India contributed the biggest drop in global case notifications last year
India is poised to miss its annual target of 2.4 million tuberculosis (TB) case notifications defined in the draft National Strategic Plan (NSP), an analysis of the monthly notifications data maintained by the World Health Organization (WHO) showed.
Total case notifications stood at 1,934,194 till November-end, of which 1,305,304 were done by the government and 628,890 by the private sector. Sector-wise notification targets outlined in NSP are 1,625,000 for the public sector and 775,000 for private.
Meeting the TB notification target is critical for countries aiming to eliminate the disease, according to global health experts. A study published in the European Respiratory Journal explained why the process is instrumental in TB eradication:
TB notifications have been on a steady rise in India the past few months, data showed. But it is not enough to meet the target.
This is a trend being recorded the world-over, as the novel coronavirus disease (COVID-19) pandemic continues to wreak havoc. WHO’s Global TB report 2021 placed the global gap at about 1.4 million cases for 2020 and attributed to redirected resources owing to the COVID-19 outbreak.
India contributed the biggest drop in case notifications last year, indicating that a large number of cases went undetected. About 41 per cent of all cases dropped in 2020 came from India.
In March, April and May 2020, TB case notifications in India dropped by 20.55 per cent, 63.47 per cent and 46.33 per cent respectively, according to the Nikshay database, a web-enabled patient management system for TB control under the Union government's National TB Elimination Program.
Shibu Vijayan, global TB technical director at PATH, a team of global innovators working towards achieving health equity, told Down To Earth.
The risk of a tuberculosis infection turning into a disease has increased, while case notification has dropped in 2020 in India. Clinics were not functioning because the workforce was redirected to fight COVID-19. All the advancement we made till now in TB elimination has declined, lack of nutrition and unemployment triggered because of COVID-19 induced lockdown has further worsened the situation.
During India’s second COVID-19 wave in 2021, a similar trend was seen, with notifications beginning to decline by April 2021. As many as 1,16,645 cases were notified in April 2021, according to the Nikshay portal.
The tally was 203,485 in March 2021 and 92,568 in May 2021. It increased by 42 per cent in October 2021 to 165,912, by when the second wave had subsided and the November figure was similar at 160,697, indicating a healthy upswing.
A study published in the journal Lancet in June 2019 on tuberculosis treatment in India’s private healthcare sector based on drug sales data revealed a potential to increase notification in this sector beyond the set target. The study underlined that a large number of TB cases being treated in the private sector are going undetected.
India was among the countries that reported the “largest relative reductions in annual notification” at 25 per cent between 2019 and 2020, according to the State of Inequality: HIV, Tuberculosis and Malaria by WHO released December 9, 2021. The report was the first by the United Nations health agency on inequality in treatment of these three infectious diseases.
Gabon (80 per cent), the Philippines (37 per cent), Lesotho (35 per cent) and Indonesia (31 per cent) were also badly affected.
India (26.2) was among the eight countries that accounted for over two-thirds of the global TB cases. India was also among the 10 countries making up 74 per cent of the global gap between estimated TB incidence and the number of people newly diagnosed with TB, according to the Global TB Report 2021.
These distressing figures paint a gloomy picture and further underscore the importance of timely notification of TB cases.
The NSP has not yet been finalised, a draft of the same — the latest of which came out in July 2020 — is available in the public domain. This was formed following Prime Minister Narendra Modi’s announcement to achieve the ‘no-TB’ goal by 2025, five years ahead of the UN-mandated Sustainable Development Goal target deadline.
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