Tuberculosis, Still Among India's Top Killer Diseases

chillibreeze writer — Renee Kulkarni

The anxious parents of a young 18-year-old looked most distraught as they walked into my room at the hospital to discuss their son’s x-rays and CT findings. He had just been through a series of tests, a routine part of investigating a three-week-long fever. The diagnosis was pulmonary tuberculosis, or TB of the lungs.

Impossible, they argued, that their well-fed, well-heeled offspring should develop this disease. Could we doctors have gone wrong somewhere?

An increasing number of urban Indians today must contend with the fact that tuberculosis is no longer an affliction of the destitute and poor. It transcends all social barriers, affecting the young and old alike, constituting a major public health burden.

Despite an apparently successful (Revised) National TB Control Program, 18 lakh new cases occur in the country each year as per WHO estimates. Globally, TB is much more prevalent today than in any other period in history. Along with AIDS and Malaria, it remains one of the top three killers on our planet.

Tuberculosis is an infectious disease caused by a rod-shaped bacterium. Infection is transmitted through droplets, usually during acts such as coughing or sneezing. The primary organ of involvement is therefore the lung; bacteria however, may be swept by the bloodstream to involve virtually any organ in the body in those with compromised immune systems.

Commonly described symptoms include low grade rise of fever in the evenings, loss of appetite, weight loss, night sweats and cough. Treatment may be rapidly initiated once the diagnosis is established; the disease is fatal only if it is untreated or unresponsive.

TB is the leading infectious killer of youth and young adults worldwide. More than 300,000 people die of TB every year in India alone.

Public awareness of tuberculosis in this country is seriously lacking. Delays in seeking and initiating treatment stem from inadequate knowledge about symptoms, cost of transportation and healthcare, and not the very least from the social stigma associated with TB in this country.

Untreated patients with bacteria-laden sputum remain potential threats to all those they come in contact with. Thousands of women sufferers are shunned by their families every year; many a child is forced to drop out of school to care for an ailing parent, and may in turn also contract TB.

Treatment regimes are often recklessly abandoned, predisposing to the development of drug resistant forms of the disease. Poorly motivated, ill-informed patients confronted with monetary issues often do not comply with treatment.

Co-existing medical conditions like diabetes and AIDS and habits like smoking and alcoholism jeopardize the patient further. Inadequately trained doctors, government apathy and the increasing presence of spurious drugs in the Indian market also compound the problem.

MDR and XDR – TB are drug resistant variants, treatment of which is expensive, often frustrating and associated with a higher incidence of toxic side effects. Indeed, cure rates of resistant forms are low and mortality is high. Multidrug resistant tuberculosis now threatens to derail global disease control efforts and constitutes a grave health risk.

TB can however be controlled by early detection and prompt institution of treatment. The DOTS Program (Directly Observed Treatment, Short Course) has been identified by the World Bank as one of the most cost-effective health regimens available.

An appropriate diagnosis of TB and registration of each patient detected is followed by standardized, directly observed multi-drug treatment, ensuring that a continuous supply of high quality anti-TB drugs is available to all patients. When optimally implemented, it has been proven to be a highly effective means of treating patients, preventing new infections and the development of drug resistance.

The need of the hour is an awareness campaign to carry information about all aspects of this disease to the masses. It is imperative to take the movement against TB beyond government organizations and politicians.

Taking note of the fact that community participation is vital, the slogan coined for this year's World TB Day is `I am stopping TB.’ It highlights the compelling need for all of us - health care providers, families and communities, teachers, as well as industrialists, bureaucrats and the media - to come forward and contribute to the formidable task of eliminating tuberculosis from our midst. High time that the eradication of this scourge of mankind receives the attention it very justly deserves.

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Renee writes for chillibreeze.

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