Eradication of Tuberculosis in India: UPSC Current Affairs

Context

In the backdrop of COVID19 pandemic, the threat of TB and its social impacts continue to be one of the gravest concerns. 

Probable Question

Despite all the efforts and targeted policies, India continues to be one of the highest burden countries in the world. Critically analyze the situation of Tuberculosis in India. 

About Tuberculosis (TB)

It is one of the worst diseases among endemic diseases. Cases of TB are quite high globally, out of which more than 26% or 1/3rd of the total cases are from India.

Causes

It is caused by bacteria Mycobacterium Tuberculosis, which also causes Leprosy in humans as well as in a wide range of animals.

Other than Human to Human transmission, TB can be transmitted from human-to-animal to livestock (cattle). 

Impact

Every year approx 1.5 million people, globally, die of TB out of which 1400 die in India every year, the TB capital of the world.

Large proportions of adults carry TB infection in the lung in a dormant condition for life (latent TB) in their most productive years. 

The rising cases of TB, especially in adults in their most productive years, impoverish the family and the nation.

Vaccination for TB 

VPM (Vaccine Project Management) 1002 and MIP (Mycobacterium Indicus Pranii) are the only two vaccines developed for TB, several clinical trials are going for other vaccines. 

Some Critical Types of Tuberculosis (TB)

Overt TB disease  

Among those who carry TB, some of them deteriorate and develop this type.

Overt TB disease is also known as Reactivation TB.

Causes: HIV infection, diabetes, undernutrition, lung damage due to pollution, tobacco smoking, and fall in immune functions due to chronic diseases, alcoholism, etc.

Drug-Resistant Tuberculosis

Some Mycobacterium tuberculosis bacteria become drug-resistant after certain mutations. 

Mono-Resistance: It is resistance to one first-line anti-TB drug only.

Poly-resistance: It is resistance to more than one first-line anti-TB drug, other than both isoniazid and rifampicin.

Multidrug Resistance (MDR): Patients who are infected with strains resistant to isoniazid and rifampicin, called multidrug-resistant (MDR) TB.

Extensive Drug Resistance (XDR): It refers to MDR-TB strains that are resistant to fluoroquinolones and second-line injectable drugs.

Rifampicin resistance (RR): It is any resistance to rifampicin, in the form of mono-resistance, poly-resistance, MDR or XDR.

Tuberculosis and India 

• India has been called the world's TB capital due to the significant number of cases of TB, every year. 
• Causes:The main driving force of TB in India is malnutrition. 50% of the people in the 15 to 55 age group are malnourished and they are contributing to around 30% of TB cases.
• Initiative: TB Harega Desh Jeetega Program, The NIKSHAY Ecosystem, and Nikshay Poshan Yojna (NPY) are some of the initiatives by the Indian Government. 
• Other steps to eliminate TB: 
  • Bi-directional screening for TB, post-treatment follow-up, Presumptive TB examination, preventive therapy, and the recent development being sub-national Certification of TB cases.
  • Artificial Intelligence (AI) is being developed for early diagnosis, where the AI will use cough sound to identify if the person has Tuberculosis.

Revised National TB Control Programme (RNTCP)

• The Government of India revitalized the NTP as the Revised National TB Control Programme (RNTCP) in 1993, as guided by the World Health Organization (WHO).
• The program was initiated in 1993 and launched in 1997.
• It overcame the shortcomings of the Government of India’s National TB Control Programme (NTP) of 1962.
• Treatment - RNTCP recommended Directly Observed Treatment Short-course (DOTS) in 1997, to achieve a cure rate of at least 85%. 
• Flaws in the RNTCP: Despite constant improvement in RNTCP, it ultimately failed due to —
  • There is no prescribed method of monitoring the trajectory of TB control.
  • The assumption that treating pulmonary TB patients alone would control TB was epidemiologically fallacious in India. The theoretical principle is ‘source reduction’.
  • RNTCP has failed to elicit people’s partnership in TB control, to control any disease awareness of the same is crucial.
• Improvement in RNTCP:
  • After RNTCP failed, WHO called for another revised program through a World Health Assembly Resolution, in 2014, to eliminate TB by 2035. 
  • RNTCP has released a 'National strategic plan for tuberculosis 2017-2025' (NSP) for the control and elimination of TB in India by 2025.
  • NSP TB has been integrated into four pillars – Detect - Treat - Prevent - Build (DTPB).

Measures to Control TB

Apart from all the international and national level initiatives in treating TB, some more measures can be adopted to curb the same;

• Secular Trend: A repetitive pattern that shows that such endemic diseases tend to decline by 1% or 1.5% per year, globally, with better housing, nutrition, education, and income.
• High-level control and documentation is also an effective way to curb TB, along with the engagement of the private sector.
  • Notified TB cases are tracked through web-based portal Ni-kshay.
  • Integration with Ayushman Bharat-Health & Wellness Centres to decentralize screening and treatment services closer to the community.
  • Intensified IEC campaigns to reduce stigma, raise community awareness and improve health seeking behaviour.
• Treatment Completion: TB can be eliminated only when the patients act responsibly in completing the course of the treatment, which can help stop the spread of infection and drug resistance.
• Free Drug: Government has a provision of free drugs and diagnostics to TB patients including for drug resistant TB.
• Nutritious Diet: 
  • It is of utmost importance to take all kinds of vegetables, green leafy vegetables, especially when the patient is undergoing treatment, as they have more appetite.
  • Nikshay Poshan Yojana for nutritional support to TB patients.
• Maintaining cough hygiene – Covering the nose and mouth whenever you cough and wearing masks – can greatly help in controlling the spread of the infection. 

Source: The Hindu, PIB

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