Despite best efforts, here's why India is far from being TB-mukt

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. Beginning as a mild flu-like illness, it can spread quickly through the body. It usually affects the lungs and manifests as weight loss, fever and severe cough. However, TB can also affect other parts of the body, including the kidneys, spine and brain. Data from India’s National Strategic Plan (NSP) for Tuberculosis Elimination 2017-2025 show that TB kills around 1,400 people every day and about 480,000 every year. About a million cases go unreported or undiagnosed across the country. [caption id=“attachment_522086” align=“alignleft” width=“380”]  Representative image. AP[/caption] In March 2018, the Central government had launched the TB-Mukt Bharat Abhiyan under NSP to detect, treat, prevent and build resistance to TB. There’s just one problem: comorbidities - when two or more diseases are present in a person at the same time or one after the other. In India, four conditions are slowing down attempts to eradicate TB: undernutrition, tobacco use, diabetes and HIV infection. The challenges Globally, TB claims 1.3 million lives each year, according to the World Health Organization’s 2018 Global Tuberculosis Report - HIV comorbidity accounts for an additional 300,000 deaths. About two-thirds of this total burden of 1.3 million deaths is borne by the developing nations, with the highest number of cases - 27%- coming from India. The latest NSP was designed to eliminate TB by 2025-30. From public-private partnerships to listing every TB case in the country and building better infrastructure for the timely diagnosis and proper treatment, the NSP is starting to cover bases. Yet, the challenges are nothing to sneeze at. “Despite the major steps taken for controlling TB and eradicating the existing cases, to achieve their goal and completely eradicate TB by 2025, the government of India has to focus more on specific challenges that are particular to India, which include diabetes and undernutrition,” wrote Pranay Sinha, a fellow physician at the Boston Medical Center in ‘Food for Thought: The role of undernutrition and diabetes in India’s TB epidemic’, an article published in the peer-reviewed International Journal of Medicine and Public Health. Diabetes, undernutrition and TB The central tuberculosis division of India lists diabetes and undernutrition as the top comorbidities along with HIV and tobacco in TB patients in India. Research suggests that both diabetes and undernutrition have a bidirectional relationship with tuberculosis - that is, the presence of either of these conditions can lead to TB and vice versa. According to the writers of ‘Undernutrition and tuberculosis in India: Situation analysis and the way forward’, an article published in the Indian Journal of Medical Research, undernutrition and TB perpetuate each other - TB leads to extreme weight loss and undernutrition is a major risk factor for TB. The presence of both conditions in the same person at the same time just worsens the outcomes. About 50% of TB cases in India are because of undernutrition - women, young adults, rural population, scheduled tribes and people living below the poverty line make up most of this number. With diabetes, too, TB has a two-way relationship. On the one hand, wrote Dr Sinha in his article in the International Journal of Medicine and Public Health, diabetics are 300% more likely to develop TB than healthy individuals - this is because they have reduced immunity and wide-range immunosuppression. On the other hand, pancreatitis — or inflammation of the pancreas — in TB patients can lead to new-onset diabetes. The pancreas gland produces insulin, which regulates blood sugar. Often, TB-induced diabetes can go undetected until the later stages when symptoms manifest clearly. India ranks second in the world, after China, in terms of the prevalence of diabetes. Over 72 million adults in India suffer from diabetes, according to the International Diabetes Federation (IDF). Join forces Comorbidities like diabetes and undernutrition can trip up the TB eradication programme. Experts say that addressing just these two factors could bring the number of new TB cases down by an estimated 36%. Additionally, addressing undernourishment in the central Indian states alone could mean 4.8 million fewer cases of TB in the country. Experts have also suggested a number of other measures to check TB. Examples include the integration of nutrition programmes with the TB eradication programme, increasing the monthly food allowance to TB patients - currently at Rs 500, collaborative management of diabetes and tuberculosis and more funding in the research sector to find novel, cheaper and more efficient ways to combat the disease. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest online resource for verified medical information. At myUpchar, researchers work closely with specialist doctors to bring you reliable information on all things health. To read more on this topic, please visit https://www.myupchar.com/en/disease/tuberculosis-tb