The menace of tuberculosis has been growing unabated despite being declared a global health emergency way back in 1993. It is more severe in developing countries with China and India together accounting for about 40% of global burden (India 26% and China 12%).
In India, 1.8 million people develop the disease and 3,70,000 die every year (recent data). Two people die of TB in India in every three minutes. RNTCP (Revised National Tuberculosis Control Programme) based on DOTS (Directly Observed Treatment, Short course) to tackle the disease began in 1993 on pilot basis and launched in 1998. But it is a passive system that waits for patient to walk in and get tested. It has not been able to reduce incidence of new cases and development of drug resistance.
Further, cases of drug resistant cases are on the rise in the form of MDR-TB (Multi Drug Resistant-TB), XDR-TB (Extremely Drug Resistant- TB) and TDR-TB (Totally Drug Resistant TB). What are the causes and problems that have caused unchecked growth of the disease in India and what are the potential solutions? Let us try to find out.
Private Practitioners Majority of patients first contact private practitioners but only 30,000 private practitioners provide RNTCP services at present. Also private practitioners are not well equipped to track and follow up all patients. In a landmark (but delayed) decision in 2012, government made TB a notifiable disease that will make it mandatory for hospitals, doctors, laboratories, etc to report every TB case detected. There are also high number of wrongly diagnosed and wrongly treated cases in private sector. It is important to establish a standard of care for treatment. RNTCP should involve private sector as a priority.
Diagnosis Serological (blood) tests to diagnose TB continue to be widely used despite being banned by the government in June 2012. Not only these tests have low sensitivity (50%), it also cannot determine drug resistance. Xpert MTB/RIF not only has high sensitivity(70% with one test and 90% with three tests) and specificity (99%) but it can also diagnose rifampicin (important marker of MDR-TB) drug resistance. Patients resistant to rifampicin are mostly resistant to isoniazid (another first line drug) also. Resistance to at least these two drugs is required to classify a patient as having MDR-TB. It also gives result within 2 hours. Widespread use of such tests should be promoted rather than relying on serological tests and X-rays for diagnosis.
Treatment No new drug was developed in last 40 years because pharmaceutical companies do not see it as profitable business as TB commonly affects poor people. However some breakthroughs have been made and new drugs and combinations are likely in next few years. REMox TB (a large trial) is evaluating moxifloxacin based regimen which could shorten the duration of treatment by a third. Another trial showed that PaMZ (new drug combination containing PA-824, pyrizinamide, moxifloxacin) has potential to effectively manage both drug sensitive and resistant cases. Before new drugs and combinations enter India, it should be ensured they are not abused. Doctors should follow the guidelines and not create their own regimens. Drug resistance is the biggest threat for any hope to check the expanding shadows of the menace. Therefore TB drugs should not be dispensed to patients without prescriptions from qualified practitioners.
Social Factors It is important to address the social factors (overcrowding, poverty, malnutrition, pollution, tobacco abuse, etc) because they influence the treatment and facilitate recovery. TB should be linked to social support programmes of the government.
It is time we wake up and directly confront this menace before it assumes dangerous and irreversible proportions. Current scenario is characterized by delayed diagnosis, wrong diagnostic tools, faulty treatment and lack of follow up resulting into resistance development. Immediate measures should be taken to reverse this trend.
this is a good Article
very informative piece on such a sensitive issue. TB, apart from being a disease itself, inflicts many side effects, which are no less dangerous, early detection and complete medication is the key to survival.
a complete informative article raising awareness ..great job done
Tuberculosis is a bacterial disease usually affecting the lungs (pulmonary TB). Other parts of the body can also be affected, for example lymph nodes, kidneys, bones, joints, etc. (extra pulmonary TB). Approximately 1,300 cases are reported each year in New York State
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