Browsing by Author "Gopi, P G"
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Item A 20-year study of the Leprosy Control Programme at the Hemerijckx Leprosy Centre in Polambakkam in South India.(1985-07-01) Nair, N G; Radhakrishna, S; Christian, M; Ramakrishnan, R; Gopi, P GThe Hemerijckx leprosy centre at Polambakkam in South India covers a rural population of about 800,000 and has treated over 40,000 cases of leprosy during the period 1955-75. Based on a stratified random sample of 25% of the case records, information was obtained about the profile of newly-detected cases in various cohorts (1955-57, 1958-60, 1961-64, 1965-69, 1970-75), regularity in drug collection and response to treatment. In newly-detected cases, the ratio of males to females was stable (3:2), but the proportion of adults aged 45 years or more increased from 15% in 1958-60 to 20% in 1970-75 and the lepromatous rate decreased from 9% to 6%; the proportion deformed at the time of diagnosis ranged from 11% to 15%. Regularity in drug collection was unsatisfactory even in the first year of treatment, with less than half the patients making 6 (or more) of the 12 monthly drug collections. The clinical status at 4-6 years was known for 70-75% of the patients who started treatment and of those approximately 60% had inactive or arrested disease. Data from population surveys was sparse; about 60% of the expected numbers were initiated and less than 30% of these had a coverage of 75% or more. The limited evidence, however, showed a decline in the prevalence of about 2 per thousand per annum. Field studies to evolve strategies for better motivation of patients, introduction of short-course regimens, and continuous monitoring of the programme are urgently needed.Item Annual Risk of Tuberculosis Infection Among the Tribal Children of Jhabua, Madhya Pradesh.(2011-01) Yadav, R; Rao, V G; Bhat, J; Gopi, P G; Wares, D FA cross sectional tuberculin survey was undertaken to estimate the Annual Risk of Tuberculosis Infection (ARTI) amongst tribal children aged 1-9 years in Jhabua district, Madhya Pradesh, India. Of the 1056 test-read children, 774 (73.3 %) had no BCG scar. The prevalence of infection was estimated as 6.3% (95% CI: 4.8-7.7) and ARTI as 1.2 % (95% CI: 0.9-1.5). The findings suggest that the tuberculosis situation in the tribal population of Jhabua district is not that different from the situation among the non-tribal population in the country. However, there is a need to further intensify tuberculosis control measures in the area.Item Annual risk of tuberculosis infection in Chennai city.(2008-07-24) Gopi, P G; Prasad, V Venkatesh; Vasantha, M; Subramani, R; Tholkappian, A S; Sargunan, D; Narayanan, P RAIM: To study the proportion of children infected with Mycobacterium Tuberculosis in Chennai city. METHODOLOGY: A cluster sampling methodology was adopted to select an estimated sample size of 7000 children from five corporation zones selected systematically from ten zones of the city. A total of 7098 children aged 1-9 years were subjected to Mantoux and test read; 1897 (27%) from slum area and 5201 (73%) from non-slum area. RESULTS: The prevalence of infection among children without BCG scar was estimated to be 10.5 % (ARTI of 2.0%) and was similar to that among children irrespective of scar status. The prevalence of infection was higher among children in slum areas (11.1%; ARTI 2.1%) compared to non-slum areas (8.9%; ARTI 1.7%); but the difference was not statistically different. CONCLUSION: The tuberculosis situation in Chennai as measured by risk of infection was higher in urban city area than rural areas and comparable to that found in other cities as reported from earlier studies. This information can be used as baseline information for monitoring the epidemiological trends in Chennai city in future.Item Assessment of X-ray Readers in TB Prevalence Surveys.