Eradication of Tuberculosis (TB): Challenges Persist
GS PAPER 2
(HEALTH)
THE HINDU EDITORIAL ANALYSIS
Survivors Against TB, a group of TB survivors, wrote to the Prime Minister ahead of World TB Day, urging the expansion of efforts to address India's TB crisis. They highlighted challenges including TB diagnosis, treatment access, nutrition, mental health support, stigma-free care, economic support, and quality care.
Tuberculosis is a “biosocial problem that requires biosocial solutions”, says a commentary in The Lancet. It is a curable infectious disease linked to inequities. “Socioeconomic conditions create vulnerabilities to the disease and its catastrophic outcomes.”
India could lead in TB elimination
- India's TB efforts are seen as a new global model, with 199 new infections per 100,000 people in 2022. 13% of treated patients and 2.5% of new cases were drug-resistant. Approximately 400,000 people die from TB annually in India.
- Biomedical strategies for reducing new infections include the BCG vaccine for childhood TB, tuberculosis preventive treatment for various groups and shorter rifamycin-based regimes.
- Challenges like inadequate diagnosis, treatment access, stigma, and socioeconomic barriers hinder India's efforts to combat the disease.
- Undernutrition is a significant risk factor for new TB cases and severe TB leading to deaths.
- Undernutrition in adults contributes to 34–45% of new cases yearly. It is a significant risk factor for TB deaths, increasing drug toxicity and relapse risk in TB patients
- The most critical risk in TB management is undernutrition, impacting TB occurrence and treatment outcomes such as mortality, drug toxicity, and relapse.
- It is important to have nutrition assessment and support. The government has launched schemes like direct benefit transfer of ₹500 since 2018 and a food-basket scheme under the PM TB Mukt Bharat Abhiyan to provide nutritional support.
Nutritional support
- In a 2023 study in The Lancet Global Health, patients who received nutritional support showed weight gain within the first two months and a 40-50% reduced risk of death.
- Delayed diagnosis and lack of access to quality care worsen the issue.
- There is a need to enhance diagnostic facilities by incorporating mobile testing units, ensuring access to affordable molecular testing, and delivering prompt and precise results.
- Early diagnosis is crucial for TB, suggesting India should expand the use of rapid molecular diagnostic tests for presumptive TB patients.
Multi-drug resistance worsens matters:-
- In 2022, 63,801 patients were diagnosed with drug-resistant TB in India. A study highlighted gaps in MDR-TB care, citing barriers like diagnosis delays, lack of counseling, late referrals to the national TB elimination program, and high costs.
- Late referrals due to delayed reporting to health centers are a significant issue in India. The second national TB prevalence survey reveals that many individuals with TB symptoms do not seek healthcare due to neglect, self-treatment, or financial constraints.
- TB in children is a significant issue in India, comprising 31% of the global burden. Children make up 6-7% of patients treated in the national TB elimination program annually.
Comprehensive care
- To improve nutrition for TB patients, India's national TB program suggests doubling the monthly ration for households of severely undernourished patients. It also recommends measuring the body mass index of all adult TB patients at diagnosis.
- As an alternative, providing financial support to households affected by TB for at least a year can improve nutrition and reduce TB transmission among family members.
- Patients with severe undernutrition require therapeutic nutrition like liquid oral feeds during inpatient care