5.4 lakh unreported TB cases in India

According to the World Health Organization’s Global TB report, the number of tuberculosis patients in India reduced by around 50,000 in 2018 compared to the previous year. However, around 5.4 lakh tuberculosis cases went unreported last year in India which is among the top eight countries with the highest burden of the disease. 

“Globally, three million tuberculosis cases go unreported to national TB programmes across the world. In India, of the estimated 2.69 million cases emerging in 2018, 2.15 million were reported to the government of India a gap of 540,000 patients who are going unreported,” the WHO report said.

It also adds that 2018 saw a reduction in the number of TB deaths globally — 1.5 million people died from TB in 2018, down from 1.6 million in 2017.

In 2017, India had 27.4 lakh tuberculosis patients which came down to 26.9 lakh in 2018. Also, tuberculosis incidence per 100,000 population has decreased from 204 in 2017 to 199 in 2018.

In 2018, 22.819 TB cases among health care workers were reported from 74 countries and India accounted for 56 per cent of these cases. 

In India, there has been a particularly striking and impressive increase in the TB-specific budget, and in domestic funding for this budget, since 2016. Between 2016 and 2019, the national TB budget almost doubled, and domestic funding for this budget quadrupled. Domestic funding for the national TB budget is 10 times higher in 2019 than it was in 2006.

The government of India’s national strategic plan for TB elimination (2017–2025) committed to pursuing several bold and people-centred policies. These included providing a direct benefit transfer (DBT) to all TB patients to support improved nutrition and help address the financial burden faced by TB patients and their households, under a national scheme called Nikshay Poshan Yojana.

Nikshay Poshan Yojana

Nikshay (Ni=end, kshay=TB) is the web enabled patient management system for TB control under the Revised National Tuberculosis Programme (RNTCP). 

Nikshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. 

It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the government of India.

The ministry launched the direct benefit transfer scheme for nutritional support to tuberculosis patients as Nikshay Poshan Yojana (NPY) from April 1, 2018. 

The DBT provides Rs 500 per month to notified TB and multidrug-resistant TB patients for the duration of their treatment.

As on January 1, 2019, 8.78 lakh people have received the benefit under the scheme.

Treatment success rate increases globally

Globally, seven million people were diagnosed and treated for TB - up from 6.4 million in 2017 – enabling the world to meet one of the milestones towards the United Nations political declaration targets on TB.

The number of patients being tested for resistance towards rifampicin — a frontline anti-tuberculosis drug — has increased from 32 per cent in 2017 to 46 per cent in 2018. The treatment success rate has increased to 81 per cent for new and relapse cases in 2017 from 69 per cent in 2016.

With more people receiving life-saving treatment for tuberculosis in 2018 than ever before, largely due to improved detection and diagnosis, the Global TB Report stated that 2018 also saw a reduction in the number of tuberculosis deaths worldwide with 1.5 million people having died from the disease in 2018, down from 1.6 million in 2017.

“The number of new cases of tuberculosis has been declining steadily in recent years. However, the burden remains high among low-income and marginalized populations — around 10 million people developed tuberculosis in 2018,” the report stated.

Drug resistance remains another impediment to ending the disease. In 2018, there were an estimated half a million new cases of drug-resistant tuberculosis across the world and only one in three of these people was enrolled for treatment.

New WHO guidance aims to improve treatment of multidrug resistant TB, by shifting to fully oral regimens that are safer and more effective. The guidance is part of a larger package of steps released on March 24, 2019 — World TB Day — to help countries speed up efforts to end the disease. 

The report highlighted that fragile health infrastructure and workforce shortages make it difficult to provide timely diagnosis and the right treatments for tuberculosis. Besides, weak reporting systems are another problem as health providers may treat people but fail to report cases to national authorities, leaving an incomplete picture of national epidemics and service needs.

Further, up to 80 per cent of TB patients in high-burden countries spend more than 20 per cent of their annual household income on treating the disease.

“Sustained progress on tuberculosis will require strong health systems and better access to services. That means a renewed investment in primary health care and a commitment to universal health coverage,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. 

Facts on TB

Tuberculosis (TB) is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent (ranking above HIV/AIDS). 

It is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air; for example, by coughing. 

It typically affects the lungs (pulmonary TB) but can also affect other sites (extrapulmonary TB). About a quarter of the world’s population is infected with M. tuberculosis and thus at risk of developing TB disease.

With a timely diagnosis and treatment with first-line antibiotics for six  months, most people who develop TB can be cured and onward transmission of infection curtailed. 

The number of TB cases occurring each year (and thus the number of TB-related deaths) can also be driven down by reducing the prevalence of health-related risk factors for TB (eg: smoking, diabetes and HIV infection), providing preventive treatment to people.