Tuberculosis (TB) is a contagious disease, primarily caused by the bacterium Mycobacterium tuberculosis. While TB most commonly affects the lungs (pulmonary TB), it can also impact other parts of the body, including the lymph nodes, bones, kidneys, brain, and other organs (extrapulmonary TB).
TB spreads through the air when individuals with active TB in their lungs cough, sneeze, speak, or sing, releasing tiny droplets containing the bacteria. Transmission usually requires close and prolonged contact with an infectious person. It’s important to note that latent TB, where the bacteria are inactive in the body, is not contagious.
There are two types of Tuberculosis: Latent TB Infection (LTBI) and Active TB Disease. In Latent TB, the bacteria are present in the body but are not actively multiplying and do not cause illness. People with LTBI have no symptoms and are not infectious. However, the bacteria can become active and cause TB disease later, especially if the immune system weakens. In Active TB Disease, the bacteria are actively multiplying and causing illness. People with active TB have symptoms and can transmit the bacteria to others if the TB is in their lungs or throat.
Symptoms of Active TB Disease can vary depending on which part of the body is affected, but common signs include: A persistent cough lasting two weeks or longer (may produce sputum or blood), Chest pain, weakness or fatigue, unintentional weight loss, loss of appetite, fever, night sweats, and chills.
TB is usually diagnosed through a medical history and physical examination, TB skin test (TST) or TB blood test, Chest X-ray or other imaging tests(looking for abnormalities in the lungs or other affected areas), Sputum tests(for pulmonary TB, samples of mucus coughed up from the lungs are examined for the presence of TB bacteria), and Biopsy(in cases of extrapulmonary TB, a tissue sample from the affected site may be taken for examination)
Tuberculosis is a curable disease with antibiotics. Treatment depends on whether the TB is latent or active and whether the bacteria are drug-resistant.
In India, Tuberculosis is a significant public health concern, although considerable progress has been made in recent years.
Key Statistics:
High Burden: India continues to bear a disproportionately large share of the global TB burden. In 2020, India accounted for 26% of the incident TB cases worldwide.
Incidence Rate Decline: The incidence rate of TB in India has shown a 17.7% decline from 237 per 100,000 population in 2015 to 195 per 100,000 population in 2023. This decline rate is more than double the global average reduction.
Reduction in Deaths: TB deaths in India have reduced by 21.4% from 28 per lakh population in 2015 to 22 per lakh population in 2023.
Notified Cases: In 2023, 25.52 lakh TB patients were notified, an increase from 24.22 lakh in 2022. Approximately 67% of these were reported by the public sector and 33% by the private sector.
Treatment Success Rate: The treatment success rate among notified Drug-Resistant TB (DR-TB) patients was 65%.
Mortality: While the mortality rate has declined, in 2022, there were still an estimated 3.31 lakh deaths due to TB in India.
Undernourishment: A significant number of TB patients, around 7.44 lakh in 2022, were undernourished, highlighting the link between nutrition and TB.
Challenges:
Meeting Elimination Targets: Despite the progress, achieving the ambitious goal of eliminating TB by 2025 remains a significant challenge. The number of cases and deaths recorded in 2023 fell short of the set targets.
Private Sector Engagement: While the private sector’s contribution to TB case notification has increased, more needs to be done to ensure standardised treatment and reporting in this sector.
Drug Resistance: The emergence and spread of drug-resistant TB (MDR-TB and TDR-TB) pose a serious threat and require complex and prolonged treatment regimens.
Undernourishment: Addressing the high prevalence of undernourishment among TB patients is crucial for improving treatment outcomes.
Stigma and Awareness: Continued efforts are needed to reduce social stigma associated with TB and enhance community awareness about the disease and its prevention.
Co-infection with HIV: TB is a leading cause of death among people living with HIV in India, requiring integrated approaches for diagnosis and treatment.
National TB Elimination Program (NTEP):
The Government of India renamed the Revised National Tuberculosis Control Program (RNTCP) to the National TB Elimination Program (NTEP) in 2020, with the goal of eliminating TB by 2025, five years ahead of the global target of 2030.
Key Initiatives:
Early Diagnosis and Treatment: The program focuses on expanding access to diagnosis at all healthcare levels, including the use of advanced diagnostics like Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) and TruNat.
Free Drugs and Diagnostics: Provision of free anti-TB drugs and diagnostic services to all TB patients.
Active Case Finding: Conducting campaigns in vulnerable and co-morbid populations to identify missing TB cases.
TB Preventive Treatment (TPT): Providing TPT to contacts of TB patients and vulnerable populations. In 2023, approximately 15 lakh beneficiaries received TPT.
Ni-kshay Portal: A case-based notification system for tracking TB cases and ensuring patient care.
Ni-kshay Poshan Yojana: Providing a financial incentive of ₹500 per month to TB patients for nutritional support.
Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA): An initiative to unite communities, businesses, and institutions to support TB patients.
Ni-kshay Mitra Initiative: Encourages individuals, NGOs, corporates, and others to “adopt” TB patients and provide them with nutritional, social, or economic support. Over 1.5 lakh Ni-kshay Mitras have committed to this.
100-day TB Elimination Campaign: Launched in identified high-priority districts to find missing TB cases.
Tribal TB Initiative: Specifically addresses TB among tribal communities.
Mission Indradhanush: Under which the BCG vaccine is provided for TB prevention.
India has demonstrated a strong commitment to combating tuberculosis through its National TB Elimination Programme. The decline in TB incidence and mortality rates is a testament to the efforts being made. However, the country still faces significant challenges in achieving its ambitious elimination goal by 2025. Sustained efforts, increased resources, and multi-sectoral collaboration are crucial to further reduce the burden of this disease in India.
The writer is a teacher at the Higher Secondary School Nehalpora, Pattan
Kousar Ahmed Rather
ko************@***il.com