India has the highest incidence of TB in the world, according to the WHO's Global Tuberculosis Report 2013. The report reveals that the country also has the world’s most missed TB cases
At the forum of International Union against Tuberculosis and lung Health, held in Paris recently, Indian officials were booed. Slogans of ‘Shame on India’ reverberated the amphitheatre. The officials were asked as to what the Government was doing to check the spread of tuberculosis that has taken an epidemic form — claiming a life per minute in India.
India was in the focus in the 44th Union World Conference on lung Health for bad management. Civil society activists questioned why India was not doing enough to save innocent lives. The questions asked persistently were: Why were the multi-drug-resistant TB cases on the rise in IndiaIJ What was New Delhi doing to control itIJ Indian officials were red-faced. They did not have an answer on why TB cases were on the rise despite international pressure and global financial assistance.
The anger of the activists was not misplaced. It reflects the negative role of Government in controlling the menace. The World Health Organisation has recorded that one person dies every minute in India of the disease, and the number is bound to go up. The Post Graduate Institute of Medical Education and Research in Chandigarh has confirmed the WHO statistics.
India has the highest incidence of TB in the world, according to the WHO’s Global Tuberculosis Report 2013. The report reveals that India also has the most missed TB cases of any country. At least 31 per cent of the global missed cases are reported from India. Out of the 22 high-burden countries, India was one that saw the greatest increase in multi-drug-resistant TB between 2011 and 2012.
At the conference, Indian officials informed that over 30,000 MDR-TB patients are under treatment in India. The activists contested this claim and said the figure was three times more.
Another shocking fact which came to light was ‘stock-out’ — meaning that, at one point of time, India did not have medicines to combat MDR-TB. The Government has launched the Direct Observation Treatment project — under which patients are given medicines by TB health volunteers in DOT centres. This being a Union Government scheme the medicines are sent to States by the former. In June, the Union Government declared a ‘stock-out’, said it does not have medicines and asked the respective State Governments to do the needful.
Activists raised this issue, and wondered how India, which has emerged as a global medicine supplier, could declare a stock-out of MDR medicines. Where had all medicines have goneIJ But, the Indian officials did not have an answer.
MDR-TB is caused by bacteria that is resistant to most effective anti-TB drugs like Isoniazid and Rifampicin. MDR-TB can take up to two years to treat with medications that are stronger than the standard ones, and the treatment is 100 times more expensive. If the medicine to treat MDR-TB is mismanaged, further resistance can occur, leading to extensively drug-resistant TB. This trait of TB is even harder to treat.
MDR-TB is caused from either primary infection or may develop in the course of a patient’s treatment. In a majority of the cases, treatment does not come from specialised doctors but from quacks. In villages in States such as Uttar Pradesh where health facilities are poor, villagers more often than not visit untrained doctors. These jhola-type doctors give high potency antibiotics to the patients, which initially give relief; in the long term, the patients develop a resistance to drugs.
Experts say that MDR is strictly a man-made problem. Poor prescriptions, faulty case management, lack of coordinated education and haphazard treatment are the major causes of drug resistance. They point out that the world is on the brink of multi-drug resistant TB epidemic and India will be the epicentre of this menace. The country is heading for doom if steps are not taken immediately.
Government records suggest India has the largest TB cases — anything between two million and 2.5 million. Doctors even suggest that India has almost one lakh TB patients who have developed MDR. The National TB Control Programme suggests that 70 per cent of TB patients are aged between 15 and 54 years — with two-thirds of them male. In females, it generally hits the younger generation, as almost 50 per cent of affected patients are below 34 years of age.
Despite such a gloomy scenario, and India missing targets on a regular basis, the Global Fund to Fight TB, HIV and Malaria has pledged $30.45 million for the next two years under the Project Axshya. This project prioritises vulnerable populations and people living in hard-to-reach areas who have the greatest difficulty in accessing treatment for TB.
The fund will expand access to tuberculosis information and services, increase the reach of the national programme and empower civil society and people affected by TB. The fund is coordinated through the union office that will work with 1,200 NG0s.