war-on-tb-a-long-way-to-go

Malnutrition is the culprit in many diseases. Tuberculosis, an infectious disease caused by bacteria, is one of them. In a country like India, where undernutrition is rampant, particularly among children, eradicating Tuberculosis continues to be a major challenge. The 2025 target, set by the central government nearly a decade ago for complete elimination of TB, appears a tall order, given the ground realities.

 

The Global Tuberculosis Report by the World Health Organisation (WHO) shows that India accounts for 26% of the world’s TB burden and 27% of global multi-drug resistant tuberculosis. This grim statistic underscores the challenges facing the country’s National TB Elimination Programme, set against a backdrop of rising multidrug-resistant tuberculosis (MDR-TB), a public health crisis in its own right.

 

Though the overall incidence of TB in the country decreased by 17.7%, from 237 cases per 100,000 population in 2015 to 195 per 100,000 in 2023 and the deaths reduced by 21.4%, from 28 per 100,000 population in 2015 to 22 per 100,000 in 2023, they fall short of the milestones set by the government for complete eradication of the disease.

 

Challenges galore

 

The healthcare authorities are grappling with multiple challenges. Grossly inadequate diagnostic facilities and delayed detection are the major areas of concern in the fight against the disease. Access to efficient and high-quality care — diagnosis, treatment and support — is still not available to patients. Erroneous prescription and dosage, poor quality of drugs, and the discontinuation of medication regimens are some of the other key challenges.

 

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Early diagnosis holds the key. The sooner treatment commences, the quicker the cycle of airborne transmission is halted. With under-investment in public health and the TB programme, the public sector is over-stretched. Because of the deficiencies in the public sector, nearly 80% of Indian TB patients choose to incur large out-of-pocket expenses and seek treatment with unregulated private practitioners.

 

Some experts have suggested a multi-sectoral approach in the war against the disease. Poverty alleviation, improvement in nutritional status, well-ventilated housing and better air quality will all contribute towards reducing TB. Recent research has shown that nutritional supplementation reduced TB incidence substantially in household contacts of adults with microbiologically confirmed pulmonary TB.

 

The infectious diseases like TB disproportionately affect the most marginalised in society, including children and the urban poor. It leads to an economic crisis which pushes families and communities into debt and poverty.

 

Drug resistant TB

 

The MDR-TB complicates the situation further, with India housing the largest global burden. It often arises from treatment mismanagement and requires longer, costlier and more toxic medications. Unfortunately, only 44% of the MDR-TB cases receive adequate treatment. This stark gap reveals the strain on India’s health infrastructure and the impact on patients whose access to quality care remains inconsistent.

 

The costs of treating and managing TB prove burdensome for many households in India. Moreover, funding for TB has dwindled in recent years. The government must bridge funding gaps and tackle the socio-economic factors driving TB, including poverty, undernutrition and limited healthcare access.

 

Furthermore, increasing awareness about MDR-TB and expanding the use of newer treatment regimens could be game-changers. Without robust investment and coordinated efforts, TB will continue to thwart India’s health goals and global ambitions. Poverty and malnutrition are responsible for up to 40% of incidence in the country. A good diet not only reduces the incidence of the disease among vulnerable people living with infected people, but it also brings down mortality in TB patients. Unequal access to economic opportunities, limited health care, poor sanitation, crowded living conditions, malnutrition and illnesses such as diabetes or HIV are all associated with increased risk of tuberculosis.

 

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TB is curable, but requires patients to undergo a strict six-month regimen of antibiotics. Any deviation from this program can quickly lead to drug resistance, so patients require constant supervision.

 

Inadequate funding

 

In India, the National Tuberculosis Elimination Programme (NTEP) recognises the need to improve nutrition and under the ‘Nikshay Poshan Yojana’ an amount of Rs 500 is given every month to those diagnosed with TB. This is grossly inadequate to take care of the nutritional requirements. The NTEP guidelines recommend that a tuberculosis patient consume 2,800 calories every day. Nikshay Poshan is a half-hearted attempt at addressing one of the root causes of the problem. The scheme has also been dogged by systemic challenges.

 

By tackling the underlying root causes of TB, India can make significant strides towards eliminating the disease and improving the overall health and well-being of its population.

 

Technology as a tool

 

Leveraging technology and innovation too holds immense promise in enhancing TB care efforts in India. The adoption of Artificial Intelligence (AI) and digital health solutions for TB diagnosis, adherence and surveillance can revolutionise the way TB care is delivered and accessed in the country. By investing in developing better vaccines, India can hope to ultimately eliminate this airborne disease.

 

The AI-powered tools are now available to assist health workers in detecting undiagnosed cases, deciding on treatment plans, and preventing people from dropping out of treatment.