With a thousand people dying of tuberculosis everyday and 2.2 million new cases getting registered annually, India is home to the largest population of TB patients in the world — 18 % of the TB patients globally and 66 % in south east Asia.
In reply, India runs the largest healthcare programme for the eradication of TB under Revised National TB Control Programme (RNTCP), which comprises an infrastructure of 13,000 designated microscopy centres and medication available free at DOT centres and PHC in all districts. However, the success rate is not good — over 15.9 million patients have been placed under treatment and only 2.9 million have successfully been treated since the full implementation of RNTCP.
“Would you believe that on an average one TB patient passes on this disease it to at least 15 healthy people and the number keeps multiplying? Be it a normal TB or multi-drug resistant TB (MDR-TB), there are three main reasons why India has failed to control it. The first is inefficient diagnosis mechanism in both government and private establishments. TB being a social stigma, patients do not approach government establishment and thirdly, the poor and sub-standard living condition which play sheet-anchors role in transfer of this diseases,” said Dr JN Banavlaiker, vice chairperson of the Tuberculosis Association of India.
“More than 40 per cent Indians don’t complete the course of treatment as most of them are poor and can’t sit at home for six months of treatment. This attributes to the patient’s death as his financial instability doesn’t allow him to take treatment which is free. Secondly, diagnosis hasn’t been very good as in most cases, the patient gets to know about the diseases after it passes a certain stage,” said Dr Deepak Yaduvanshi, medical director and CEO of Soni group of hospitals who has also served at WHO as a consultant.
Although the National Strategy Plan (NSB) for TB Control 2012-17 envisions a TB-free India through universal access of quality diagnosis and treatment for all TB patients, failure in diagnosis even at big hospitals like the AIIMS puts a question mark on such a goal. “It would take time as the disease is contagious and most patients get diagnosed for TB after it crosses the initial stage,” said Dr Rohit Sarin, director, National Institute of Tuberculosis and Respiratory Diseases.