TB continues to blight India; children vulnerable

Bengaluru: Despite numerous efforts tuberculosis (TB) continues to be a challenge for healthcare professionals in India and the prevalence of drug resistant TB cases is a major concern. One in four children die of TB in India and 96 percent cases remain undetected and untreated, despite advances in diagnosis and treatment.

On the eve of World Tuberculosis Day on Sunday, doctors have expressed concern that children below the age of 15 are more vulnerable. The theme for World TB Day 2019 is “Its time”.

According to Department of Health and Family Welfare's recent data, a total number of 83,707 cases were reported in 2018, 88% of these cases were put on treatment within the stipulated time, while 2,733 have drug-resistant TB. The data also revealed that there are 4,493 paediatric cases or 5.3% of overall cases.

“Children are more prone to life-threatening TB because of immature immune system. Malnutrition and concomitant HIV infection impairs the immune system and makes children susceptible,” said Dr M.G. Satish, Vice-President and chief pathologist, Medall Diagnostics.

He also said that it is difficult to diagnose TB in young children because the symptoms would be non-specific and obtaining a sample like sputum may be difficult. Children also have a low bacillary load (paucibacillary), hence record negative on smear examination and are missed.

Cites dwellers at risk
Doctors also pointed out that chances of spread of TB was higher in overpopulated cities like Bengaluru. “People who live in thickly populated areas are at greater risk of contracting the disease. In fact, those staying in contact with an untreated TB patient are more prone to getting affected. In case, any family member is affected, it would be advisable for the entire family to undergo a check-up,” said Dr Ranganath, Department of Pulmonology, Narayana Health City.

India tops TB mortality
According to The Lancet panel, India saw 4,21,000 deaths due to TB in 2017.  Air pollution and drug susceptibility testing are some of the areas that the country needs to make improvements to fight against TB, the report said. Public health doctor and researches Dr Sylvia Karpagam blamed private hospitals for the problem. She said, “The private health sector in India is not being held accountable for tuberculosis in the country. If private sector claims to provide almost 70% of healthcare in the state, then either they are failing to diagnose TB cases or not reporting. Partially treated or wrongly treated patients are a big factor in the development of multidrug resistant (MDR) TB.” She also pointed out that if the private sector doesn't provide the data, how can effective policies be formulated? The government actually has a very good treatment protocol for TB, which has to be followed by both public and private sectors.

Eradication a distant dream
The government’s effort to eradicate the disease has proved to be elusive and India still accounts for 27% of TB patients in the world. Dr K.K. Aggarwal, President, Heart Care Foundation of India said, “Despite several efforts to address and combat the disease, TB continues to remain a public health emergency, especially in India. The need of the hour is to step up on the commitment made towards eradication of this disease through concerted efforts at all levels, he added.