Quote on WORLD TB DAY by Dr P T JAMES
HoD, PULMONARY MEDICINE
AMRITA INSTITUTE OF MEDICAL SCIENCES, KOCHI
Regarding TB, India is a high burden country along with China, Pakistan and African countries. The usual causes are poverty, malnutrition, overcrowding and poor infection control measures as in any other high burden country. Additional reasons are socio-economic diversity, poor access to healthcare facilities by all, social stigma and major chunk treatment from unorganised private sector which includes traditional practioners and alternative medicines, from where correct data is not available. Other factors like HIV infection also may be a reason as in any other high burden countries.
Long-term trend in India is towards a decrease of Tuberculosis. We don’t see many advanced cases of TB now-a-days as we used to see earlier. Various control measures especially the supervised treatment strategy under RNTCP is the drive.
RNTCP and DOTS therapy has helped in decreasing TB in India. Continuing efforts by govt. for early diagnosis and treatment of the cases will prevent further infection and thereby help eradication of the disease. Proper treatment of MDR & XDR TB also will help the eradication process. Incorporating RNTCP services to private sector and mandatory TB notification also helps in the process.
For minimising the risk of infection, the govt. should follow the measures for early diagnosis and treatment. People should follow strict infection control measures, like following cough etiquette, not spitting in open places, patients wearing mask to prevent infection to others etc.
The trend of rising microbial resistance is due to poor treatment compliance of the patients and also may be due to detection of the more and more undetected cases by the increasing lab facilities and newer diagnostic techniques made available by the govt. MDR TB can be definitely cured, but the cure rate is less (around 50%) for various reasons. The breakthrough in the treatment is the introduction of PMDT (programmatic management of drug resistant TB), newer drugs like Bedaquiline, delaminid etc, and shorter duration regimens like Bangladesh regimen- 9 months treatment instead of 24 months treatment.
In the present scenario TB elimination by 2025 doesn’t sound realistic. Even after 50 years of TB control program we were not able to achieve proper control of the disease. However, genuine political commitment for implementing the strategies will help to achieve this target. In addition, measures may be adopted for proper control; and management of the important co morbidities like HIV and Diabetes for successful TB elimination.