A third of the unaccounted for cases are in India, where private hospitals rarely report TB
IN A recent report, the World Health Organization (WHO) has said that India has the highest number of unaccounted tuberculosis (TB) cases. Close to a million TB cases in the country go unreported every year, primarily because of wrong diagnosis.
Across the world, about 2.9 million TB cases are missed every year—India accounts for 31 per cent (0.9 million) of these cases, according to the Global Tuberculosis Report (GTR) 2013, released on October 23. The report is based on data provided by WHO’s member states.
Anurag Bhargava, associate professor of medicine at the Himalayan Institute of Medical Sciences, Dehradun, says a high number of unreported cases undermines efforts to control the highly contagious disease. “Every year, there are 270,000 TB-related deaths in India. Treatment will be possible only if cases are detected,” he adds.
India follows the WHO-specified DOTS (Directly Observed Treatment-short course) programme, under which every patient is supposed to take medication under the supervision of a qualified medical professional. “But private hospitals do not religiously follow this system or patients do not understand its importance,” says Madhukar Pai, assistant professor at McGill University, Canada. He has researched medicine delivery and monitoring of TB patients in Chhattisgarh.
Pai clarifies that the missing cases, however, do not indicate that 0.9 million patients in the country do not receive treatment. “Although it is mandatory to notify the concerned authority under the government’s Revised National TB Control Programme (RNTCP), private doctors and hospitals rarely do so. As a result, these end up as ‘missing cases’,” Bhargava adds. He believes government health programmes, like the National Rural Health Mission and the National Urban Health Mission, should focus more on TB, and suggests that RNTCP can achieve more by integrating its efforts with the primary healthcare services of the government.
Nutrition matters, too
Both Bhargava and Pai think providing nutrition incentives—be it in the form of food or medicinal supplements—along with the treatment of the disease will aid speedy recovery.
A research paper, Nutritional Status of Adult Patients with Pulmonary Tuberculosis in Rural Central India and its Association with Mortality, published on October 24 in PLOS ONE, a peer-reviewed journal, states that a large number of TB patients are malnourished. According to the study, malnutrition is the top comorbidity prevailing among TB patients followed by anaemia, diabetes and HIV.
The research was conducted by Jan Swasthya Sahyog (JSS), a non-profit organisation engaged in providing health services in Bilaspur district of Chhattisgarh since 2000.
Yogesh Jain, who is associated with JSS and co-authored the research paper, says, “Medicines will be more effective if patients get nutritional support.” Nutrition could serve as a powerful incentive to seek treatment under RNTCP, which currently serves only half of the TB patients in the country, he adds.
Bhargava agrees with Jain. He, along with Pai, was involved in the research related to TB in Chhattisgarh from 2004 to 2009, during which 1,695 patients were examined. Their diagnosis found that more than 85 per cent of rural men and women with pulmonary TB suffered from undernutrition.
These findings need to be taken into account as India’s TB control programme does not talk about malnutrition. Bhargava says the majority of the 56 countries with high cases of TB and malnutrition provide nutritional support in their TB control strategy, and that India could follow suit.
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