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Laboratory Network under RNTCP

National Reference Laboratories (NRL): Six NRLs under the programme:
1. National Institute for Research in TB, Chennai
2. National TB Institute (NTI), Bangalore
3. Lala Ram Swarup Institute of TB and Respiratory Ds, Delhi
4. JALMA Institute, Agra
5. Regional Medical Research Centre, Bhuvneshwar
6. Bhopal Memorial Hospital, Bhopal
Lab committee of the National labs supervises and directs the state level ‘Intermediate Reference Labs’

RNTCP Structure

RNTCP Structure
The structure of RNTCP comprises of 5 levels
1. National
2. State
3. District
4. Sub – District
5. Peripheral health institutions

1. National: Central TB Division
• Programme Manager/DDG(TB)
• Plans/Supervises/Monitors/Evaluation
• National Committee on TB Diagnosis and Treatment
• National Laboratory Committee
• National Technical Working Group for TB/HIV
• National Institutes Etc.

Evolution of Revised National TB Control Program (RNTCP)

• The National Tuberculosis Programme of India (NTP) was initiated in 1962 and was originally designed for
– Domiciliary treatment, using self- administered standard drug regimens.
• A review of the programme in 1992 concluded that the NTP was poorly managed, inadequately funded and could not achieve TB control
– Treatment success rates was unacceptably low
– Over-reliance on X – ray for diagnosis
– frequent interrupted supplies of drugs
– Default rates remained high
– Death rates due to TB were still high

TB Control Faces Daunting Challenges in India

• Decades of unrestrained transmission has left hundreds of millions of Indians with latent TB infection, which may re-activate at any time.
• A significant proportion of the population is undernourished, which weakens immunity and drives TB reactivation.
• A considerable number more suffer from risk factors for tuberculosis,
– Diabetes,
– Indoor air pollution from cook stoves, or smoking.
• The dense, growing urban environment facilitates the transmission of the disease cutting across all economic strata.

TB in Pregnancy and Lactation

Before initiating treatment for TB in women, she should be asked about current or planned pregnancy
• EXCEPT Streptomycin, all first line anti –TB drugs are safe for use in pregnancy
–Streptomycin is ototoxic to the fetus and should not be used during pregnancy

In case of MDR –TB: Test for pregnancy
• If not pregnant advised to use birth control
– OCPs should be avoided
– Use of barrier methods or IUD is recommended

Integrated Management of Neonatal and Childhood Illness (IMNCI)

• The most common causes of infant and child mortality in developing countries (including India) are:
– Acute respiratory infections
– Diarrhoea
– Malaria
– Measles and
– Malnutrition
• Making a single diagnosis may not be feasible or appropriate
– Because many children present with overlapping signs and symptoms of diseases
– Clinical outcome depends upon treating not only the immediate presenting symptom but the underlying disorders as well

Role of Genetic Predisposition in Common Disorders

• Some traits like intelligence, physical ability and longevity are genetically determined but the effect of external and environmental influences are the main determinants of health and survival
• With increased control of environment, genetic makeup is becoming more important determinant of individual health
• Genetic predisposition may lead to the premature onset of common diseases of adult life such as
– Cancer
– Coronary heart disease
– Diabetes
– Hypertension and
– Mental disorders
• Cancer:


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