Tuberculosis in India

Published on 13 Feb 2025

Tuberculosis (TB) is one of India’s major public health problems. As per WHO, every day, around 4100 people lose their lives to TB. India accounts for roughly 28% of TB cases in the world, as per the Global TB Report 2022.

Infection Prevalence

✔     10 million people get TB annually, and 1.5 million dies, making it the leading infectious killer.

✔     Half of all TB cases are in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, the Philippines, and South Africa.

✔     2 billion people have dormant TB.

✔     India TB Report 2024 by Ministry of Health and Family Welfare

●      The TB mortality rate decreased from 28 per lakh population in 2015 to 23 per lakh in 2022.

●      In 2023, 33% of TB cases were reported by the private sector, up from 1.9 lakh in 2015.

●      India met its 2023 target by starting treatment for 95% of diagnosed TB patients

Reasons for increased Tuberculosis in India

✔     Poverty and Malnutrition: Poor nutrition weakens the immune system, making individuals more susceptible to infections developing active TB.

●      Example: As per a recent research, undernutrition contributes to 902,000 of India’s 2.64 million annual TB cases.

✔     High population density: Live and work in poorly ventilated and overcrowded conditions, facilitating easy transmission of infectious diseases.

●      Example: According to the Journal of Urban Health, the odds of developing tuberculosis are around 5 times in urban slums, which have the highest population densities.

✔     Air pollution: Prolonged exposure to high levels of air pollution can weaken the respiratory system, making individuals more susceptible to respiratory infections.

●      Example: According to the National TB Prevalence Survey 2019-2021, Delhi has the highest number of pulmonary TB cases with 534 cases per 1 lakh population.

✔     HIV co-infection: Individuals with HIV have a weakened immune system thus increasing the risk of TB in people with HIV.

●      Example: According to the World Health Organization, in 2019, of the estimated 10 million people who developed TB worldwide, 8.2% were people living with HIV.

✔     Development of Multi Drug Resistant TB: Drugs have little effect against drug resistant TB, which increases the mortality and health expenditure.

●      Example: As per the latest report of the Government of India in March 2021, In India, there are 1.24 lakh cases of Multidrug-resistant tuberculosis.

✔     Lack of awareness: Unawareness about TB, its symptoms and the importance of completing the full course treatment lead to delayed diagnosis and spread of disease.

●      Example: Based on a survey conducted in Vaithikuppam slum by NCBI, only 1% of the slum residents knew overcrowding can increase chances of TB.

✔     Smoking: Damages the lungs and impacts the body's immune system, making smokers more susceptible to TB infection.

●      Example: According to Oxford Academic, around 17% of tuberculosis cases and 15% of tuberculosis mortality have been attributed to smoking.

Issue Faced for Curbing TB

✔     Excessive use of antibiotics: Excessive and unregulated antibiotic use, combined with treatment non-compliance, drives drug-resistant TB.

●      Example: Multidrug-resistant TB (MDR-TB) is resistant to isoniazid and rifampin.

✔     Disproportionately Impacting Marginalized Groups: TB disproportionately impacts marginalized groups, including children, prisoners, and those with HIV/AIDS.

●      Example: In India, 50% of TB cases occur among the poor, with higher prevalence rates among urban slum dwellers, prisoners, and HIV-positive individuals.

✔     Evaluating Screening Methods: Studies by The Lancet and ICMR show that symptom-based TB screening is insufficient; X-ray imaging is more effective.

✔     Limited Use of Molecular Tests: Despite a rise in the availability of NAAT machines (nucleic acid amplification test) India faces limited use due to high costs.

✔     Dual Burden of Diabetes Mellitus (DM) and TB: DM worsens TB outcomes and increases health and system burdens due to treatment complications.

✔     Only Focussing on the Medical Aspect: Overemphasis on TB's medical aspects often neglect patients' real-life experiences and wider social impacts.

✔     Social Stigma: Causes delayed diagnosis and isolation.

Impact on health and society

✔     Respiratory System: TB primarily affects the lungs, leading to persistent cough, chest pain and difficulty breathing, and the infection leads to inflammation, damage to lung tissue, and spread to other organs of the body.

✔     Easily vulnerable to other diseases: TB weakens the respiratory system, making affected individuals more susceptible to other respiratory diseases.

●      Example: People with tuberculosis were more prone to COVID, and associated mortality.

✔     Burden on the health sector: The already strained health sector finds it difficult to accommodate the increased TB cases, leading to health emergencies.

✔     Economic impact: Affected individuals may face loss of income due to illness and experience financial strain due to costs associated with TB treatment.

●      Example: According to the Journal of Urban Health, on average 3 to 4 months of employment is lost for a person suffering from TB, reducing the income by around 30%.

✔     Discrimination: Stigma associated with TB can lead to discrimination and social isolation of infected peoples.

●      Example: According to a study published in the Annals of General Psychiatry, anxiety was associated with around 50% of TB patients. Isolation and lack of proper support can trigger anxiety.

Government initiatives

✔     National Tuberculosis Elimination Programme (NTEP): Aims to strategically reduce TB burden in India by 2025.

✔     Nikshay Poshan Yojana(NPY): Aims to provide financial support to TB patients and for proper TB management.

✔     Pradhan Mantri TB Mukt Bharat Abhiyan: To bring together all community stakeholders to support those on TB treatment.

✔     Tribal TB Initiative: It aims to tackle TB in tribal populations.

✔     Nikshay SAMPARK: It is under National Tuberculosis Elimination Program (NTEP), and is a helpline providing TB patients with information and treatment support.

Global initiatives

✔     Find. Treat. All. #EndTB: The WHO Global Fund, and Stop TB Partnership have launched this joint initiative against tuberculosis

✔     Global Plan to End TB 2023-2030: It is adopted by all Member States of the United Nations (UN) and the WHO.

✔     End TB Strategy:  expands efforts to align with UN Sustainable Development Goal 3.3 which targets ending the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030.

Way Forward

✔     Detection: Early detection through advanced diagnostics and expanded healthcare networks reduces disease spread.

●      Example: South Africa's use of GeneXpert machines has boosted TB case detection.

✔     Tailored Treatment: Customizing treatment based on drug resistance ensures effective therapy and reduces relapse.

●      Example: Russia uses drug susceptibility testing for individualized TB treatment plans.

✔     Adherence: Ensuring full treatment adherence through follow-ups and support prevents drug resistance.

●      Example: China uses SMS reminders to improve TB treatment adherence.

✔     Improve Data: Improved TB data collection and analysis enable better monitoring and response.

●      Example: U.S. uses electronic medical records for real-time TB case monitoring.

✔     Strengthen healthcare infrastructure: Ensure adequate facilities, trained healthcare professionals, and access to quality diagnostic and treatment services.

✔     Public health awareness and education: Implement public health awareness campaigns to educate communities about TB, its symptoms, transmission, and the importance of seeking timely medical help.

✔     Behavioural change: Reduce practices like smoking, which could reduce the vulnerability to respiratory diseases.

✔     Community engagement: Encourage community participation in awareness programs and supporting individuals throughout their treatment.

With collaborative efforts and commitment, India will be able to make progress in reducing the burden of the disease and working towards its TB elimination strategy.

Tags:
Social Justice

Keywords:
Tuberculosis National Tuberculosis Elimination Programme Nikshay Poshan Yojana Pradhan Mantri TB Mukt Bharat Abhiyan

Syllabus:
General Studies Paper 2

Topics:
Social Justice