• Internal Code :
  • Subject Code : HSYP8100
  • University : Macquarie University
  • Subject Name : Public health

Tuberculosis in India

Introduction

Tuberculosis is a very commonly observed communicable disease. This is mainly caused by bacteria that might attack upon various body parts such as lungs, kidneys and spine and so on. This condition can be fatal for the person if it is left untreated. It can be spread from one person to another, by the means of air. If an active TB status patient sneezes, these particles can spread in the air. Any other person coming in close contact with the affected person at that time can contact with the infection. However, the spread of infection is not by the means of sharing food, shaking hands or any other form of physical contact with the affected person. As per the statistics approximately more than one-third of the world’s population is affected by tuberculosis.

Annually more than 9 million people tend to get sick because of this communicable disease. As per WHO reports, India is the biggest contributor to increasing number of patients having active tuberculosis (WHO, 2016). This public health related problem is the biggest in the issue in the world and India holds the burden on its shoulders to a larger extent. According to the estimations put up by WHO India has the world’s largest tuberculosis epidemic. There is also an underlying factor of increased number of population being drug resistant to tuberculosis treatment (Sharma, 2017). Due to this reason the number of infected individuals is greater in number as compared to the number of patients getting recovered from the same.

This new category of drug-resistant tuberculosis population of patient is an outgrowing challenge for the nation. These patterns are more fatal and require early intervention for early management and controlling the spread of the infection through the increasing population. In initial stages of spread India remained in denial for long and that has led to the spread of infection largely to multiple parts of the country. There are multiple factors that have been governing the development and treatment policies for handling the situation of tuberculosis in India. These factors are comprise of both social as well as economic factors. These policies are still in the making and the one already in place needs improvements by a larger capacity.

The social factors are mainly inclusive of the demographics and the culture in the country. These are also inclusive of the inequality amongst the society, the concern about the lack of awareness about the severity and complexity of the disease and the wealth and power required to handle this epidemic spread (Srinivasan, 2018). The economic factors are the ones being analyzed on a much larger scale. These factors are associated with productivity and growth and the economic status a country might hold for handling these crisis. The lack of modern means of treatment is another hurdle in the progress for treating and eradicating this public health related issue.

Social Factors

In order to improve the situation with TB, India needs to work on socio-economic determinants of health. These are the factors that are hampering the ease of access and the quality of treatment that is available for the common masses. India is a pollution driven country. These are multiple causative elements that prevail in the air to be breathed. These factors are also responsible for aggravating the present overall rate of population suffering from TB. The infection gained through breathing this air has increased not only chances of getting Tb, but also person sustaining with the condition for long as well. The next major limitation is the country being in a status of developing nation.

There is a poor infrastructure in terms of fighting for health rights and the economic equality amongst the population spread. The slums dwelling in major metropolitan cities, such as Mumbai, Delhi and Kolkata, have a higher ratio of people living in a one-room setting (Rao, 2018). This environment is sure to cause development of TB individuals by coming in contact with the affected individuals. The poor ventilation in these home dwellings is also responsible for causing the longitivety of the presence of infection in the surroundings. Poor working hazards, overcrowded homes and poor ventilation are all attributing factors for developing TB.

There is also a social stigma associated with the patients having a TB positive status. They can be observed to be socially marginalized on larger grounds. There is a crude isolation that is faced by these individuals (Mukerji, 2018). The government has although revised its policies for TB in these recent years. These social and economic factors are the foundational grounds around which these policies and plans are being implemented. The DOTS treatment has also been launched by the government at the grass root level. This program has been helpful in providing the patient with the required treatment and thus, promoting their autonomy (Mandal, 2017).

This implementation plan also covers for the non-clinical needs of the patients, thus, providing them with a holistic treatment approach. These plans also aim at working for social causes in the society, by supporting various non-governmental organizations that are supporting the main framework in managing delivery of healthcare services to these individuals. Apart from them Tuberculosis Association of India is also a voluntary organization that has been working on this cause, shoulder to shoulder with the government.

Its main work is to work in various TB centers throughout the nation and provide them with the required medical supply, information and other support material (Kadam, 2017). They have also been a huge help in keeping a close monitoring on the active patient status and thus, have been helpful in early identification of the target population in the given particular community as well. Greater patient autonomy is also required in the process to hear the point of view of the patient on an individualized basis. This is very important form the point of view of reducing overall burden of TB from the population as a whole.

