Tuberculosis (TB) rates in various countries of the world have shot up, sided by tattered healthcare systems, political instability and lack of commitment to curtail it, the World Health Organisation (WHO) says. The disease has become a bigger cause of human mortality than malaria and AIDS combined, but experts complain that attention has shifted instead to more publicised illnesses. There are 10 times more TB cases in the world than AIDS cases, data compiled by WHO has revealed.
TB is caused by the tubercle bacillus (Mycobacterium Tuberculosis) which belongs to the acid-fast group of bacteria (Mycobacteria) and of which several types exist, including the human, bovine and avian. The disease attacks the lungs besides other organs – lymph nodes, bones and joints, skin, stomach, intestines, kidneys, genitals and adrenal glands – mostly transmitted to healthy persons by way of the respiratory and alimentary tracts or by direct inoculation through the skin, is now among the top human killers worldwide.
According to WHO, TUB has become more frightening than ever, as it moves with people and does not respect national boundaries. Health experts attribute the spread of this infectious disease to poverty, malnutrition, poor living conditions, lack of essential medicines and low priority accorded by the governments to their state-run healthcare systems. The death rate is especially high in densely populated countries with poor hygiene. It is calculated that in general the prevalence is approximately 20 times the mortality, but both prevalence and mortality vary considerably in different circumstances. The daily movement of immigrants already having the disease has increased the number of cases even in countries that have well-functioning public healthcare systems.
India accounts for a high number of worldwide TB cases – nearly one-third of the global total. Recent worldwide estimates have also shown that the country has 27 per cent of the world’s new TB cases. India has 2.8 million new TB cases in 2015, up from 2.2. million in 2014. Besides, India has double the number of estimated deaths by TB in 2015 – 4,80,000 deaths, up from 2,20,000 deaths in 2014, because previous estimates were too low, according to the WHO Global Tuberculosis Report 2016. The report, however, is a calculation of only the number of new TB cases in 2015, and not calculation of the total number of TB cases (old cases and new), known as the prevalence of TB, because the WHO is awaiting results from the national TB prevalence survey scheduled for 2017-2018.
More and more TB cases diagnosed and treated in the private sector healthcare have been registered with the government over the last two years. Until 2012, when the government made it mandatory for private doctors to report cases to the government, no government or private agency nationwide tracked how many patients were diagnosed or treated successfully in the private sector. The notification of private sector patients had gone up by nearly four times. India’s private sector notified 14.4 cases per 100,000 people in 2015, up from 3.1 in 2013, according to data from India’s national TB programme, the Revised National Tuberculosis Programme (RNTP). The government also has better estimate of the TB cases in the private sector because of a 2016 study published in the ‘Lancet’. The private sector in India treats an estimated 2.2 million TB cases, the study said, based on the data from the sale of drugs containing ‘rifampicin’ the main anti-TB drug.
To make matters worse, there is a growing incidence of drug-resistant TB – which does not respond to most effective drugs, fast moving across India. The country had a higher estimated number of patients with drug-resistant TB in 2015 – 79000, 11 per cent more than the cases in 2014. About 2.5 per cent of new TB cases are resistant to rifampicin, or to both rifampicin and isoniazid – the two most commonly used anti-TB drugs. The TB epidemic is larger than previously estimated, reflecting new surveillance and survey data from India, the WHO report said.
What is worse, India also has a large number of multi-drug-resistant (MDR) TB cases. Globally, there are an estimated 10.4 million cases fo the MDR TB strain, with 1.8 million deaths annually. India, however, estimates that 3 per cent of MDR TB cases in the country are untreatable with standard drug regimens. The MDR TB has several issues that have proved highly problematic for India. As against the 6-month treatment regimen for normal TB, MDR TB treatment taken up to two years or more to treat with drugs that are less potent and more toxic. Moreover, medicines for MDR TB Treatment are highly expensive.
WHO has been emphasising that there was an urgent need to expand and accelerate diagnosis capabilities in countries, and have technology that could diagnose MDR TB in two days rather than traditional methods which can be taken up to four months. Recently, WHO gave its nod for an affordable drug combination that cuts down time needed to treat MDR TB from 24 months to around nine months.
The worst form of drug-resistant TB – the extreme type referred to as XDR TB, is also raising its head much more frequently. WHO estimates there may be around 40,000 XDR TB cases a year worldwide, with most proving fatal. Since XDR TB was first defined in 2006, a total of around 60 countries, including India have reported atleast one case of this killer strain till 2015. Mumbai is called the TB capital of India after the emergence of totally-drug-resistant (TDR) TB in 2011; doctors at Hinduja Hospital, Mahim, identified a number of patients in whom most drugs known to treat TB were ineffective.
The Union Government, recently said that it has realised the need for additional investment annually through budget allocation in order to reach the ambitious goals of the End TB Strategy. The government, along with WHO adopted the End TB Strategy in May 2014, which is crucial for the country as it bears nearly one-third of the global burden of the disease.
(The writer is a freelance journalist)
