Iravatham Chitra C, Kumar Neela Venkata Sanjeev, Valluri Vijaya Lakshmi
Iravathams Clinical Laboratory, Hyderabad, 500 029, Telangana, India; Immunology and Molecular Biology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, 500 004, Telangana, India.
Immunology and Molecular Biology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, 500 004, Telangana, India.
Indian J Tuberc. 2019 Jan;66(1):203-208. doi: 10.1016/j.ijtb.2019.02.008. Epub 2019 Feb 27.
Mahavir DOT Centre, Hyderabad, Telangana, India INTRODUCTION: Urban slums are characterized by crowding, poverty. In such setting due to lack of infection control the transmission of tuberculosis is known to rise, thereby creating a "Hot" spot. Distribution of residences in such areas does not necessarily follow postal codes, making it difficult for health workers to locate TB patients unless accompanied by the STLS.
To investigate the utility of integrating the help of local postman and geographic positioning system (GPS) to identify and create map of hot spots in an area under a regional DOT centre.
MATERIALS & METHODS: Retrospective and prospective demographic data of TB patients enrolled during 12 years (1999-2011) was analysed from the TB register at a ward where number of cases continued to increase despite active implementation of DOTS strategy. Non-Spatial data was generated with the local postman identifying individual house addresses. The corresponding co-ordinates were recorded with GPS and uploaded in Google Earth to identify the locations. Area map was created by software (AutoCAD, Map R3, MapInfo Pro 7.5 Trial Version and MS office Tools). Residences of Index patients were marked in different colours year wise on the map.
Maps displayed in the DOT centre area helped in identifying HOT SPOT and visualization of the clustering of TB cases in the area. Time interval between subsequent infections (3 months-5 years) could be calculated in the locality, within household, neighbourhood and random contacts. Average distances (<1 m) between houses indicated the probable source of infection. Risk factors included crowding, poor ventilation and sanitation contributed to TB transmission in HOT spot area.
Integrating local postman and information technology to identify HOT SPOT in RNTCP, will help in early intervention by health personnel to arrest TB transmission.
印度特伦甘纳邦海得拉巴市玛哈维尔直接观察治疗中心
城市贫民窟的特点是人口密集和贫困。在这种环境下，由于缺乏感染控制，结核病的传播率会上升，从而形成一个“热点”地区。这些地区的居民分布不一定遵循邮政编码，这使得卫生工作者很难找到结核病患者，除非有社会动员与培训支持小组（STLS）陪同。
研究整合当地邮递员的帮助和地理定位系统（GPS），以识别和绘制区域直接观察治疗中心所在地区的热点地图的效用。
从一个病房的结核病登记册中分析了12年（1999 - 2011年）期间登记的结核病患者的回顾性和前瞻性人口统计数据，该病房尽管积极实施直接观察治疗策略，但病例数仍持续增加。通过当地邮递员确定各个房屋地址来生成非空间数据。用GPS记录相应的坐标，并上传到谷歌地球以确定位置。通过软件（AutoCAD、Map R3、MapInfo Pro 7.5试用版和微软办公工具）创建区域地图。索引患者的住所每年以不同颜色标注在地图上。
直接观察治疗中心区域显示的地图有助于识别热点地区以及该地区结核病病例聚集情况的可视化。可以计算当地、家庭内部、邻里和随机接触者中后续感染之间的时间间隔（3个月至5年）。房屋之间的平均距离（<1米）表明了可能的感染源。拥挤、通风不良和卫生条件差等风险因素导致了热点地区的结核病传播。
在国家结核病防治规划（RNTCP）中整合当地邮递员和信息技术来识别热点地区，将有助于卫生人员进行早期干预以阻止结核病传播。
