What are the difficulties in tuberculosis control in India?

This picture has been used for representational purpose

As per the Global Tuberculosis Report 2018 by World Health Organization (WHO), TB is one of the top 10 causes of death and the leading cause from a single infectious agent. As per the best estimate, globally 10 million people developed TB out of which 27 % were from India. As per an estimate, there were new 27,90,000 cases in India in 2016.

Ministry of Health & Family Welfare, Government of India has developed an ambitious National Strategic Plan 2017-25 for the elimination of TB. Various measure taken by Government includes free diagnosis and treatment of tuberculosis cases, health education measures and active case findings. However, any government programme cannot succeed without active participation from people.

Following are major issues which create hurdles in Tuberculosis control in India

• Mode of transmission: TB is an infectious disease and mainly spreads by droplets when the patient with bacteria in sputum coughs, sneezes, talks and spits. Millions of Bactria spread in the atmosphere during these activities. Lack of civic sense in general population such as spitting anywhere and not covering the mouth while coughing or sneezing help the spread of TB. People living or working in small, ill-ventilated, overcrowded rooms further compound the problem.
• Socio-economic issues: TB is also a social disease and is described as a barometer of social welfare. Malnutrition is rampant thus lowering the body immunity to any infection including tuberculosis. Poverty is a major issue and many TB patients do not comply to treatment because of issues such cost of treatment, cost of travel to health care institution, loss of daily wages etc. Poverty, malnutrition, poor housing, poor quality of life, lack of awareness, lack of education, population explosion, early marriages, large families etc. are all interrelated social factors that make TB control difficult. TB started declining in the western world long before the advent of Anti-TB drugs. This has been attributed to improved quality of life.
• Adherence to the treatment: One of the major problems in TB treatment is that it is prolonged (at least for 6 months) and patients stop the treatment when they feel better or develop some side effects or due to some other social reasons. Not completing the treatment is dangerous because there is a strong chance of relapse of the disease and the TB germs become resistant to the medicines.
• The emergence of Drug-resistant TB germs: This is now a major problem in TB control. Drug-resistant cases require the second line of drugs which are more costly and toxic, and treatment is prolonged beyond 6 months.
• Associated medical problems: Associated medical problems such as concurrent HIV infection, alcoholism, uncontrolled diabetes, smoking further weaken the immunity thus making control and cure difficult.

What can be done by the general public and TB patients to help the Government in TB control?

• Early Detection: Seek medical help or encourage others to do so when there are symptoms such as chronic cough lasting more than 3 weeks, blood in sputum, chest pain, fever, night sweats, loss of weight, loss of appetite and fatigue. Early detection and treatment are highly effective in controlling the spread of the disease. Family members and near contacts of TB patients also should be screened.
• Adhere to treatment: Take full treatment for at least 6 months or more as advised by the doctor. Do not miss even a single dose of medicine. Every TB patient before starting the treatment must be counselled about this issue. It is the duty of family members to see that the patient takes the medicine regularly and completes the treatment as per the advice of the doctor. In case of any side effects, promptly consult your doctor.
• Civic sense: Follow common precautions such as covering the mouth while coughing or sneezing. Do not spit on roads or in public.
• Diet: Adequate nutrition plays an important role in recovery as it boosts the immunity system which fights against the infection. A person suffering from TB should consume a well balanced and nutritious diet consisting of adequate carbohydrates, proteins, vitamins and minerals. Our Indian diet of rice, dal, roti, vegetables including green leafy vegetables, salads and fruits is adequate. In addition, follow the advice of your doctor regarding the diet.
• Lifestyle changes: The TB patient while on treatment should ensure that she/he gets adequate sleep, remains active (unless she/is very sick), drinks adequate water and strictly avoids alcohol, smoking, tobacco or narcotic drugs. If a patient has any associated illness such as diabetes or HIV, it should be treated adequately. Adopting a healthy lifestyle even in non-infected individuals enhances immunity thus contributing to TB control
• BCG Vaccine: Ensure each new-born child is administered BCG vaccine within the first month after birth
• Psychological support: TB can lead to a lot of psychological distress for the patient as well as the family members. This can lead to depression and a sense of loneliness. Hence, it is necessary to look for symptoms of mental illness and help her/him cope with the disease. This will help in improving their thinking pattern, compliance to treatment and accelerate the recovery.
• Public Awareness: Awareness in general public should be enhanced through print media, television, posters, pamphlets, social media etc.

Tuberculosis is curable. Concerted efforts of all stakeholder such as general public, TB patients and their family members, health professionals, health care institutions, government, lawmakers, media and NGOs will help the Government of India to achieve its ambitious goal of TB eradication by 2025.

- Dr. Santosh Datar, Medical Director, Ziqitza Healthcare Ltd (ZHL)

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