Tuberculosis India-2014

Tuberculosis is no longer a disease afflicting only the poor. Its thrives on deprived/distorted lifestyle and on the offshoots of the so-called newer arena of development that the country witnesses today

By Sachin Kumar Jain
Published: Monday 30 November -0001

Tuberculosis is no longer a disease afflicting only the poor. Its thrives on deprived/distorted lifestyle and on the offshoots of the so-called newer arena of development that the country witnesses today

The title of this article may rather appear weird. However, the annual report released by the Central Government year-on-year on situation of tuberculosis or TB in India is invariably titled as TB India, (with year as the subscript). The one for the current year is titled as TB India 2014. Situation of TB in India and Tuberculosis India: In fact, these two connotations meant to define and express the title completely alter the context and the seriousness that the subject entails.

When we look at the situation of TB and its prevalence, we find the title given in the government reports is quite apt. Tuberculosis is no longer a disease afflicting only the  poor. Now its genesis is traced to deprived/distorted lifestyle and that it thrives on the offshoots of the so-called newer arena of development that the country witnesses today. In India, as many as 3.3 million people are suffering from one or the other type of TB and that annually 276,000 lives are lost due to tuberculosis. As many as 9.4 million cases of TB are detected worldwide every year. India accounts for more than one-fifth of the same at about 1.98 million. Two to three per cent of the newly detected cases are also found to be drug-resistant and when the patients abandon the course of treatment mid-way, this proportion of non-resistant cases rises to the range of 14 – 17%.

TB is no less than a silent contagion one sees its devastating impact on life. Generally, those persons who are infected by the TB bacteria and have visible symptoms of TB are referred to as TB patients. However, the World Health Organisation informs that one-third population of the world or about 2,000 million people carry the Mycobacterium tuberculosis, defined as Latent TB. If the people have a strong resistance to disease, these bacteria remain dormant and do not manifest as infection of TB. The WHO apprehends that the bacteria may become active in 20 million of these people at any time and cause a widespread tuberculosis infection. According to the TB India Report 2012, 40% of the country's population carries the Mycobacterium tuberculosis (the TB bacteria) in the passive form. Malnutrition plays an important role in activating this latent and passive TB bacteria. This poses a real threat to the 65 million underweight children in the country. The bacteria becomes active in the wake of lowered immunity which is caused by lack of nutritious food intake. The probability of developing tuberculosis amongst the younger children is very high. It thus becomes crucial that a strong action plan is put in place for addressing the occurrence of this disease amongst children under 6 years of age and that the community is engaged in monitoring the same.  

It appears that a major change has come about in detection and treatment of tuberculosis cases between 1990 and 2012. It is believed that the incidence of tuberculosis has reduced from 216 per 100,000 per year in 1990 to 176 per 100,000 per year in the year 2012 in India , the tuberculosis mortality per 100,000 population having been reduced from 38 in year 1990 to 22 in 2012. In absolute numbers, mortality due to TB has scaled down from 330,000 to 270,000 annually. Now the moot question is whether we have really brought the tuberculosis under control. The answer is in the negative. The World Health Organisation says that the incidence of active TB has reduced due to detection and treatment. However, the latent TB stands unabated (490 million people of the country continue to carry the dormant bacteria with them. As soon as the immunity drops, it can lead to the activation of the disease) and that we have not been able to bring its determinants under control. Risk factors  including biomedical (such as HIV infection, diabetes, tobacco, malnutrition, silicosis, tumor or malignancy etc.), environmental (indoor air pollution, lack of ventilation etc.) or socio-economic (crowding, urbanization, migration, poverty etc.) lead to progression of latent TB to active disease. World Health Organisation believes that enough work has not yet been done in India to address the linkage between the prevalence of TB and these risk factors.

In the meantime, the International Diabetes Federation has released the estimates of the global burden of diabetes mellitus (DM) vide its 2011 Diabetes Atlas. A study in South India shows that diabetes is an independent risk factor for tuberculosis. Modeling from the study suggests that diabetes accounts for 14.8% of all tuberculosis whereas 20.8% of smear-positive TB cases are traced to diabetes. In the context of health, it is now strongly believed that consequent upon the rapid urbanization and socio-economic development, diabetes mellitus (DM) has been assuming the proportion of an epidemic. Now 61.3 million people in India suffer from this incurable disease. Widespread prevalence of TB is largely owed to person-to-person transmission of infection. Whilst its diagnosis and treatment are underway, it is the other factor of progression of latent TB to active disease which is also of serious concern. Accordingly, it is not necessary that a person shall contract TB from another TB-infected person. A research paper  informs that HIV and malnutrition are major population attributable risk factors in progression of latent TB to active disease. The study reveals that population attributable fraction for adults would stand at 16% due to HIV, 27% due to malnutrition, 10% due to diabetes, 13% due to alcohol use (>40g/day), 21% due to active smoking and 22% due to indoor air pollution. It thus brings out clearly that mere diagnosis and treatment would not be able to contain the prevalence of TB. We would need to review our life style and have a relook in to the policies of distorted development.

TB has a straight linkage with poverty and working conditions. With the discontinuity in regularly getting adequate nutritious diet, the immune system in the human body weakens and the TB bacteria proliferate their effect. When the bacillus Mycobacterium tuberculosis (the TB bacteria) are inhaled by the host into the lungs, they start getting multiplied and invade the hilar lymph nodes through the lymphatics. Subsequently, it reaches the kidneys, brain and bones through the blood flow and begins causing its adverse effect on them.

Although the immunisation programme of India includes BCG (Bacillus Calmette–Guérin) vaccination for prevention of TB, there are many issues with regard to the quality of programme implementation. It was claimed that 87% children were administered the BCG vaccination in year 2007. However, since then and over the years until year 2013, the claim status continues to be at 87%! The population wing of the United Nations too has raised questions on these claims. Probably, the problem is that we have reposed so much of faith in BCG vaccination that the attention to diagnosis of TB in children and their treatment has been relegated in terms of importance and priority.

Presently, these days all of us seem to measuring up ourselves in terms of economic indicators (value of money). The TB India Report 2014 informs that the family loses its income in the range of 20 to 30% because of this illness and that the country as a whole suffers huge loss to the tune of Rs.1422, 000 million! The kind of government resources that are being pumped in to the so-called development, it is apparent that the policy making in fact is apparently oblivious to the twin price that is being extracted from the public, namely, economic insecurity and death. Accordingly, whenever next the government seeks to review the status of TB in the country, it should rather examine as to how it would combat the TB arising due to urbanization, malnutrition and air pollution! One should no longer hide the epidemic in the guise of data pertaining to diagnosis centres and number of patients treated.

Sachin Jain is with Vikas Samwad Human Development and Food Rights Resource Centre,  Bhopal and can be contacted at                         


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