Context

India notified the highest number of 24.04 lakh tuberculosis cases last year as against an estimated 26.9 lakh cases by WHO, indicating that around three lakh patients missed out from the national TB programme, according to India TB Report 2020.

Background

• TB has existed in India for several thousand years. TB in India is an ancient disease. In Indian literature there are passages from around 1500 BCE in which consumption is mentioned, and the disease is attributed to excessive fatigue, worries, hunger, pregnancy and chest wounds.
• In 1880s it was widely believed that TB was an inherited disease. However, a scientist Robert Koch was convinced that the disease was caused by Mycobacterium tuberculosis and was infectious.
• In 1882, he published his findings on tuberculosis and later attempted at developing a drug to treat this disease, thereby finding the drug tuberculin which today is used for TB diagnosis.
• In 1905 he received the Nobel Prize in Physiology and Medicine for his work with Tuberculosis.
• Tuberculosis in India was first recognised through a resolution passed in the All India Sanitary Conference, held at Madras in 1912.
• The first open air institution for isolation and treatment of TB patients was started in 1906 in the Himalayas in 1908.
• The anti-TB movement in the country gained momentum with the TB Association of India was established in 1939. 
• Even today, India bears a disproportionately large burden of the world’s tuberculosis rates. And it continues to be the biggest health problem in India.

Analysis

Learning the truths about TB

• Tuberculosis(TB) is a contagious infection that usually attacks your lungs. It can spread to other parts of your body, like your brain and spine.
• Caused by: A type of bacteria called Mycobacterium tuberculosis causes it.
• Symptoms of TB: Typical symptoms of TB include-
  • a persistent coughthat lasts more than 3 weeks and usually brings up phlegm, which may be bloody
  • weight loss
  • night sweats
  • high temperature
  • tiredness and fatigue
  • loss of appetite
  • swellings in the neck
• There are two TB-related conditions exist:
  • Latent TB infection (LTBI): Latent TB occurs when a person has the TB bacteria in their body. But the bacteria are present in extremely small numbers. People with latent TB are not infectious and do not feel ill. They cannot pass the TB bacteriaon to other people.
  • TB disease or Active TB: TB disease is what happens when a person has latent TB and then becomes sick.

How does it spread?

• TB bacteria are spread through the air from one person to another when a person with TB disease coughs, speaks or sings.
• When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow.
• From there they can move through the blood to other parts of the body.

What is drug-resistant TB?

• Drug-resistant TB can occur when TB bacteria become resistant to the two most powerful antibiotics normally used to treat the illness.
• This means the TB is more difficult to treat and treatment will take much longer (usually at least 18 months).

Key-highlights of the India TB Report 2020

• The India TB Report 2020 stated that 79,144 deaths due to tuberculosis were reported in 2019, which is much lower than the WHO estimate of 4.4 lakh fatalities.
• The “missing cases” — the gap between estimated incidences and notified cases — has drastically reduced from over 10 lakh in 2017 to 2.9 lakh in 2019 through greater engagement with private healthcare sector along with other initiatives.
• Around 24.04 lakh TB patients were notified in 2019, registering 14 per cent increase over the previous year while the private sector saw an increase of around 35 per cent with 6.78 lakh tuberculosis patients notified.
• State TB Index: On the basis of the score in State TB Index-
  • Gujarat, Andhra Pradesh and Himachal Pradesh were the top three best-performing states for tuberculosis control under the category of states with 50 lakh population.
  • Tripura and Nagaland were best-performing in the category of states having less than 50 lakh population.
  • Dadra and Nagar Haveli, and Daman and Diu were selected as the best performing Union Territories.

How is the situation worldwide?

• Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS).
• In 2018, an estimated 10 million people fell ill with tuberculosis(TB) worldwide. 5.7 million men, 3.2 million women and 1.1 million children. 
• TB occurs in every part of the world. In 2018, the largest number of new TB cases occurred in the South-East Asian region, with 44% of new cases, followed by the African region, with 24% of new cases and the Western Pacific with 18%.
• In 2018, 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases: India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

India’s target to end TB

• The global target for eliminating TB is 2030, but the target for India to eliminate TB is 2025, five years before the global target.
• India’s TB control Programme renamed as the National TB Elimination Programme has set a target of reducing has set a target of reducing the country’s TB incidence rate from 217 patients per lakh population in 2015 to 77 by 2023 and 44 by 2025.
  
  

WHO’s “END TB Strategy" WHO’s “END TB Strategy" adopted by the World Health Assembly in 2014 aims to end the TB epidemic globally. It aims at 95% reduction by 2035 in the number of TB deaths compared with 2015, 90% reduction by 2035 in the TB incidence rate compared with 2015 and Zero TB-affected families facing catastrophic costs due to TB by 2035. The strategy also sets interim milestones for 2020, 2025 and 2030 as the United Nations sustainable development goals include ending the TB epidemic by 2030.

Government initiatives to end TB

• Nikshay Poshan Yojana (NPY): Government of India introduced Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) as monthly financial assistance towards nutrition for TB patients in 2018. It aims to-
  • To determine the number (proportion) of TB patients who received the benefits
  • To explore the challenges encountered by the health care providers in delivering the NPY through DBT
  • To explore the ways the incentives were utilised by the patients.
• TB Harega Desh Jeetega: Launched in 2019, it is a nationwide campaignto spread disease awareness about TB and encourage people with TB symptoms to seek medical attention.
• Saksham Pravah Project: The project provides home-based counselling to MDR-TB patients and caregivers. Patients are encouraged to share fears and talk about the discrimination, depression, and familial discord they face. 

Conclusion

India bears the world’s largest burden of tuberculosis (TB), accounting for one-fourth of all new infections. Its prevention and control is a challenge at multiple levels, requiring the united efforts of a diverse range of stakeholders. Though India has been proactive against TB in recent years, there is still a long way to go.