RESEARCH REPORT ON

Effectiveness of parents Teachers Council in primary

Education System at Tehsil Khall Dir (L)

M.A Sociology

Submitted By
Azmat Bari
Roll #: 04
Submitted To:

Mr. Abdul Hameed

UNIVERSITY OF PESHAWAR
DEPARTMENT OF SOCIOLOGY
Session: 2013-2014

RESEARCH REPORT ON

PREVALANCE OF TUBERCULOSIS IN
THE URBAN SLUMS OF DISTRICT PESHAWAR

Submitted By
MR. SHOAIB MUHAMMAD
Registration#: 2011-NCSP-361

Supervised By:
Dr. Khalid Masud
Submitted to the Department of Management Sciences, NCS university System Peshawar.
In partial fulfillment of the requirement for the degree of master in Public Health

NCS University System Peshawar

Department of Management Science
Affiliated With
UNIVERSITY OF PESHAWAR

University of Peshawar
Approval Sheet
The thesis of Mr. Shoaib Muhammad has been approved

Supervisor:
Dr. Khalid Masud

______________________

Dated:

_______________________

External Examiner:
_______________________

Name:

_______________________

Signature:

_______________________

Dated:

_______________________

Counter Signed By:

_______________________
Director

TABLE OF CONTENTS
S.No

CONTENTS

P.No

List Of abbreviations and definitions

iii

List of tables

viii

List of Figures

ix

Acknowledgement

CHAPTER-I
I

Introduction

4
CHAPTER-2

AIM AND OBJECTIVES

2.1

Aim of the study

2.2

Objectives of the study

CHAPTER-3
HISTORICAL_PERSPECTIVE
3.1

A history of tuberculosis chemotherapy

10

3.2

Chemotherapy today

11

3.3

TB and poverty

12

3.4

TB and children

14

3.5

TB and women

16

3.6

TB Migrants, and refugees

17

3.7

TB and substance abuse

19

3.8

TB and HIV: Dual epidemic, double discrimination

21

3.9

Tuberculosis infection and transmission

22

3.10

Global and regional incidence

23

3.11

How to identify 1,TB suspects

24

3.12

Drug-Resistant TB

25

3.TB

Directly observed treatment short course (DOTS)

26

3.14

Why expand the dots framework?

28

3.15

Goals, targets and guiding principles

29

3.16

The expended strategic framework

30

3.17

Magnitude of the problem

37

CHAPTER-4
LITERATURE REVIEW
Literature Review

40

CHAPTER-5
STUDY DESIGN
5.1

Sampling

43

5.2

Inclusion criteria

44

CHAPTER-6
METHODOLOGY
6.1

Data collection methods

48

6.2

Data analysis

48

6.3

Procedure in the field

48

CHAPTER-7
RESULTS AND_DISCUSSION
7.1

Results

49

7.2

Discussion

74
CHAPTER-8

CONCLUSION AND RECOMMENDATION

Conclusion

76

Recommendation

76

Summary

79

References

80

LIST OF ABBREVIATIONS AND DEFINITIONS

BHU:

Basic health unit.

BCC:

BacilIa -Calmette Guerin, A live vaccine against TB derived from an attenuated

strain of M. bouis by two French doctors, Calmette and Guerin.
Bacilli Long rod shaped bacteria.

C.D:

Civil dispensary.

C.II:

Civil Hospital.

Cured:

Initially sputum smear positive patient who has completed the treatment (eight
months) and is sputum smear negative in the last month of treatment and on at
least one previous occasion,

Completed:

Sputum smear positive cases who completed treatment. With negative smears at
the end of initial phase, but with no or only one negative sputum examination in
the Continuation phase and none at the end of the treatment. Or sputum smears
negative patients, who received a full course treatment,

Death:

Patient died during treatment regardless cause.

Defaulter:

A patient who returns to treatment after having interrupted treatment for two
months or Inure.

DOTS:

Directly observed treatment Short Courses,

DTO:

District Tuberculosis office.

Extra- pulmonary tuberculosis:

TB of organs other than the lungs. TB of the pleura (TB pleurisy) of peripheral
Iymphnodes, abdomen, genito urinary tract, skin, joints and bones Tuberculosis.
Meningitis).
Failure Case: Smear positive case that remained or became again smear positive, five months or
later after commencing treatment.
OR
Smear negative patient found smear positive at the end of 2nd month,
Re-Treatment Cases:
Re-treatment cases are previously treated cases (for at least four weeks) including
failures, relapses, defaulters who returned to the health services, with positive

sputum smear examination. All should be put on fully supervised re-treatment

regimen.

Pulmonary Tuberculosis, Smear Negative (PTB-):

Tuberculosis in a patient with symptoms suggestive of tuberculosis and at least
three sputum examination negative for AFB. And radiographic abnormalities
consistent with active pulmonary tuberculosis determined by a medical officer
followed by a decision to treat the patient with a full course of anti- tuberculosis
therapy. OR: Diagnosis based on positive culture but negative AFB sputum
examination.

Pulmonary tuberculosis, smear positive (PTB):

Tuberculosis in a patient with at least two initial sputum smear examinations
(direct smear microscopy) positive for Acid Fast Bacilli (AFB+)
OR
Tuberculosis in a patient with one sputum examination positive for AFB+ and
radiographic abnormalities Consistent with active pulmonary tuberculosis as
determined by the treating medical officer. OR: Tuberculosis in a patient with one
sputum specimen positive for AFB+ and culture positive for AFB+

Smear Examination for Tubercle Bacilli:

A laboratory technique for seeing mycrobateriurn under the microscope.

