The recent World Health Organisation report has stated that the number of people infected with tuberculosis, including the kind resistant to drugs has rose globally for the first time. India stands in the top 30 countries carrying the highest burden of tuberculosis (TB) cases across the world.
Report shows that men accounted for 56.5 per cent, women for 32.5 per cent and children for 11 per cent of the TB burden. Many new cases were attributed to five major factors — undernutrition, HIV infection, alcohol use disorders, smoking and diabetes.
The UN health agency said more than 10 million people worldwide were sickened by tuberculosis in 2021, a 4.5 per cent rise from the year 2020.
As per WHO about 450,000 cases involved people infected with drug-resistant TB, 3 per cent more than in 2020.
According to recently released India TB Report 2022, an estimated 1.9 million new active cases were notified in India in 2021. The total number of incident TB patients (new and relapse) notified during 2021 were 19,33,381 . The mortality rate also grew between 2019 and 2020 by 11 per cent in India. At 31 per cent, India also has one of the highest childhood TB burdens in the world.
After COVID-19, TB is the world’s deadliest infectious disease. It is caused by bacteria that typically affects the lungs. The bacilli are mostly spread from person to person in the air, such as when an infected individual coughs or sneezes.
TB mostly affects adults, particularly those who are malnourished or have other conditions like HIV; more than 95 per cent of cases are in developing countries.
According to the WHO report, only one in three people with drug-resistant TB are receiving treatment.
Drug-resistant TB is curable, but alarmingly, cases are on the rise for the first time in these years.
According to data by the National Strategic Plan for Tuberculosis Elimination (2017-25), India has more than a million “missing” TB cases every year. The results of a National TB Prevalence Survey released in the year 2021, showed that majority of the symptomatic population (64 per cent) did not seek healthcare services. This is because sixty eight per cent ignored their symptoms, 18 per cent did not recognise TB symptoms , 12 per cent were on self-treatment, and two per cent could not afford to seek healthcare.
At present, the Government of India’s National Tuberculosis Elimination Programme (NTEP) provides numerous health facilities with free treatment to all citizens. As per reports, Rs 1,488 crore was paid to 57.33 lakh TB patients under the Nikshay Poshan Yojana (NPY) as direct benefit transfer (DBT) from April 2018 to February 2022.
Private organisations are also being encouraged to join the Corporate TB Pledge, a joint initiative with the Central TB Division, Ministry of Health and Family Welfare in India, and United States Agency for International Development (USAID), to support the government’s goal to end TB.
For the TB mitigation strategy to be effective, it is important to increase awareness about the disease. The youth, who are widely adept at social media and other emerging technologies, can play a particular role in this effort by helping amplify the right messages about available care services, normalising conversations around TB and encouraging people to seek care. Instead of relying on antibiotics, the government needs to focus on holistic treatment.
A 2017 report published in The Lancet Respiratory Medicine, warned that some of the progress made in the global fight against TB could be lost with the emergence and spread of drug-resistant strains of the disease. As per the report, approximately 20 per cent of TB cases globally are estimated to be resistant to at least one of the first- or second-line anti-TB drugs, and 5 per cent are resistant to both isoniazid and rifampicin, the most powerful and commonly used antibiotics in first-line treatment. Of the estimated 4.8 lakh cases of multidrug- resistant (MDR) TB, approximately 10 per cent are either extensively drug-resistant (XDR) – with additional resistance to second-line drugs – or totally drug resistant.
A decline in global spending on essential TB services from US $6 billion in 2019 to US $5.4 billion in 2021 was seen, which was half of the global target of US $13 billion annually by 2022. The recent WHO report noted that the number of people newly diagnosed with TB fell from 7.1 million in 2019 to 5.8 million in 2020. Partial recovery of 6.4 million was seen in 2021, but it was well below pre-pandemic levels. The three countries that accounted for most of the reduction in 2020 were India, Indonesia and the Philippines (67 per cent of the global total). They made partial recoveries in 2021, but still accounted for 60 per cent of the global reduction, compared with 2019.
It is time to put a stop to this long-time killer.
It is with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threat of tuberculosis.
(Dr Naresh Purohit is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of Southern India including Thrissur based Kerala University of Health Sciences)
(The views and opinion expressed in this article are those of the author)