A death review or mortality audit is a means of documenting the causes of death and the factors that contributed to it, identifying factors that could be modified and actions that could prevent future deaths, putting the actions into place and reviewing the outcomes.
The aims of the audit or review of deaths in hospitals and health services are to:
The treatment for TB is demanding in terms of duration of treatment, adverse drug reactions, the requirement of prolonged adherence by patients and catastrophic expenditures. The presence of a special condition added on by a TB diagnosis makes it even more challenging.
To improve the outcomes for such challenging situations, the programme recommends certain modifications in the regimen, which are listed in the table below.
Table: Management of TB in Special Situations
There are five principal ways to prevent Drug-resistant Tuberculosis (DR-TB), as given in the figure below.
Treatment interruption is defined as a patient-initiated episode in which the patient discontinues TB treatment. All efforts must be made to ensure that TB patients do not interrupt treatment or are not lost to follow-up. Action should be taken to promptly retrieve patients who fail to come for their daily dose by the treatment supporter
The management of treatment interruptions is made based on the following criteria:
i. Type of case: Whether new, relapse or failure
The management principles of Extrapulmonary Tuberculosis (EPTB) are shown in the figure below.
Figure: Ten principles about what every EPTB patient in India needs as a basic standard of care
Abbr: CBNAAT:Cartridge-based Nucleic Acid AMplification Test; PTB: Pulmonary TB; NTEP: National TB Elimination Programme
Diagnosis of EP-TB
Follow-up Sputum Examination is useful for the clinical follow-up which helps in assessing the response to treatment, and to establish cure or failure at the end of treatment.
Pharmacovigilance is defined by the World Health Organisation (WHO) as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.
Importance of Pharmacovigilance
Directly observed treatment (DOT) is one of the key elements of the DOTS strategy. In DOT, an observer (health worker or trained community volunteer, or trained family member for selected patients) watches and supports the patient intaking their drugs. Direct observation ensures treatment adherence with the right drugs, in right doses for the right duration.
TB patients may not stay in one place throughout the treatment duration. When they move from one place to other, there should be a mechanism to hand over the responsibility of continuing the patient's treatment in a facility near the new place of the patient. This is the concept of patient transfer and can be easily managed in Nikshay portal.