(2010-06) Gopi, P G; Vasantha, M; Muniyandi, MA prevalence study was carried out a rural community in Tiruvallur district in Tami Nadu to standardize the method of assessing an X-ray reader in tuberculosis (TB) prevalence surveys by means of different measures of agreement between the reader and a Standard Reader (SR). The exercise on assessing the X-ray readers was carried out on two occasions; one involving three trainee readers (R1, R2, and R3), and the other involving one trainee reader (R4). The extent of agreement was estimated using Kappa statistics (K), over-diagnosis, under-diagnosis, crude agreement and prevalence adjusted bias adjusted kappa (PABAK). The overall performance of readers R1, R2 and R3 was not satisfactory in terms of K (21, 34 and 14%) in the first assessment. The K, over-diagnosis and under-diagnosis were estimated to be 61, 28 and 4% for R1, 63, 18 and 4% for R2 and 58, 31 and 5% for R3 in the final assessment. This suggested that R2 performed well compared to the other two readers. The K was 68% for R4 in the first assessment. As the over-diagnosis was to the extent of 40%, the trainee reader underwent one more assessment. The K was 64% which was as good as before, but there was no improvement in the over-diagnosis (43.5%) in the second assessment. Based on the performance, only one reader (R2) was certified as qualified for X-ray reading in the first occasion while the reader (R4) assessed in the second occasion was not qualified. These findings were subject to the inherent variation in the SR’s readings against which the readers were assessed.Item Association of conversion & cure with initial smear grading among new smear positive pulmonary tuberculosis patients treated with Category I regimen.(2006-06-04) Gopi, P G; Chandrasekaran, V; Subramani, R; Santha, T; Thomas, A; Selvakumar, N; Narayanan, P RBACKGROUND & OBJECTIVES: Early diagnosis of tuberculosis (TB) is important for initiating treatment to gain cure. The present investigation was undertaken to study the association of conversion and cure with initial smear grading among pulmonary tuberculosis (TB) patients registered in a directly observed treatment - short course (DOTS) programme in Tiruvallur district, south India. METHODS: All new smear positive cases registered from May, 1999 to December, 2002 were analysed for conversion and cure related to initial smear grading. RESULTS: Of the 1463 patients, 1206(82.4%) were converted at the end of the intensive phase and 1109 (75.8%) were declared 'cured' after the completion of treatment. The cure rate decreased as the initial smear grading increased and the decrease in trend was statistically significant (P=0.01). Similarly, a significant decrease in conversion rate was also observed with increase in initial smear grading (P<0.001). In multivariate analysis, lower cure rate was significantly associated with patient's age (AOR=1.5, 95% CI=1.1-2.1), alcoholism (AOR=1.7, 95% CI 1.2- 2.4) and conversion at the end of intensive phase (AOR=3.5, 95% CI= 2.6-4.8). INTERPRETATION & CONCLUSION: Cure and conversion rates were linearly associated with initial smear grading. High default and death rates were responsible for low cure and conversion. The proportion of patients who required extension of treatment and those who had an unfavourable treatment outcome were significantly higher among patients with a 3+ initial smear grading. This reiterates the need to pay more attention in motivating these patients to return to regular treatment and sustained commitment in the control of tuberculosis. There is a need to extend the treatment for one more month in the intensive phase of treatment.Item Comparison of tuberculin reaction sizes at 48 and 72 hours among children in Tiruvallur district, south India.(2007-07-25) Gopi, P G; Vasantha, M; Kolappan, C; Narayanan, P RSETTING: A rural population in Tiruvallur district, south India. OBJECTIVE: To study the variability of skin test reaction sizes between 48 and 72 hours. METHODS: A tuberculin test survey was conducted among children aged less than 10 years. The reaction sizes were read by the same reader at 48 hours and 72 hours independently. The results of the tuberculin test were compared. RESULTS: Of 957 children aged below 10 years were included in the study; the male and female ratio was 1: 1.1. There were no significant differences between the readings of reaction size at 48 and 72 hours. CONCLUSION: The tuberculin test results can be read either at 48 hours or 72 hours without compromising the validity.Item Course of action taken by smear negative chestsymptomatics a report from a rural area in south India.(2006-01) Thomas, Aleyamma; Gopi, P G; Santha, T; Jaggarajamma, K; Charles, Niruparani; Prabhakaran, E; Narayanan, P RObjective: To evaluate adherence to diagnostic algorithm of Revised National Tuberculosis Control Programme (RNTCP) and course of action taken by smear-negative chest symptomatics (CSs). Method: Interviewing smear-negative chest symptomatics. Results: Of the 423 smear-negative CSs interviewed, 85 (20%) were not prescribed antibiotics and only 133 (39%) received it for more than seven days. Of the 148 patients with persistence of symptoms, 83 (56%) returned for further investigations and only 39% were X-rayed. Main reasons for not returning were: ‘not aware’ or ‘consulted another health provider.’ Conclusion: Strict adherence to diagnostic algorithm and proper counselling of patients are important for diagnosing smear-negative pulmonary tuberculosis (PTB) cases.Item Default during the intensive phase of treatment under DOTS programme.(2005-10) Chandrasekaran, V; Gopi, P G; Subramani, R; Thomas, A; Jaggarajamma, K; Narayanan, P RObjective: To study default and its associated risk factors during the intensive phase of treatment among new sputum smear positive patients registered under a Directly Observed Treatment- Short Course (DOTS) programme in Tiruvallur district, Tamil Nadu. Design: Analysis of data collected from the Tuberculosis Register, treatment cards and interview schedules during May 1999 to December 2002. Results: Of the 1463 patients registered, drug regularity results were available for 1406 patients. The cure rate was 76% with an overall default rate of 15%, of which nearly three-fourth occurred during the intensive phase. The potential risk factors were identified by multivariate analysis. A higher likelihood of default was associated with age > 45 years (AOR=1.9; 95% CI=1.2-3.0), illiteracy (1.6; 1.0-2.4), alcoholism (2.7; 1.8-4.2), DOTS inconvenience (1.9; 1.1-3.4) and cases identified and referred by the community survey (1.8; 1.1-3.0). Of the 75 defaulters from two cohort periods visited separately, 53 defaulted during the intensive phase. Among these, only 31 patients were interviewed since 17 (32%) migrated, three died, one was untraceable at the address provided while another had treatment elsewhere. Drug related (84%) and work related (32%) problems were the other reasons for default reported by the patients interviewed. Conclusion: The majority of defaults occurred during intensive phase of treatment. All efforts should be made to retrieve these patients and return them to treatment to achieve the expected goal of the RNTCP.Item DOTS Reacdes Socially Marginalized Population in the Community a Study from a Rural Area of South India.(2009-09) Narayanan, P R; Gopi, P G; Subramani, R; Santha, T; Chandrasekaran, V; Muniyandi, M; Radhakrishnan, SWe report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village.Item DOTS reaches socially marginalized population in the community: a study from a rural area of South India.(2008-09-28) Narayanan, P R; Gopi, P G; Subramani, R; Santha, T; Chandrasekaran, V; Muniyandi, M; Radhakrishnan, SWe report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village.Item Estimation of annual risk of tuberculosis infection among children irrespective of BCG scar in the south zone of India.(2006-01) Gopi, P G; Subramani, R; Kolappan, C; Prasad, V Venkatesh; Narayanan, P RObjective: To estimate the proportion infected and compute Annual Risk of Tuberculosis Infection (ARTI) among children irrespective of BCG scar and compare with that among children without BCG scar. Methodology: Tuberculin survey was conducted in south zone of India as a part of the nation-wide survey to estimate the ARTI in different parts of the country and ARTI was computed among children without BCG scar excluding children with BCG scar. In this exercise, the tuberculin test results of children with BCG scar and irrespective of BCG scar were considered for analysis and the results were compared. Results: The prevalence of infection and ARTI estimated among children irrespective of BCG scar aged 1-9 years were 5.7% and 1.0% (95% C.I: 0.8-1.3) respectively. The corresponding figures among unvaccinated children were 5.9% and 1.0% (95% C.I: 0.7-1.4) respectively. The ARTI among children irrespective of BCG scar were similar to that among unvaccinated children. Conclusion: Estimation of proportion of children infected and computation of ARTI using mirror-image technique could be undertaken among children irrespective of BCG scar among children aged either from 1-9 years or 5-9 years.Item Estimation of burden of tuberculosis in India for the year 2000.