Dr Lalit Kumar Anande
TB is today the world’s foremost infectious disease killer, with the WHO recognising it as a “global health crises”. As per the Global TB report 2017, the estimated incidence in India was approximately 28 lakh, accounting for about a quarter of the global total. Prime Minister Narendra Modi announced in 2018 that the government is implementing a National Strategic Plan to end TB in India by 2025, five years ahead of the global End TB target.
Metropolitan cities such as Mumbai have the maximum share of drug-resistant TB cases, according to the Central TB Division’s India TB Report 2018. The city has higher levels of MDR-TB than in other parts of India, at 24-30% of new cases. Studies show that Mumbai also has 22% of notified cases of TB and around 50% potential drug resistance; TB treatment is estimated at 600 per 100,000 in slum areas and 458 in non-slum areas. The reasons for such high incidence are manifold—overcrowded, congested conditions, poor access to healthcare facilities, migrants entering the city daily. Other factors are inadequate nutrition, lack of ventilated spaces, proximity to industry that makes people vulnerable to the harmful effects of pollution, and lack of accessible quality diagnostic services. Extending testing facilities under trained staff to government dispensaries and primary health centres is a must. Many lives can be saved if tests are cheaper, accurate and patients , particularly migrants, are given counselling and other forms of support.
The Revised National TB Control Programme , India has scaled up basic TB diagnostic and treatment services, however, it can’t beat the powerful bacterium unless we adopt an out-of-the-box approach.
There is a need to urgently increase funds for drug research, train health workers and technicians in accurate detection and increase counselling support for patients. We need a new line of thinking to support treatment of the disease by boosting the immunity of the body to fight infections through commonly available antioxidants in food items. Another focus area should be strengthening of the thoracic surgical procedures to treat pulmonary or spinal TB cases.
Eliminating TB by 2025 requires close collaboration between varied stakeholders, including Ministry of AYUSH. We must participate as a community, speak up, ask questions, strengthen TB messages and raise awareness among the larger public.
Author is medical superintendent, TB Hospital, Sewri, Mumbai