New Delhi: Among the many fallouts of the Covid pandemic over the past two years has been the gap in data collection on the number of tuberculosis (TB) cases in India. And to bridge this gap, the Narendra Modi government is now gearing up to launch a special door-to-door TB screening programme on 24 March, observed as World TB Day.
According to a World Health Organisation (WHO) report released last year, India accounted for 41 per cent of the global dip in reporting TB cases during the pandemic.
“The countries that contributed most to the global drop between 2019 and 2020 were India (41 per cent), Indonesia (14 per cent), the Philippines (12 per cent) and China (8 per cent); these and 12 other countries accounted for 93 per cent of the total global drop of 1.3 million,” said the report, titled ‘Global Tuberculosis Report 2021’.
A 2020 analysis by India’s ministry of health and family welfare had also found notification of TB cases in the country to have reduced by 25 per cent between January and December 2020, because of the lockdown and diversion of resources for Covid-19 control measures.
However, under the government’s new screening programme, over the following two-to-three weeks, health workers will visit the houses of the vulnerable population to check whether they have any symptoms of TB, such as persistent cough, chest pain, weight loss or fatigue. If found to be symptomatic, they will be tested using TrueNAT, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) or sputum microscopy, according to the local availability of tests.
Getting back to 2019 levels of reporting
Active case-finding is an important part of the TB control programme in India because there is a large number of missing TB cases — either those that have not been reported to the system or are simply not diagnosed. TB is a mandatorily notifiable disease and the reduction in notifications is a red flag.
Ordinarily, in pre-Covid times, such active case-finding campaigns among vulnerable populations — are carried out every six months across the country. Active-case finding is important because of the highly infectious nature of the disease, congested living conditions in India and the fact that treatment, even when it is started, can be long and tedious — with patients often dropping out midway, leading to the genesis of drug resistant varieties of the tuberculosis bacterium.
Health officials say this month’s special campaign is targeted at achieving at least the TB notification numbers of 2019 — 24,00,025, which was about 84 per cent of that year’s target of 28,71,755. Since then, annual TB notifications have gone downhill because of a number of reasons, including periodic lockdowns and the diversion of staff from the Revised National TB Control Programme (RNTCP) to Covid management.
“We will launch a special active case finding campaign in vulnerable people such as those living with HIV, or in congested conditions, or who are malnourished or immunocompromised. Those found symptomatic will be tested. It has been our practice so far to carry out active case-finding programmes, but many states have not been able to carry that out. Hence this intensified campaign for about two to three weeks,” a senior health ministry official told ThePrint.
“The idea is to get back to where we were in 2019, back to the pre-Covid levels. Some states have already reached there, but we want all states to work on this,” the official added.
India’s ‘severest health crisis’
The health ministry had, in its ‘National Strategic Plan for Tuberculosis Elimination 2017-2025’, called TB India’s “severest health crisis”, as it kills an estimated 4,80,000 Indians every year and around 1,400 every day.
India also has more than a million “missing” cases every year that are not notified; most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector, the health ministry strategic plan added.
According to data available on the Nikshay dashboard (a government portal for TB-related information), TB notifications in India dipped to 18,11,663 in 2020, which was 60 per cent of the year’s target of 29,99,030. In 2021, the number improved marginally to 21,43,760 — about 71 per cent of the year’s target of 29,94,330. In 2022, till now, 3,46,189 tuberculosis cases have been notified.
Earlier this year, the government’s guidelines for clinical management of Covid-19 cases listed TB as one of the diseases that can put patients at “high risk” of severe infection with the SARS-CoV-2 virus, partly because of the high vulnerability of the lungs in both infections.
(Edited by Poulomi Banerjee)