From UPSC perspective, the following things are important :
Prelims level : Nothing much
Mains level : TB elimination in India - links to Nutrition, Sanitation
The Annual India Tuberculosis (TB) report released by the government says that India is now home to about a quarter of the total global TB patients. The current government is committed to ending TB in India by 2025.
TB in the context of Malnutrition and Sanitation
- Prime Minister declared that rural India was open defecation free (ODF).
- The Global Hunger Index 2019 put India at 102 in a list of 117 countries. India’s ranking was below Nepal, Bangladesh and Pakistan.
- It has been established beyond doubt that TB is more of a social disease owing to its roots to poverty, malnutrition and poor sanitary conditions.
State of TB in India
- The TB report reveals the progress on the government’s action plan on combating TB.
- The highest number of TB cases – As per the report, 21.5 lakh TB cases were reported in the country in 2018. This is the highest number of TB cases registered in any country.
- Nikshay – The report says that with the introduction of Nikshay – the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.
Barriers to TB notifications
- The working of such a surveillance programme in an unequal country like India should be taken with a pinch of salt.
- In a paper published in the BMJ Open concluded that despite a national notification system — of Nikshay — other factors decide notification of patients.
- Issues like patient confidentiality, poor knowledge of notification system, etc, prevented notification of TB patients in a hospital setting.
- These factors are social and without intervening at that level, it is hard to believe that notification of TB cases can reach a significant number by 2025.
- Of the total notifications, 5.4 lakh cases were from the private sector, an increase of 40% from last year. More than 80% of healthcare is now being delivered by private health enterprises.
Issues in TB control for public health system
- Public health – An increase in the notification of TB patients could be heartening for the government. But is not a good indicator for the public health system.
- The GHI report reminds that a hungry India cannot be free of TB.
- Dietary deprivation is a direct indicator of inequality. Unequal societies cannot be made free of disease and infirmity.
- BMC Pulmonary Medicine journal from Ethiopia shows that the proportion of malnutrition in TB patients was nearly 60%.
- Even a very distal reason for malnutrition in the community became a proximal cause for TB.
- Open Defecation
- TB and sanitation have a direct causal relationship.
- The Integrated Disease Surveillance Programme run by the National Centre for Disease Control maintains a web portal that details the outbreak of epidemics.
- The validity of the claims of the Swachh Bharat Abhiyan (SAB) through this data shows that there was no statistically significant reduction in the occurrence of vector-borne epidemics in the country, two years after the launch of SAB.
An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in the response to TB. This should include a more sensitive approach on gender and towards the underprivileged.