Overview Of The Incidence Tuberculosis in India

TUBERCULOSIS IN INDIA

Objectives:
To give an overview of the incidence of
tuberculosis in India
To describe the needs of the Indians using
epidemiological, quantitative or qualitative data
on tuberculosis
To discuss about one intervention that could
reduce the burden of tuberculosis
To present actions needed to implement the
intervention described previously

Tuberculosis
Tuberculosis (TB) is an airborne disease caused by the
spread of Mycobacterium tuberculosis bacteria that
spreads from one individual to other through air
Tuberculosis mainly attacks the lung, however it can
damage other body parts such as kidney and the brain
too
Some of the basic clinical manifestations of TB is
sickness, night sweating and weight loss.
Due to progression of the disease, other symptoms
seen in patient includes frequent cough, spitting of
blood and chest pain.
Mantoux skin test is done to diagnose TB (CDC, 2014).

Risk factors
Low body weight
Head or neck cancer
HIV infection
People who are more vulnerable to risk of TB include
individuals with weak immune system such as
malnutrition, HIV and people using tobacco.
For people with HIV, risk of TB increases by 20 times.
All people irrespective of age has the possibility to
be infected by
Risk of transmission is high in overcrowded areas
(Silva et al., 2018)

Epidemiology
TB accounted for 1.5 million deaths globally in the year
2018
Another most crucial statistics is that India is leading
across the high TB burden countries WHO, 2019).
According to the Global TB report 2017, the prevalence of
TB in India was 28, 00, 000 and this data is equivalent to
quarter of the global TB cases.
In the year 2015, the estimated number of deaths due to
TB was 0.48 million.
Although the Indian government goal is to end TB by 2025,
this goal can be achievable only when incidence of TB
decreases by more than 10-15% per year (Prasad, Gupta &
Banka, 2017).

NSP 2017-2025 Results Framework
Impact indicators of the NSP 2017-2025. Source: (Ministry of
Health and Family Welfare, 2018)

Self-reported cases of TB across Indian
states
Source: (Mazumdar, Satyanarayana & Pai, 2019).

Concerns associated with TB prevention:
The rise in the incidence of multi-drug resistant TB
(MDR TB) is one of the greatest barrier to TB prevention
MDR TB is the disease that is resistant to two most
efficacious anti-TB drug namely Rifampin and Isoniazid.
According to the WHO (2019) report, there were 4, 84,
000 new cases of MDR TB which were resistant to
rifampicin.
Apart from China and Russia, the burden of MDR TB
falls on India too. These three countries together
accounts for 50% of the global MDR-TB cases (CDC,
2014).

Quality of TB care in India
The cost of TB treatment is not uniform in India
because of fragmented health care delivery system
• 80% of the individuals with TB first contact health care
and 50%of the TB care occurs in private care
(Arinaminpathy et al., 2019)
• Anand et al. (2017) highlights treatment of TB is
mostly dominated by private secror in India
Evidence has reported people being challenged by
high cost of treatment
A systematic review on quality of TB care in India
revealed suboptimal quality of TB care particularly in
private sector (Satyanarayana et al., 2015).

Barrier to TB notification
One of the alarming statistics related to TB in India is rise in
number of missing cases
A recent report shows that India contributes to 25% of the
missing cases globally
Another major shortcoming of the TB screening in India is that
only 50% of TB diagnosed and treated cases are notified to
public health care system.
Some of the barriers to complete notifications included
operational complexities, lack of time, poor awareness about
complexity and fear of breaching complexities (Siddaiah et al.,
2019).
Geographical barrier to TB management and prevention is also
a concern as lack of transportation facilities is a major barrier
for treatment adherence (Negandhi et al., 2017).

Health strategy to reduce burden of TB in
India
There is a need for the Indian government to implement
fixed dose regimen throughout the country and improve
disease surveillance activity to prevent TB.
WHO recommends use of fixed dose combinations (FDCs)
of anti-TB drugs
This strategy can eliminate prescription errors
Strengthening TB surveillance system in India is important
to get better estimate of TB incidence and reach out to
groups which cannot afford treatment (Pai, Bhaumik &
Bhuyan, 2016)
It is recommended to improve patient tracking by
improving specimen transport mechanism too (Shewade et
al., 2018)

Actions needed to implement the intervention:
To effectively implement the above health intervention,
the Indian government needs to take the following
actions:
Increase budgetary provisions needed to achieve the
goals of the RNTCP.
Promote intersectoral coordination to streamline
services and achieve uniform quality of care in both
private and public sector
Engage diverse stakeholders like user interface
agencies, political groups, quality control groups and
epidemiologist so that innovative steps related to
surveillance and FDCs are implemented.

