TB IN INDIA
Tuberculosis in India
Tuberculosis or TB is one of India's greatest public health challenges. Unknown to many, it is the one of the leading causes of death in India- killing 2 persons every three minutes, nearly 1,000 every day. A contagious disease, it spreads through the air and if left untreated, each person with active TB can infect on average between 10-15 people every year.
India has the highest burden of tuberculosis in the world, accounting for one fourth of the global incidence- 2.8 million new cases annually. The direct and indirect costs, in the case of India stand at $23.7 billion annually. TB causes endless suffering and pushes families and communities into debt and often-extreme poverty.
Additionally, India is currently faced with rising number of drug resistant (DR) TB with close to 100,000 case -the second highest in the world. MDR-TB is defined by resistance to the two most commonly used drugs namely isoniazid and rifampin. Many of these cases may also be Extensively -Drug Resistant Tuberculosis (XDR- TB). MDR-TB can transform into XDR- TB through inadequate or interrupted treatment with second-line anti-TB drugs. This generally occurs when patients are not treated in adherence to national or international guidelines. In 2012, doctors at Hinduja Hospital documented the first 12 cases of Totally Drug Resistant TB. The treatment for any kind of DR-TB is extremely complex, expensive and with terrible side effects and chances of recovery are les than 40%.
While the disease affects a larger number of men in India, it poses far graver risks to women's and children health -a fact that is often neglected. In women aged 15-44 years in developing countries TB is the third most common cause of morbidity and mortality combined, and TB kills more women than any other infectious diseases.
In India, it is estimated that more than 100,000 women lose their status as mothers and wives because of the social stigma of TB, and that TB kills more women in India than all causes of maternal mortality combined. A study done by NIRT Chennai revealed that 11% children drop out of school on account of parental illnesses and 20 % children have to take up jobs to support families because their parents had TB. It estimated that more than 3,00,000 children may have left school permanently because of their parents' TB.Thus, TB remains a silent killer of women and children who remain undiagnosed, untreated and undocumented.
India's efforts to TB Control: India's Revised National Tuberculosis Control Programme (RNTCP) under the Ministry of Health is the primary body coordinating TB prevention control and treatment activities in India. Despite the success of this program, TB continues to affect people at an alarming rate in India. Many argue that this is because 70% of all TB patients seek care in the private sector where there is extensive use of inaccurate diagnostics and inappropriate treatment. The program ahs been unable to engage the private sector effectively as a partner in controlling TB. A lack of effective partnerships and a rigid public program has resulted in millions of patients being unable to access appropriate diagnosis and treatment causing extreme suffering. It is believed that close a million patients in India remain undiagnosed, untreated, and undocumented.
What India can do: If India wishes to effectively address its TB epidemic it will needs a multidimensional approach that addresses not just issues of access but a massive growth in public health infrastructure, an effective partnership with the private sector and much needed focus on the social determinants. Every TB patient must be provided access to free diagnosis and treatment whether in the public or private sector. If diagnosed with TB, patients and their families must be provided with counseling, nutritional and economic support. Considering India's massive TB crisis, the RNTCP's annual budget of 500 crores remains abysmally inadequate to achieve this.
India also desperately needs new drugs for the growing population of patients with more extreme forms of drug resistant TB who have exhausted virtually all available first and second line drugs. Yet none of this possible without political will and additional resources. This is both urgent and necessary to end the suffering impoverishment and deaths of millions of Indians.