Tuberculosis in India
Tuberculosis in India is a major health problem, causing about 220,000 deaths every year. In 2020, the Indian government made statements to eliminate tuberculosis from the country by 2025 through its National TB Elimination Program. Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.
India bears a disproportionately large burden of the world's tuberculosis rates, with World Health Organization (WHO) statistics for 2011 giving an estimated incidence figure of 2.2 million cases for India out of a global incidence of 9.6 million cases.[1]
Tuberculosis is one of India's biggest health issues, but what makes this problem even worse is the recent discovery of Totally Drug-Resistant Tuberculosis,
The cost of this death and disease to the Indian economy between 2006 and 2014 was approximately US$1 billion.[4]
Epidemiology
Tuberculosis is one of India's major public health problems. According to World Health Organization (
Compared to India, Canada has about 1,600 new cases of TB every year.[9] Citing studies of TB-drug sales, the government of India now suggests the total has gone from being 2.2 million to 2.6 million people nationwide.[10] On March 24, 2019, TB Day, the Ministry of Health & Family Welfare of India notified that 2.15 million new tuberculosis patients were discovered only in 2018.[11]
In India, tuberculosis is responsible for the death of every third AIDS patient. Moreover, India accounts for about a quarter of the global tuberculosis burden.[11] The ministry reiterated their commitment to eliminating tuberculosis in the country by 2025.[11] As part of its efforts to eliminate tuberculosis, the Union Government changed the name of Revised National Tuberculosis Control Program (RNTCP) to National Tuberculosis Elimination Program (NTEP) on December 30, 2019.[12]
Cause and symptoms
The bacterium that causes TB is called
Common symptoms include:
Additional causes
Susceptibility to tuberculosis is heightened by a weak
Socioeconomic Dimensions of TB
Local decreases in the incidence of tuberculosis in India correlate with improvements in social and economic determinants of health more than with access to quality treatment.[14] In India, pollution is widespread throughout the country. Pollution causes many effects in the air that people breathe, and since TB can be passed from person to person through the air, the chances of catching TB remain high in many parts of India.[15]
Lack of infrastructure
Another major cause for the growth of TB in India has to do with its standing as a developing country. A study of Delhi slums has correlated higher scores on the Human Development Index and high proportions of one-room dwellings tend to correlate with TB at higher rates.[16] Poorly built environments, including hazards in the workplace, poor ventilation, and overcrowded homes have also been found to increase exposure to TB [14]
Lack of access to treatment
Another major reason for the high incidence of TB in India is because the majority of those infected are not able to afford the treatment drugs prescribed. “At present, only the 1.5 million patients already under the Indian government's care get free treatments for regular TB. That leaves patients who seek treatment in India's growing private sector to buy drugs for themselves, and most struggle to do that, government officials say.”
While RNTCP has created schemes to offer free or subsidized, high quality TB care, less than 1% of private practitioners have become fully involved.[17] This is exacerbated by a lack of education and background information which practitioners and professionals hold for prescribing drugs, or those private therapy sessions. A study conducted in Mumbai by Udwadia, Amale, Ajbani, and Rodrigues, showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR-TB.[19] Because the majority of TB cases are treated by private providers, and because the majority of poor people access informal (private) providers, the RNTCP's goals for universal access to TB care may have difficulty being met.[17]
Poor health
Poverty and a lack of financial resources are also associated with malnutrition, poor housing conditions, substance misuse, and HIV/AIDS incidence. These factors often contribute to a weakened immune system and are accordingly correlated with a higher susceptibility to TB.[14] They also tend to have a greater impact on people from high incidence countries such as India.[20] Indeed, addressing these factors may have a stronger correlation with decreased TB incidence than removing the financial burdens associated with care.[14] Yet, the RNTCP's treatment protocols do not address these social determinants of health.[14]
Treatment
Although tuberculosis is on the rise in India,
70-80% of TB patients first visit the private sector, where the diagnostic and treatment services of TB are suboptimal and need to be improved.[22][23] Directly observed therapy (DOT) has been helpful to increase adherence and reduce resistance. In recent years, as smartphone usage and accessibility to low-cost internet services have gained traction in India, perceptions of alternative services such as SMS reminders, voice calls and video DOT (vDOT) have been explored and shown to be acceptable to a variety of patient population thus saving time and money.[24]
History
India's response to TB has changed with time and with the increasing sophistication of technology.[25] Responses to TB have evolved, from pre-independence through post-independence to the current WHO-assisted period.[25] The first national study of tuberculosis was carried out by Arthur Lankester in 1914.[26][27]
Following Independence, the Indian government established various regional and national TB reduction programmes.
