187404 Health by the people: The control of tuberculosis using a community-based primary health care approach in Jamkhed, India

Monday, October 27, 2008: 3:30 PM

Aroonsiri Sangarlangkarn, BA , Global Health Center, Mount Sinai School of Medicine, New York, NY
David Luo, BS , Global Health Center, Mount Sinai School of Medicine, New York, NY
Shobha Arole, MBBS, DCBHD , Comprehensive Rural Health Project, Jamkhed, Dist. Ahmednagar, India
Ratna Kamble, MA , Comprehensive Rural Health Project, Jamkhed, Dist. Ahmednagar, India
Yosef Pandit, DCHD , Jamkhed, Comprehensive Rural Health Project, Maharashtra, India
Daniel Caplivski, MD , Division of Infectious Diseases, Mount Sinai School of Medicine, New York, NY
Natasha Anandaraja, MD , Global Health Center, Mount Sinai School of Medicine, New York, NY
The Comprehensive Rural Health Project (CRHP) in Jamkhed, India embodies the community-based primary healthcare (CBPHC) philosophy, recognizing that health status is influenced by multiple elements. CRHP uses village health workers (VHWs) to implement programs including community-based healthcare, community empowerment, and income generation. We investigated the impact of CRHP's VHW-driven strategy on TB control as a measure of CRHP's effect on village health.

From June-August 2007, we surveyed TB patients to identify factors affecting access to care and treatment course. We surveyed VHWs to define their role in CRHP's TB program. We reviewed existing TB incidence data of CRHP villages from 1973-2007 and identified regional and national data for comparison.

Patient surveys (n=8) found that medication costs and employment affected treatment, and CRHP involvement included free medicine and socioeconomic assistance. VHW surveys (n=5) found that VHWs educate communities, provide detection/referral, and ensure treatment compliance through follow-ups. A two-sample t-test on TB incidence in 2000, 2002, 2004-2007 showed that rates in CRHP villages (mean=35/100000) were significantly lower than rates in “rural Maharashtra” (mean=89/100000, p<0.0001 except 2006 p=0.0813), “all Maharashtra” (mean=129/100000, p<0.0001 except 2006 p=0.0650), and national rates (mean=143/100000, p<0.0001, except 2000 p=0.0015 and 2006 p=0.0757).

We found that TB treatment is influenced by economic barriers and by VHWs' role in education, detection, and treatment compliance. Our findings of lower TB incidence in CRHP villages suggest that CRHP's program is an important component of TB control in Jamkhed. We believe that CRHP's model is adaptable worldwide to help communities improve their own condition.

Learning Objectives:
Recognize CRHP’s program as an example of CBPHC Analyze the central role of VHWs in CRHP’s TB control program and CRHP's effects on TB patients and incidence rates. Discuss the application of the CRHP model to other community settings

Keywords: Community-Based Health Care, TB

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: - Research in Behavioral Neurobiology, Strupp Laboratory, 2003-2006, Cornell University - Bachelor's Degree in Biological Sciences, 2006, Cornell University - Medical degree candidate, expecting 2010, Mount Sinai School of Medicine - Participant in Comprehensive Rural Health Project's "Course on Community-Based Health and Development for Medical/MPH/Allied Health Students", 2007, Jamkhed, India
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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