Tuberculosis Study Guide - M.M. Savula 2002

Tuberculosis control activities of feldsher-obstetric station (FAP) staff

A feldsher-midwife station is the primary level of pre-physician medical care for the population. The main responsibilities of the medical staff at a feldsher-midwife station include:

♦ obtaining information from the chest X-ray unit or the district physician regarding preventive fluorography screenings completed by village residents, and actively referring all individuals over 15 years of age who have not undergone this screening for 2 years or more;

♦ referring individuals with bronchopulmonary symptoms (cough lasting more than 3 weeks) and signs of systemic toxicity (weakness, weight loss, sweating, low-grade fever) identified during home visits or consultations at the feldsher-midwife station for X-ray Examination between scheduled fluorography screenings;

♦ participating in the Organization of annual preventive (including fluorography) screenings for mandated groups (livestock workers, employees of schools and preschools, food enterprises, shops, and other mandatory groups);

♦ monitoring the timely follow-up examination of individuals with pulmonary abnormalities detected during mass fluorography screening;

♦ participating as part of a medical team in organizing and conducting annual tuberculin Skin testing for children starting from 12 months of age, and adolescents;

♦ referring children and adolescents to a TB dispensary for further evaluation in cases of a newly positive tuberculin reaction (not vaccinated with BCG in the previous year), hyperergic reactions to tuberculin (papule of 17 mm or more, or the presence of a vesicle or lymphangitis), as well as individuals whose tuberculin reaction (papule size) has increased by 6 mm or more compared to previous results;

♦ referring family members of children with tuberculin conversion to a TB dispensary for screening to identify the source of infection;

♦ administering BCG Vaccination (following a pediatrician's consultation) to children who, for various reasons, were not vaccinated in the maternity hospital;

♦ participating in the work of teams performing tuberculosis revaccination for children with a negative Mantoux test at ages 7 and 14;

♦ monitoring The Development of post-vaccination reactions following BCG vaccination; documenting them in the child's medical records; recording data on the presence and size of the post-vaccination scar one year after vaccination;

♦ registering and conducting dispensary surveillance of tuberculosis patients and their contacts, monitoring their scheduled visits to the TB dispensary; The Scope of dispensary surveillance is determined by the TB specialist's recommendations;

♦ implementing health and sanitary measures in the foci of tuberculosis infection;

♦ providing the infection focus with disinfectants and training the patient and their family members on how to use them;

♦ providing supervised outpatient Treatment for patients and Chemoprophylaxis for individuals at high risk of tuberculosis, as prescribed by a TB specialist;

♦ taking measures for the timely hospitalization of tuberculosis patients based on epidemiological indications (e.g., birth of a child) and in cases of suspected exacerbation of the specific process;

♦ providing pre-physician emergency medical care to tuberculosis patients;

♦ conducting health education work among the residents of the service area: promoting a healthy lifestyle, explaining the necessity of fluorography screenings (once every 2 years) starting from age 15, annual tuberculin testing in children for early detection of tuberculosis, and BCG vaccinations at scheduled intervals to prevent tuberculosis in children;

♦ actively participating in village council initiatives aimed at the suitable employment of tuberculosis patients and improving their living conditions, Nutrition, and daily life.

To track tuberculosis control activities, the following documentation must be maintained at the feldsher-midwife station:

1. A list of mandatory (mandated) groups subject to regular fluorography screening.

2. A list of individuals at high risk of developing tuberculosis (recurrent Pneumonia, residual pulmonary changes after previous tuberculosis, Diabetes Mellitus, PEPTIC ULCER DISEASE of The Stomach and duodenum, post-operative status for these conditions, Pneumoconiosis, psychiatric disorders, alcoholism, drug addiction, history of exudative Pleurisy, HIV-infected individuals, and persons undergoing corticosteroid or Radiation therapy).

3. A registry of tuberculin skin testing and BCG vaccinations.

4. Lists of tuberculosis patients by dispensary follow-up groups.

5. Patronage nurse records.

6. Phthisiologist's prescriptions for conducting controlled therapy or chemoprophylaxis in outpatient settings.

All anti-tuberculosis work is performed by FAP staff under the guidance and supervision of a phthisiologist and the sanitary-epidemiological service, who analyze the work performed and make recommendations aimed at improving tuberculosis care for the rural population.