(2005-09-28) Gopi, P G; Subramani, R; Santha, T; Chandrasekaran, V; Kolappan, C; Selvakumar, N; Narayanan, P RBACKGROUND AND OBJECTIVE: Data on the burden of tuberculosis (TB) in India are vital for programme planners to plan the resource requirements and for monitoring the nation-wide TB control programme. There was a need to revise the earlier estimate on the burden of TB in India based on the increase in population and current epidemiological data. This study estimates the burden of disease for the year 2000 based on recent prevalence of TB and annual risk of tuberculosis infection (ARTI) estimates. METHODS: Data on prevalence generated among adults by the Tuberculosis Research Centre (TRC), Chennai, among children by National Tuberculosis Institute (NTI), Bangalore, and the ARTI estimates from the nation-wide sample survey by NTI and TRC were used for the estimation. The prevalence of disease corresponding to 1 per cent ARTI was extrapolated to different parts of the country using the estimates of ARTI and the population in those areas and added together to get the total cases. Abacillary cases that required treatment were estimated from X-ray abnormals. The estimates of bacillary, abacillary and extrapulmonary cases were then combined to get the national burden. RESULTS: The estimated number of bacillary cases was 3.8 million (95% CI: 2.8-4.7). The number of abacillary cases was estimated to be 3.9 million and that for extrapulmonary cases was 0.8 million giving a total burden of 8.5 million (95% CI: 6.3-10.4) for 2000. INTERPRETATION AND CONCLUSION: The present estimate differs from the earlier estimates because we have included the disease burden of X-ray cases that are likely to breakdown to bacillary cases in a one year period, and extrapulmonary TB cases. The current estimates provided baseline information for advocacy and planning resource allocation for TB control activities. Also, these estimates can be compared with that in future years to measure the long term impact of TB control activities in India.Item Evaluation of different types of chest symptoms for diagnosing pulmonary tuberculosis cases in community surveys.(2008-07-24) Gopi, P G; Subramani, R; Narayanan, P RBACKGROUND: Prevalence of tuberculosis (TB) is an important epidemiological index to measure the load of the disease in a community. A series of disease surveys were undertaken in rural community in Tiruvallur district in Tamilnadu, south India OBJECTIVE: To investigate the yield of pulmonary tuberculosis (TB) cases by different symptoms status and suggest predominant symptoms for detection of cases in the community based surveys. METHODS: Three disease surveys were conducted during 1999-2006, in a random sample of 82,000 adults aged > or = 15 years to estimate the prevalence and incidence of pulmonary TB. All subjects were screened for chest symptoms and chest radiography. Sputum examination was done among those who were either symptomatic or abnormal on X-ray or both. Cases observed through symptom inquiry were included for analysis. RESULTS: In survey-I, 65.6% had cough of > or = 14 days and yielded 79.1% of the total cases. In surveys II and III, symptomatic subjects with cough contributed 69.5% and 69.2% of the cases respectively. In survey I, 26.8% had symptoms without cough but with at least chest pain > or = 1 month contributed 8.4% of total cases. The corresponding proportions in subsequent surveys were 29.3, 11.5%; and 23.4, 11.2% respectively. The number of symptomatics without cough and chest pain but with fever > or = 1 month was negligible. CONCLUSION: The relative importance of cough as a predominant symptom was reiterated. The yield of pulmonary TB cases from symptomatics having fever of > or = 1 month was negligible. Fever may be excluded from the definition of symptomatics for screening the population in community surveys.Item Evaluation of Directly Observed Treatment Providers in the Revised National Tuberculosis Control Programme.(2005-04) Nirupa, C; Sudha, G; Santha, T; Ponnuraja, C; Fathima, R; Chandrasekharan, V; Jaggarajamma, K; Thomas, A; Gopi, P G; Narayanan, P RBackground: Non-governmental personnel such as Anganwadi workers and community volunteers have been used as directly observed treatment (DOT) providers in the Revised National Tuberculosis Control Programme (RNTCP), but their effectiveness has not been documented. Aim: To assess the treatment outcome and problems encountered by patients managed by different DOT providers in the RNTCP. Material and Methods: Patients diagnosed with tuberculosis at 17 Primary Health Institutions (PHIs) in Tiruvallur District during a 3-year period received DOT from one of the four types of trained DOT providers (PHI staff, governmental outreach workers, Anganwadi workers, community volunteers), and their treatment outcomes were compared. Of the 1131 new smear-positive patients treated between May 1999 through June 2002, 199 (18%) received DOT from PHI staff, 238(21%) from outreach workers, 496 (44%) from Anganwadi workers, and 170 (15%) from