India battles staggering tuberculosis burden
(March 24 is World TB Day)
By Madhulika Sonkar, IANS,
New Delhi : Hundreds walk into the multi-chambered waiting room of a rudimentary chest clinic in north Delhi's Gulabi Bagh, where the benches are packed with patients and the sound of harsh coughing fills the air. This is the capital's prime tuberculosis (TB) clinic that sees over 500 patients every day.
Even as success stories on the Directly Observed Treatment Short course (DOTS) chemotherapy under the Revised National Tuberculosis Control Programme (RNTCP) (1997) are shared, experts say the disease still casts a long shadow over the country's health.
Ashok Kumar, deputy director general of the central TB control division under the ministry of health and family welfare, feels DOTS still has "miles to go" before the country can finally be declared TB free.
"To think that we can eradicate TB overnight in India is neither practical nor possible. With the population size that we have, it is important to be practical in our approach towards the disease," Kumar told IANS.
According to the health ministry's TB Control India statistics, the disease kills two people every three minutes, and accounts for over 3 million (3 lakh) deaths every year.
The airborne disease is caused by the bacterium Mycobacterium tuberculosis that affects the lungs.
Symptoms include severe cough which lasts for three weeks or longer, producing bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain in breathing or coughing.
Also known as "the disease of the poor", TB's death toll has reduced significantly after the World Health Organisation (WHO) rolled out DOTS in 1994.
"TB does not come alone as it follows malnutrition and poverty, and is likely to develop in unhygienic conditions. These factors are some of the major challenges for the government," said Kumar.
Under the RNTCP that was implemented in the country over a decade ago, patients are given the six-month long DOTS treatment.
Hailed for its accurate or "sure-cure" approach by experts, DOTS has also been facing criticism for its failure in case the treatment in discontinued, which then results in patients being multi-drug resistant (MDR), a fatal condition.
"Why blame DOTS? We are facing an increase in number of MDR patients because there is an unwanted delay in receiving patients from the private hospitals. We have to admit that the strata affected by TB is illiterate and unaware of the consequences of leaving DOTS treatment midway," R.P Vashisht, the state TB control officer for Delhi, told IANS.
Health experts have their hopes pinned on the 90-minute test endorsed by WHO, promising a quicker diagnosis of MDR TB by looking for bacterial DNA in a person's sputum.
"We are aware about the high cost, but efforts are on to introduce it at fully subsidised costs. The focus would be primarily on making the TB patients complete DOTS course by an efficient patient tracking system, follow-up mechanism by roping in civil society," explained Kumar.
According to officials from the TB control division in the health ministry, the cost would be incurred by the ministry. The test costs around Rs.900 ($20) per sputum sample.
Delhi has 585 DOTS centres spread across its 12 zones.
However, experts caution against adopting a lopsided approach to tackling the disease.
"In metropolitan areas, we have a migrant population that can reap the benefits of a well-developed health system. But for the rural areas, you have to consider the uncertainties and dangers of low-quality diagnostic facilities and reach of the programmes," said Naresh Gupta, professor of medicine at Lok Nayak Hospital.
Experts believe that TB eradication has a long way to go, with challenges such as lack of diagnostic centres, delay in diagnosis, break in DOTS treatment, the social and mental trauma that comes along with TB and inadequate drug support to HIV patients who are most likely to get the disease because of their weak immune system.
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