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Rotary kiln incinerators, like the other types, are designed with
• A primary chamber, where the waste is heated and volatilized, and
• A secondary chamber, where combustion of the volatile fraction is completed.
The primary chamber consists of a slightly inclined, rotating kiln in which waste materials migrate from the feed end to the ash discharge end.
The waste throughput rate is controlled by adjusting the rate of kiln rotation and the angle of inclination.
Volatiles and combustion gases pass from the primary chamber to the secondary chamber.

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
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.

• DOTS strategy had 5 main components:
1. Political will (therefore administrative commitment) (C)
2. Diagnosis by quality microscopy of sputum (M)
3. Adequate drug supply (S)
4. Directly observed treatment (O)
5. Accountability – systematic monitoring (A)
Thus RNTCP shifts the responsibility for cure from the patient to the health system
Suggested Mnemonic: SCAM – O

• 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

• 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.

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

IMNCI (Integrated Management of Neonatal and Childhood Illness) is India’s adaptation of the WHO–UNICEF IMCI strategy. It focuses on children under five, especially newborns, using evidence-based, syndromic case-management charts. The approach improves assessment, treatment, referral, caregiver counselling and health-system readiness at first-level facilities.

Reference:
WORLD HEALTH ORGANIZATION, 2003. Review of Ethical Issues in Medical Genetics: Human Genetics Programme, Management of Non-communicable Diseases; Geneva: WHO/HGN/ETH/00.4