community volunteers. Twenty-eight patients (2%) collected drugs for self-administration. Results: Treatment success rates among patients treated by different DOT providers, Anganwadi workers (80%), governmental outreach workers (81%), community volunteers (76%) and PHI staff (76%), were statistically similar. Patients who received drugs for self-administration were significantly more likely to fail to treatment or die than patients who were treated by a DOT provider (5/28 versus 84/1103; odds ratio=4.1; 95% confidence interval=1.2-12.6; p=0.02). Conclusion: In addition to governmental staff, Anganwadi workers and community volunteers can be effectively utilized as DOT providers.Item Failure to initiate treatment for tuberculosis patients diagnosed in a community survey and at health facilities under a dots programme in a district of south India.(2005-07) Gopi, P G; Chandrasekaran, V; Subramani, R; Narayanan, P RWe studied the proportion and fate of tuberculosis patients who were not initiated on treatment (initial defaulters) in Tiruvallur district of Tamilnadu, where DOTS strategy was implemented. These patients were visited to find out the reason for default. Treatment was not initiated in 57 (23.5%) of the 243 sputum positive cases diagnosed in a community survey and 156 (14.9%) of 1049 patients diagnosed in health facility. Men were more likely not to have treatment initiated. The common reasons stated for initial default were unwillingness, symptoms being mild, personal reasons and dissatisfaction. There is an urgent need to improve the patient’s perception of treatment and strengthen the health systems’ capabilities to reduce initial default.Item Impact of BCG vaccination on tuberculin surveys to estimate the annual risk of tuberculosis infection in south India.(2006-07-24) Gopi, P G; Subramani, R; Nataraj, T; Narayanan, P RBACKGROUND AND OBJECTIVES: Annual risk of tuberculosis infection (ARTI) computed from prevalence of infection measures the extent of tuberculosis transmission in the community and it is used to monitor the tuberculosis control programme. This is usually derived from tuberculin surveys among children not vaccinated with BCG. This study explores whether the estimated ARTI among BCG vaccinated children is comparable to that of unvaccinated children. METHODS: Three tuberculin surveys were undertaken among children aged >10 yr as part of assessing the impact of DOTS implemented in Tiruvallur district, south India. The prevalence of infection was estimated using the anti-mode method among vaccinated and unvaccinated children. The ARTI was computed separately and compared in all the three surveys. RESULTS: The prevalence of infection among unvaccinated and vaccinated children in the first survey were 7.8 per cent (95% CI: 7.1-8.6) and 7.9 per cent (95% CI: 7.1-8.8) respectively (ARTI was estimated to be 1.6 per cent in both groups) and the difference was not statistically significant. The corresponding figures for children test read in the second and third surveys were 6.9 per cent (95% CI: 6.2-7.6) and 6.8 per cent (6.0-7.5) and; 6.0 per cent (5.2-6.7) and 6.0 per cent (5.5-6.5) respectively. The computed ARTI was respectively 1.4 and 1.2 per cent among unvaccinated children in the second and third surveys; and 1.4 and 1.2 per cent among vaccinated children in the second and third rounds. INTERPRETATION AND CONCLUSION: There was no difference in the infection with Mycobacterium tuberculosis among vaccinated and unvaccinated children. BCG vaccinated children may thus be included for estimation of infection to assess the extent of transmission in the community as well as for monitoring purpose.Item Impact of improved treatment success on the prevalence of TB in a rural community based on active surveillance.(2008-01-26) Gopi, P G; Subramani, R; Chandrasekaran, V; Santha, T; Narayanan, P ROBJECTIVE: To study the impact of improved treatment outcome of a cohort of patients treated under DOTS strategy on the prevalence of pulmonary tuberculosis (TB) in the community. DESIGN: The data from TB register of one Tuberculosis Unit (TU) in Tiruvallur district of Tamilnadu, and two TB disease surveys conducted in the same area during 1999-2003 were analysed. The successful treatment outcome was compared to the prevalence of TB in the subsequent cohort. RESULTS: The proportion of patients who completed treatment successfully was 75.3% in the first cohort period. This higher proportion of treatment success among patients treated under DOTS in the first cohort period (1999-2001) compared to