    
5.
World Health Organization. Global Tuberculosis Control, Report 2013. WHO/HTM/TB/2013.11. Geneva, Switzerland: World Health Organization; 2013.  Back to cited text no. 5
    
6.
Improving Tuberculosis Case Detection, A compendium of TB Reach Case Studies, Lessons Learned and Amonitoring and Evaluation Framework. Stop TB Partnership. Geneva, Switzerland: UNOPS; 2014. Available from: http://www.stoptb.org/assets/documents/news/TBCaseStudies.pdf. [Last accessed on 2015 Aug 25].  Back to cited text no. 6
    
7.
National Informatics Centre. Notification of Tuberculosis. Press Information Bureau, Government of India; 2012. Available from: http://pib.nic.in/newsite/erelease.aspx?relid=83486. [Last accessed on 2015 Aug 25].  Back to cited text no. 7
    
8.
Nagaraja SB, Achanta S, Kumar AM, Satyanarayana S. Extending tuberculosis notification to the private sector in India: Programmatic challenges? Int J Tuberc Lung Dis 2014;18:1353-6.  Back to cited text no. 8
    
9.
Lönnroth K, Migliori GB, Abubakar I, D'Ambrosio L, de Vries G, Diel R, et al. Towards tuberculosis elimination: An action framework for low-incidence countries. Eur Respir J 2015;45:928-52.  Back to cited text no. 9
    
10.
Philip S, Isakidis P, Sagili KD, Meharunnisa A, Mirithynjayan S, Kumar AM. “They know, they agree, but they don't do” – The paradox of Tuberculosis case notification by private practitioners in Alappuzha district, Kerala, India. PLoS One 2015;10:e0123286.  Back to cited text no. 10
    
11.
Gawde N. Do we need notification of tuberculosis? A publichealth perspective. Indian J Med Ethics. 2013;10:56-8. Availablefrom: http://ijme.in/index.php/ijme/article/view/80/2617. [Last accessed on 2015 Aug 23]  Back to cited text no. 11
    
12.
Revised National TB Control Programme. Annual Status Report, India TB Report; 2018.  Back to cited text no. 12
    
13.
Yelk Woodruff RS, Pratt RH, Armstrong LR. The US national tuberculosis surveillance system: A descriptive assessment of the completeness and consistency of data reported from 2008 to 2012, JMIR Public Health Surveill 2015;1:E15.  Back to cited text no. 13
    
14.
Centers for Disease Control and Prevention (US). National Notifiable Diseases Surveillance System (NNDSS). Atlanta, GA: Centers for Disease Control and Prevention; 2015.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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