India losing the battle against TB?

According to the World Health Organisation (WHO) 2013 Global tuberculosis report, 8.6 million people developed TB and 1.3 million died from the disease in 2012. The rate of new cases has been declining at 2 percent per year for a decade.

The scale of India’s TB control measures is laudable but population, grinding poverty and a doddering healthcare system cause the problem to dwarf all efforts, according to experts. Prevalence has reduced from 465 to 230 per 100,000 population and mortality from 38 to 22.

Yet, the scale of the scourge remains scary. Every three minutes, two people die of TB in India, and one out of every four TB patients in the world is an Indian.

“You are running very fast but you seem to be standing in the same place because so many are getting infected,” says Virendar Chauhan, director of International Center for Genetic Engineering and Biotechnology.

For two decades, Indian government has been providing the WHO-recommended DOTS: Directly Observed Treatment courses under the Revised National Tuberculosis Control Programme (RNTCP). It currently reaches 1.5 million cases in the public sector.

But about half of those affected go to the private sector, which is not involved in TB control. “Government and private sector efforts should integrate. There should be a push-and-pull mechanism,” adds Chauhan.

Routine DOTS saves lives but is not very effective in curbing transmission, says Madhukar Pai, associate director at McGill International TB Centre. “By the time patients end up in the DOTS system, they have likely infected many others.”

Poor living conditions, malnutrition, overcrowding, smoking, indoor air pollution, HIV infection, and diabetes increase the risk of TB in India.

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