the 51-55% reported during SCC, resulted in a lower prevalence of smear-positive cases, irrespective of culture results observed in the survey conducted during 2001-2003 compared to that in the survey conducted during 1999-2001 (252 vs. 323 per 100,000; annual decline of 9%). Similarly, a decline in culture-positive cases, irrespective of smear results, was also observed (443 vs. 605; annual decline 11%). CONCLUSION: The higher proportion of successful completion of treatment after DOTS implementation was associated with a substantial decline in the prevalence of TB. These findings showed that we are in the direction towards achieving the Millennium Development Goals (MDGs).Item Influence of drug susceptibility on treatment outcome and susceptibility profile of failures to category II regimen.(2006-07) Joseph, Pauline; Chandrasekaran, V; Thomas, A; Gopi, P G; Rajeswari, R; Balasubramanian, R; Subramani, R; Selvakumar, N; Santha, TObjective: To assess the influence of drug resistance on treatment outcome among patients treated with Category-II regimen and document drug susceptibility pattern of “Failures” to this regimen. Design: A retrospective analysis of patients registered from May 1999 through December 2004. Results: Treatment success was 42% among 572 patients and was similar among patients with fully susceptible or resistant but non-MDR organisms (41% of 254 and 40% of 128 patients, respectively). Among 49 MDR-TB patients, 27% had successful treatment outcome. The failure rates among patients with fully susceptible, resistant but non-MDR and MDR bacilli, were 6%, 12% and 27% respectively. Default was significantly higher among males (53% vs. 34%: p<0.01) smokers (57% vs. 36%: p <0.001), alcoholics (58% vs. 39%: p <0.001) and patients with higher initial smear grading (2+ or 3+, 56% vs. scanty or 1+, 44%: p <0.01). DST results were available for 60% (31 of 52) of failures and 10 had MDR-TB. Conclusion: The low success rate to the re-treatment regimen was mainly due to non-compliance. Failure was observed among 9% of patients and MDR-TB was 32% among Category II failures. The currently recommended Category II regimen appears to be adequate for majority of re-treatment cases.Item Is it worth treating Category I failure patients with Category II regimen.(2005-10) Santha, T; Gopi, P G; Rajeswari, R; Selvakumar, N; Subramani, R; Chandrasekaran, V; Rani, B; Thomas, A; Narayanan, P RBackground: Very little information is available on the drug susceptibility profile among patients who are treated with standardized short-course chemotherapy regimens under programme conditions. Methods: Sputum samples were collected from new sputum smear-positive patients declared ‘failure’ after treatment with Category I regimen under tuberculosis control programme using DOTS strategy from a rural area of Tamil Nadu. Results: Of 1463 patients started on Category I regimen between May1999 and December 2002, 74 cases were declared as ‘failures’ (smear positive at 5/6 months of treatment). We collected sputum samples from 60 (81%) of 74 ‘failures’ and 27% (16 of 60) of them were culture-negative for M tuberculosis and 17% (10 of 60) had organisms resistant to Isoniazid and Rifampicin (MDR TB). Conclusion: Based on the drug susceptibility profile at the time of ‘failure’, treating Category I ‘failures’ with Category II regimen with close monitoring appears to be justified.Item Is migration a factor leading to default under RNTCP.(2006-01) Jaggarajamma, K; Muniyandi, M; Chandrasekaran, V; Thomas, Sudha G A; Gopi, P G; Santha, TObjective: To study the contribution of migration to treatment default among tuberculosis patients treated under RNTCP Methods: Retrospective study by interviewing the defaulters using semi-structured interview schedule to elicit the reasons for default including migration. Results: Of the 531 patients registered under TB programme in 3rd and 4th quarters of 2001, 104 (20%) had defaulted for treatment. Among defaulters, 24% had migrated. The reasons for migration were: occupational (48%), returning to the native place (28%), domestic problems (12%) and other illnesses (12%). Conclusion: After initiation of treatment, patients should be encouraged to report to the provider, if they are leaving the area, to transfer treatment to the nearest centre to ensure continuity of treatment. These measures will help to reduce default on account of migration and achieve the desired outcome in RNTCP. Availability of treatment under the DOTS strategy should be popularized among patients, providers and community.