Saturday, January 7, 2017

Tuberculosis : An Under reported killer

Many years ago, while visiting a village called Arogyavaram in Chitoor district of Andhra Pradesh which hosts a Christian Mission Hospital, I was shown a cottage where Kamala Nehru, the wife of Jaaharlal Nehru had once stayed decades ago. At that time, Arogyavaram a place with a salubrious climate was a TB sanatorium and Kamala Nehru a patient hoping to recover her health there.  In those days, (we are talking of the period around 1930), TB had no cure and the only treatment prescribed was a longish stay in a TB Sanatorium where it was hoped that a benevolent climate and good nutrition would aid recovery. That didn’t happen to Kamala Nehru however and she moved from sanatorium to sanatorium eventually dying in one in Lausanne in Switzerland in 1936. Exactly a decade later, Streptomycin, the first drug to be effective against TB was discovered.
Tuberculosis has been with since antiquity and has always carried with it a lot of baggage and stigma. India has its share of the disease burden with about 3 million people suffering from it at any given time and is the country’s largest public health challenge. It was a challenge in itself and then in the 1990s and beyond with the spread of HIV & AIDS, and the close association with TB in immune compromised people, it became a bigger challenge.

A bigger challenge though, which multiple advances in medicine since the discovery of Streptomycin, all those decades ago, is the fact that the duration of treatment is long( six months onwards) and many of the patients drop of the treatment radar along the way. This incomplete treatment regime has given rise to strains of multi drug resistant TB. India again has the dubious distinction of having the second largest number of drug resistant TB cases after China. The problem is not going away anytime soon.

A larger question, is the data that I have cited even correct?  According to a report published in the prestigious journal ” Lancet”, more than a million tuberculosis (TB) cases may be missing from official statistics in India as many cases go unreported and the data only captures the numbers of people reporting to health care facilities in the organized sector. But because of factors that are both economic as well as social, many patients seeking treatment for TB turn to unregulated private doctors who often do not report cases. It is also difficult to track as to how many of such people actually complete the course of treatment. Again, one has to fall back on estimates and they seem to indicate that Out of the 2.7 million individuals with tuberculosis (TB) in India in 2013, estimates show that only about 1.05 million or 39 per cent completed therapy through the government TB programme and survived for one year after treatment without experiencing a relapse, according to a report published in the Indian Express. In today’s infrastructure driven age, public health does not attract too many eyeballs. Yet TB, where India hosts the largest number of patients, has an under noticed and under reported problem on its hands. 

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