Spot - Specimen:
A sputum specimen, which is collected on the spot when a patient is suspected of
having tuberculosis. This specimen is collected under the supervision of a health
worker.

Sputum-Specimen:
Material brought out by coughing from the respiratory system and used for
bacteriological examinations.

T.B:

Tuberculosis.

Transferred in:
A patient who has been received into a reporting unit, having commenced
treatment and already recorded in another unit.

Transferred out:
A patient who has been transferred to another reporting unit i.e. transferred from
one diagnostic center to another diagnostic center.
FLCF:
First level care facility
HIV infection:
Inflation caused by Human immune Deficiency Virus the virus is transmitted
through sexual intercourse, blood and bloods products and form mother to child.
Causing server immune deficiency and resulting In opportunistic that often cause
death.
Incidence:

The number of new cases of a disease in a defined population during a

specified period of time (usually one year)

Mycobacterium Tuberculosis:
The bacterium that causes tuberculosis (often abbreviated as M. Tuberculosis)
M. bovid, M. Africana, together with M. tuberculosis constitute the M.
tuberculosis complex.
New case:

A patient who has never had treatment for tuberculosis drugs for less than four
weeks

Other Cases: Patient who do not fit to the above mentioned categories.
Percentage: A part of a whole expressed in hundreds (if 50% is the percentage of people that
are male. it means that 50 out of 100 are male).
Preventive:

The number of new- case + the number of old cases present in the area for a
spiffed time

Preventive-Chemotherapy:
The treatment of person with a high risk of developing tuberculosis who have no
signs or symptoms of clinically or radio logically active tuberculosis, in order to
prevent them from developing the disease. The currently used drug for preventive
chemotherapy is ionized in a dose of 5 mg/kg/day, give for 6-12 months

Relapse:

A patient declared cured but reports back to the health service bacteriological
positive.

LRH:

Lady reading hospital.

LIST OF FIGURE

Fig# Title

P.No

1.

DOTS population coverage

Treatment success rate

35

3.

DOTS case detection rate

35

4.

Disease classification ( CD Shaheen Muslim Lawn) 48

5.

Patient Type ( CD Shaheen Muslim town)

49

6.

Category of patient ( CD Shaheen Muslim town)

50

7.

Disease classification (TBC Gunj)

52

8.

Patient Type (TBC Gunj)

53

9.

Category of patient (TBC Gunj)

54

10.

Disease classification (BHU Pandher)

56

11.

Patient Type (BHU Pandher)

57

12

Category of patient (BHU Pandher)

58

TB

Disease classification (CD Akhoon Abad)

60

14

Patient Type (CD Akhoon Abad)

6!

15

Category of patient ( CD Akhoon Abad)

62

16

Disease classification (CD Zargar Abad)

64

17

Patient Type (CD Zargar Abad)

65

18

Category of patient (CD Zargar Abad)

66

19

Disease classification ( Afghan colony)

68

20

Patient Type (Afghan colony)

69

21

Category of patient (Afghan colony)

70

LIST OF TABLES

Table # FIGURE

P.No

I.

Estimated TB incidence and mortality. 2002

Estimated incidence of Pulmonary tuberculosis 3

No. of TB cases notified in DOTS area in 2002 39

Facilities surveyed and their population

44

Health facilities/centers of district Peshawar

45

Diagnostic centers in district Peshawar

46

Treatment centers in district Peshawar

47

AKNOWLEDGEMENT
I am grateful to Almighty Allah for giving me the health, courage, and determination to complete
my post graduation.

I express my deep sincere gratitude to my supervisor Dr Khalid, for the valuable suggestions and
precious guidance I received from him during the entire research process, I was always provide
an opportunity and adequate time for consultation from him whenever I faced problems relatives
to the study:

I would like to express my sincere thanks to all those who gave me a lot of help and support
during my thesis.
1 am also very much thankful to National College of Sciences for granting me the opportunity
for participation in the MPH course. I would like to express my sincere gratitude to all
colleagues and friends who have always encouraged and helped me during the course.
At the end I will like to say thanks to my parents whose best wishes and prayers lead me towards
success.

Abstract
Tuberculosis (TB) kills approximately 2 million people each year. The global epidemic is
growing and becoming more dangerous. The breakdown in health services, the spread of
HIV/AIDS and the emergence of multidrug-resistant TB are contributing to the worsening
impact of this disease.
In 1993, the World Health Organization (WHO) took an unprecedented step and declared
tuberculosis a global emergency, so great was the concern about the modern TB epidemic.
It is estimated that between 2002 and 2020, approximately 1000 million people will be newly
infected, over 150 million people will get sick, and 36 million will die of TB
-if control is not further strengthened.

Multiple factors contribute to the global increase in TB. Infection with the human
Immunodeficiency virus (HIV), which causes Acquired Immunodeficiency Syndrome (AIDS), is
the single greatest risk for progression of TB infection to disease. People with HIV have
weakened immune systems that increase their susceptibility to TB. And in these people, TB often
progresses rapidly from the primary to the secondary stage. The increase of TB incidence is
highest in Africa and Asia, areas with the highest number of people infected with HIV.

In most part of the world, more men than women are diagnosed with TB and die from it.
TB is nevertheless a leading infectious cause of death among women. In 1999. About threequarters of a million women died of TB, and over three million contracted the disease,
accounting for about 17 million Disability Adjusted life Years (DALY). As tuberculosis
effective women mainly in their economically and reproductively active years, the impact of the
disease is also strongly felt by their children and families. The mortality, incidence, and DALY
indicators do not reflect this hidden burden social impact. (WHO, 2000).