Important stakeholders of the plan:
Private and public care providers
Interface agencies
Policy makers
Health informatics group
Political groups
Social workers

REFERENCES
aidsinfo.nih.gov 2020. HIV and Opportunistic Infections, Coinfections, and Conditions. Retrieved from:
https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/26/90/hiv-and-tuberculosis--tb-
Anand, T., Babu, R., Jacob, A.G., Sagili, K. and Chadha, S.S., 2017. Enhancing the role of private practitioners in
tuberculosis prevention and care activities in India. Lung India: official organ of Indian Chest Society, 34(6), p.538.
Arinaminpathy, N., Batra, D., Maheshwari, N., Swaroop, K., Sharma, L., Sachdeva, K. S., ... & Nair, S. A. (2019).
Tuberculosis treatment in the private healthcare sector in India: an analysis of recent trends and volumes using drug
sales data. BMC infectious diseases, 19(1), 539.
CDC (2014). Tuberculosis: An Overview. Retrieved from:
https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/archive/tb-overview.pdf
Mazumdar, S., Satyanarayana, S., & Pai, M. (2019). Self-reported tuberculosis in India: evidence from NFHS-4. BMJ
global health, 4(3), e001371.
Ministry of Health and Family Welfare (2018). India TB Report 2018. Retrieved from:
https://tbcindia.gov.in/showfile.php?lid=3314
Narasimhan, P., Wood, J., MacIntyre, C. R., & Mathai, D. (2013). Risk factors for tuberculosis. Pulmonary
medicine, 2013.
Negandhi, H., Tiwari, R., Sharma, A., Nair, R., Zodpey, S., Reddy Allam, R., & Oruganti, G. (2017). Rapid assessment of
facilitators and barriers related to the acceptance, challenges and community perception of daily regimen for
treating tuberculosis in India. Global health action, 10(1), 1290315.
Oxlade, O., & Murray, M. (2012). Tuberculosis and poverty: why are the poor at greater risk in India?. PloS one, 7(11).
Pai, M., Bhaumik, S., & Bhuyan, S. S. (2017). India's plan to eliminate tuberculosis by 2025: converting rhetoric into
reality.
Prasad, R., Gupta, N., & Banka, A. (2017). 2025 too short time to eliminate tuberculosis from India. Lung India:
official organ of Indian Chest Society, 34(5), 409.

References (continued)
Satyanarayana, S., Subbaraman, R., Shete, P., Gore, G., Das, J., Cattamanchi, A., ... & Pai, M. (2015). Quality of
tuberculosis care in India: a systematic review. The International Journal of Tuberculosis and Lung Disease, 19(7),
751-763.
Shewade, H. D., Kokane, A. M., Singh, A. R., Parmar, M., Verma, M., Desikan, P., ... & Kumar, A. M. (2018). Provider
reported barriers and solutions to improve testing among tuberculosis patients ‘eligible for drug susceptibility
test’: A qualitative study from programmatic setting in India. PloS one, 13(4).
Siddaiah, A., Ahmed, M. N., Kumar, A. M., D’Souza, G., Wilkinson, E., Maung, T. M., & Rodrigues, R. (2019).
Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study. BMJ
open, 9(2), bmjopen-2018.
Silva, D. R., Muñoz-Torrico, M., Duarte, R., Galvão, T., Bonini, E. H., Arbex, F. F., ... & Mello, F. C. D. Q. (2018). Risk
factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. Jornal Brasileiro de
Pneumologia, 44(2), 145-152.
Sineke, T., Evans, D., Schnippel, K., van Aswegen, H., Berhanu, R., Musakwa, N., ... & Rosen, S. (2019). The impact
of adverse events on health-related quality of life among patients receiving treatment for drug-resistant
tuberculosis in Johannesburg, South Africa. Health and quality of life outcomes, 17(1), 94.
Singh, P., Samal, J., Zarin, S., Elangovan, R., Hasnain, S. E., & Ehtesham, N. Z. (2019). Breaking the Transmission of
TB: A Roadmap to Bridge the Gaps in Controlling TB in Endemic Settings. In Mycobacterium Tuberculosis:
Molecular Infection Biology, Pathogenesis, Diagnostics and New Interventions (pp. 451-461). Springer, Singapore.
WHO (2017). TB causes 1 in 3 HIV deaths. Retrieved from:
https://www.who.int/hiv/mediacentre/news/hiv-tb-patient-centred-care/en/
WHO (2019). Tuberculosis. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
Zuur, M. A., Akkerman, O. W., Forsman, L. D., Hu, Y., Zheng, R., Bruchfeld, J., ... & Alffenaar, J. W. C. (2016). Fixed-
dose combination and therapeutic drug monitoring in tuberculosis: friend or foe?. European Respiratory
Journal, 48(4), 1230-1233.