Today is World Tuberculosis Day

Tuberculosis is a disease caused by a bacterial infection and spread through coughing and sneezing. Some key facts from the World Health Organization (WHO):

• Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.
• In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB.
• Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top three causes of death for women aged 15 to 44.
• In 2012, an estimated 530 000 children became ill with TB and 74 000 HIV-negative children died of TB.
• TB is a leading killer of people living with HIV causing one fifth of all deaths.

A new study has found that 1 million children around the world are infected with TB. This is twice the number previously reported. It has been harder to diagnose children, since the bacteria affect children differently. With eradication efforts focused on adults, public health officials are missing out on 1 million cases that could help curb the problem.

Traditionally, it was believed that only adults were contagious, but with new data and mounting evidence of how much children suffer, new approaches need to be added to India’s effort to fight TB.  This new data adds to an ever-growing need to take further action against this epidemic.

TB and India

A quarter of all TB cases are in India. This is after massive government and NGO efforts in the past few years to curtail the spread of TB. Since 2012, TB has been a notifiable disease, requiring everyone to report every case to the government. However, this has done little to help the efforts.

A large risk factor for TB is malnutrition, which is a problem that needs to be addressed if proper efforts are to be made in curtailing the spread of TB. This is even more important in India, where 40% of the population is infected with TB bacteria, with a majority of them having latent rather active TB.

Recent WHO reports have pointed out that India has achieved the 2015 Millenium Development Goal (MDG) of having a decreasing rate of new TB cases and is on track to meet its target goal for 2015. China has already met its goal and has been doing a much better job of pursuing TB eradication. However, the Chinese also have a much more government regulated health system, which avoids many of the problems that India’s health sector doesn’t.

TB and the Private Sector

Approximately 5o% of TB cases are dealt with in the private sector.  This means that if India is to do as well as it did in defeating polio, it is going to have to step up its game in the private sector. Problems are abundant within the Indian private sector health care system that makes it even harder to deal with TB. For example, the high cost of treatment means that patients are less likely to complete treatment as costs go up. There is also little incentive for private institutions to pursue patients who are low-income or otherwise unable to pay for the cost of treatment.

With only three labs in the county, the highly centralized process of diagnosing means that it takes longer for treatments to start. A decentralized approach with expanded TB infrastructure is needed to properly combat TB. India also accounts for 31% of missed cases, which makes it harder to secure proper funding and to control the spread of TB.

Another big problem is unregulated sale of TB drugs that gives rise to Drug-Resistant (DR) TB, which makes it even more difficult to treat patients. About half of all DR-TB cases are located in China, India and Russia. India has to increase regulation in order to ensure that drugs are being prescribed to the right patients in the right doses. DR-TB patients who continue to receive regular drugs end up having bacteria that are even more resistant to drugs. 

A public-private partnership that expands the front-line efforts to diagnose and start treatment, to provide higher quality of care, and to focus efforts in the right places is needed to effectively work towards decreasing the number of TB cases. Although perfect PPP’s are rare, this is one instance where no one can afford to stall and try to please everyone.