The contemporary response to TB includes India's participation and leadership in global TB reduction and elimination programs.[25] Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated “within the confines of government-sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis”.[18] Given this conclusion by Udawadai, et al., it is considered certain, as of 2012, that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever.[10]
Society and culture
Organizations
The Tuberculosis Association of India is a voluntary organization that was set up in February 1939. It is affiliated to the government of India and is working with the TB Delhi center.[30]
Laboratories
The
Stigma
Disempowerment and stigma are often experienced by TB patients as they are disproportionately impoverished or socially marginalized.[31] The DOTS treatment regimen of the RNTCP is thought to deepen this sentiment,[32] as its close monitoring of patients can lead to stigma. To counteract disempowerment, some countries have engaged patients in the process of implementing the DOTS and in creating other treatment regimens that give more attention to their nonclinical needs. This knowledge can complement the clinical care provided by the DOTS.[33] Pro-poor strategies, including wage compensation for time lost to treatment, working with civil society organizations to link low income patients to social services, nutritional support, and offering local NGOs and committees a platform for engagement with the work done by private providers may reduce the burden of TB[34] and lead to greater patient autonomy.
Economics
Some legal advocates have argued that public interest litigation in India must be part of the TB response strategy to ensure that available resources actually fund the necessary health response.[35] India has a large burden of the world's TB, with an estimated economic cost of US$100 million lost annually due to this disease.[36]
Special populations
How Scheduled Tribes and other Adivasi are coping with TB highlights a lack of research and understanding of the health of this demographic.[37][38] There is a belief that this community is more vulnerable and has less access to treatment, but details are lacking on how TB affects tribal communities.[37][38]
References
- ^ TB Statistics for India. (2012). TB Facts. Retrieved April 3, 2013, from http://www.tbfacts.org/tb-statistics-india.html
- S2CID 42481569.
- S2CID 39443765.
- ISBN 978-92-4-156380-2. Retrieved 14 June 2020.
- ^ WHO. Global tuberculosis control. WHO report. WHO/HTM/TB/2006.362. Geneva: World Health Organization, 2006.
- ISBN 978-92-4-003702-1. Retrieved 3 November 2021.
- S2CID 42481569.
- ^ Kanabus, Annabel. "Totally drug resistant TB - resistance to all known drugs". TBFACTS.ORG Information about Tuberculosis. Global Health Education, England. Retrieved 5 September 2021.
- ^ a b c d e f Tuberculosis - Causes, Symptoms, Treatment, Diagnosis. (2013). C-Health. Retrieved April 3, 2103, from [1][usurped]
- ^ a b c d Anand, Geeta; McKay, Betsy (26 December 2012). "Awakening to Crisis, India Plans New Push Against TB". Wall Street Journal.
- ^ a b c "India records 2.15m new TB patients in 2018". The Nation. 2019-03-26. Retrieved 2019-03-27.
- ^ AuthorTelanganaToday. "TB eradication mission renamed". Telangana Today. Retrieved 2020-01-02.
- ^ a b Sachdeva, Kuldeep Singh et al. “New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access - "reaching the un-reached".” The Indian journal of medical research vol. 135,5 (2012): 690-4.
- ^ PMID 21330583.
- ISSN 0971-751X. Retrieved 2024-04-04.
- PMID 24438431.
- ^ PMID 23413398.
- ^ S2CID 84692169.
- PMID 22190562.
- PMID 21712992.
- S2CID 20830937.
- PMID 23174376. Retrieved 4 September 2021.
- . Retrieved 4 September 2021.
- PMID 30942696.
- ^ PMID 21731301.
- ^ "TB a national emergency: Health Minister Harsh Vardhan". The Economic Times. 6 September 2014.
- ISBN 9781478091776. Retrieved 5 January 2023.
- ^ http://www.scidev.net/tb/facts[full citation needed][dead link]
- ^ Coghaln, Andy (12 January 2012). "Totally drug-resistant TB at large in India". New Scientist.
- ^ "Welcome to the Tuberculosis Association of India".
- PMID 29225954.
- PMID 17167946.
- ISBN 978-0-262-27080-9.
- PMID 22449205.
- PMID 27781000.
- PMID 22427352.
- ^ PMID 29332655.
- ^ PMID 26139779.)
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Further consideration
- Central TB Division (March 2020). "India TB Report 2020". tbcindia.gov.in. Ministry of Health and Family Welfare.
- WHO Stop TB Department (2010). "A Brief History of Tuberculosis Control in India". World Health Organization.
External links
- Central Tuberculosis Division of the Government of India