A doctor checks for tuberculosis at a health camp, March 2018. Photo: cdcglobal/Flickr, CC BY 2.0
- The National TB Prevalence Survey of India 2019-2021, the first of its kind in the country in 55 years, found that there are 312 cases per 100,000 population.
- The report says that for every notified case of the deadly infectious disease, the actual prevalent number of cases was 2.84.
- A majority of patients (64%) did not seek treatment, mostly because they ignored the symptoms or did not recognise them.
New Delhi: Tuberculosis (TB) is much more prevalent in India than previously thought, the results of a national survey undertaken by the Union government that was released on March 24 – World TB Day – showed.
The prevalence of TB is 312 per 100,000 population, the National TB Prevalence Survey of India 2019-2021 found. As many as 5 lakh individuals from across the country participated in the survey, the first of its kind in more than five decades.
The World Health Organisation had estimated the incidence of TB to be 188 per 100,000 population in 2020. TB is the world’s deadliest infectious disease and India has been the biggest contributor to the disease’s rise in global burden. Disease notifications of people newly diagnosed with TB in India rose from 1.2 million to 2.2 million between 2013 and 2019, an increase of 74%.
While annual reports talk about the incidence of TB cases in the country – the total number of cases that are reported, the survey estimates what could be the true prevalence of the infectious disease in the country because a lot of patients are “missing”.
According to the report, Delhi was estimated to have the highest prevalence of TB at 747 per 100,000 population while Gujarat had the lowest (137).
The national prevalence to notification (P:N) ratio was 2.84. In other words, for every notified case, the actual prevalent cases were 2.84. Chhattisgarh (5.30) had the highest P:N ratio, followed by Bihar (4.15), Karnataka (4.08), Northeast states (3.74), Tamil Nadu (3.67) and Kerala (3.33).
The report also found that a startling 64% of TB patients did not seek healthcare. Among the reasons cited for this ranged from ignoring symptoms, not recognising the symptoms, self-treatment and an inability to afford care. The highest proportion of patients who did not go for treatment was from Haryana (88%) and the lowest was from Kerala (46%).
Among those who sought treatment, the cost of treatment in the private sector was on average Rs 20,000. A bulk of the expenditure – Rs 10,000 – was on drugs. The rest was spent on diagnostics and other indirect costs. But curiously enough, even at government-run health facilities, the patients had to spend Rs 7,500 – though the treatment is supposed to be completely free. The report does not throw light on the reasons why patients were being charged at government facilities. Out of Rs 7,500, more than half of it was spent, again, on medicines.
Choice of care was equally distributed between government and private facilities, if the country was taken as a whole. But there were no patterns if the data from states is looked at individually. In the Northeastern states, Chhattisgarh, Odisha, Haryana, Karnataka, Jharkhand, West Bengal, Kerala, Rajasthan and Andhra Pradesh more participants had approached a government healthcare facility, the report said. On the other hand, patients in Bihar, Maharashtra, Himachal Pradesh, Uttarakhand, Jammu Kashmir, Telangana, Madhya Pradesh, Uttar Pradesh, Delhi and Punjab preferred a private facility for treatment.
Profiles of TB patients
A higher prevalence of pulmonary TB was observed in older age groups, males, malnourished people, smokers, alcoholics and known diabetics, according to the report.
The symptoms were more frequent in people above 65 years as compared to other age groups. The most common symptom was cough, chest pain, expectoration (to discharge matter from the throat through hawking and spitting) and loss of appetite.
Insofar as the gender divide goes, more males were found to be availing treatment than females in age groups 25-34 years and 55-65 years. In the age group 15-24 years, no such difference was found. “This indicates the current gaps in treatment coverage of the older age groups and females,” the report says.
An important observation in the report is that a large number of participants of this study who tested positive for TB had a past history of the same disease. In other words, these were those patients in whom there was a resurgence of TB. The “National TB Elimination Programme needs close follow up of patients completing treatment for early detection of recurrent TB and plan interventions for preventing recurrence of TB,” the report says.
The report recommends that more interventions are required for males who are in professions that make them more prone to TB.
“Nutritional interventions for malnourished, old age screening and interventions for promoting smoking and alcohol cessation needs to be scaled up for better control of pulmonary TB to address the factors which have more contribution towards its burden,” the report says.
In 2020, the WHO warned that disruptions caused by the COVID-19 pandemic have caused major setbacks to TB elimination programmes, saying that cases were likely to rise if urgent action and investment were not forthcoming. The report said that in many countries, human, financial and other resources have been reallocated from TB to the COVID-19 response.