Tuberculosis cases in India higher than estimated, finds research

The country’s private sector treats 2-3 times more people than previously counted

By Kundan Pandey
Published: Thursday 25 August 2016

India suffers from the highest burden of TB cases in the world.

A new research published in the journal The Lancet Infectious Diseases suggests that the number of tuberculosis (TB) cases in India may be underreported.

India suffers from the highest burden of TB cases in the world.

The two-part research comments estimates the total number of TB patients in India’s private sector. The first study, lead by Nim Pathy, calculates nationwide sale of anti-tuberculosis drugs in the private sector in the country. The team used this figure to calculate total cases of tuberculosis. It found that around 2.2 million TB cases were handled by the private sector in 2014—two or three times higher than the current estimates. India’s evaluation believed close to 80,000 tuberculosis cases were being treated in private sector in 2014.

Researchers used data on TB drug sales collected by IMS Health, a database management company. They used this information to estimate the treatment volume or the total patient-months of treatment for tuberculosis in the private sector.

They found 17.793 million patient-months of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60 per cent of private sector tuberculosis diagnoses are correct and treatment lasts 2–6 months on average, then 1.19–5.34 million tuberculosis cases have been treated in the private sector in 2014 alone, the report says. The mid-point of this range gives an estimate of 2.2 million cases.

The report underscores the private sector’s contribution in treating tuberculosis patients in India. It also emphasises on the need to regulate the sector and strengthen surveillance of patients.

Nimalan Arinaminpathy, lead author of the research from the School of Public Health at Imperial College London said, “Tuberculosis is the top infectious disease worldwide, yet we have had little idea of the true scale of the problem in India—the country most affected. This is because many patients in India use the private medical system as opposed to the state system. However, this vast private system consists of a huge number of providers and is largely unregulated—meaning that most cases of TB seen in the private healthcare system are not reported to public health officials.”

A 2015 committee report found the lack of regulation of private entities contributing to drug resistance in tuberculosis virus.

The joint initiative of the government, independent experts and civil society found multidrug-resistant tuberculosis (MDR-TB) to be a major health problem in India. Moreover, delay in treatment of MDR-TB is the main reason behind increasing antibiotic resistance, especially towards drug Rifampicin. 

The report found that over 70 per cent patients first visited private entities, where diagnosis was delayed and treatment quality varied. This, combined with the absence of drug distribution controls, leads to drug resistance.

Patients are not notified under the Revised National Tuberculosis Control Program, even though it is mandatory. The TB surveillance system in place lacks the capacity to count large numbers of privately-diagnosed and treated TB cases, hampering timely interventions.

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