Economic Factors

The higher rates of TB can also be contributed to the fact that the affected patients belong to a low income group category. Due to lack of financial support and means, many of these people are not able to afford the high priced medications required for the treatment purpose. The initiative were thus, launched for the same, ensuring free treatment for Tb from government side to these patients population (Yadav, 2017). However, despite the increased efforts from the government end, many people still lack the access to these medications. Another major issue that might be causing this trouble can be due to lack of education and understanding for the diseased condition. In most of the regions on India there is a high illiteracy rate, especially in rural areas. This is due to lack of resources and means of even primary healthcare support in these regions. The plans of Indian government has therefore, shifted their focus on providing educational programs at door to door step in these rural settings as well.

The issue of poverty and lack of financial resources are also contributing largely to malnutrition (Padmapriyadarsini, 2016). Poor educational standard as well as poor living conditions with no hygiene. The incidences of substance abuse and infections like HIV are also of high prevalence in these settings. These financial factors also add to the overall burden to the diseased condition of TB.

Plans for Tuberculosis in India

The government of India has come up with new strategic plan to combat against rising issue of tuberculosis. The country has come up with the National Strategic Plan (NSP) 2017-2025 (Khaparde, 2019). The plan mainly aims at eliminating the public health issue of tuberculosis all together from India. The plan describes in details the activities and the intervention strategies that will be planned in a methodical manner to fight against this condition. It will based on evaluating for the significant incidences, prevalence and mortality that can be caused due to tuberculosis. As per a survey done under this plan the state of Uttar Pradesh noted for the highest number of tuberculosis patients in India.

The plan also aims for the rural areas that lack the means and support system to help in eradicating this diseased condition. These population sects are also a major contributor to the positive TB population. The vision of the plan is to make India, Tb free with no deaths reported form the same. The goal is formulated to reduce the burden of tuberculosis in the population by rapidly declining the burden of the disease on the population. It will also be helpful in subsequently reducing the rate of mortality and morbidity related to the condition. This has been planned by the Indian government in four stages. These stages are inclusive of detect, treat, prevent and build (Purty, 2018).

The planning is done in step-wise manner. The first step is to identify for the risk factors and the population groups that pose high risk of spreading this infection. They can be defined as the targets to be examined. These targets are also inclusive of the public and private sector agencies that can be helpful in providing financial as well as material support during this process. The first step of detect of the plan strategy is to identify for the region or population group that night be wither drug sensitive or be drug resistant to TB. These individuals make for the unidentified group of individuals who are at a high risk of spreading TB to the common masses. Private sectors have been helpful in this field of work by scaling up the free diagnostic testing of TB through systematic approach and helping in identifying these individuals.

Treating the condition includes providing the affected population with the anti-TB medications. It also includes for providing the required system approach and support in social grounds. The plan includes providing for free TB medication and that too in daily basis. This has been formulated focusing on regimens based on drug resistant TB (Sachdeva, 2019). The support is also provided to the individual in a friendly manner and thus, helping them in adhering to the medications largely. One of the major aspect is covering for the nutritional support to these patient and providing them with means to sustain and improve their immunity. These drugs are also readily available at private pharmacies as well as public pharmacies. Prevention schemes under this plan is based on treating the susceptible group of population. These interventions are also based on planning for controlling various air-borne infections (Purty, 2018).

Introducing treatment intervention for latent TB infection for both confirmed as well as non-confirmed cases. The main social concerns such as living conditions, community health and so on are also been covered under these intervention plans. The build component is based on strengthening relevant policies and infrastructures involved in this process. This is also inclusive of providing for additional capacity for various human resources a well (Huddart, 2018).

The plan has strong surveillance strategies as well that help in evaluating the situation at the grass root level as well. The interventions are also planned, based on the local situations in the rural sectors mainly. The key population sects taken into close consideration to be identified and focused on includes, people living in slum dwellings, people living in refugee camps, construction site workers, old aged home care facilities, night shelters and so on.

References

Huddart S, Nafade V, Pai M. Tuberculosis: a Persistent Health Challenge for India. Current Epidemiology Reports. 2018 Mar 1;5(1):18-23.

Kadam ND, Wagh SS, Rajput UC, Surawashi RA, Rode S, Jagdale S, Khaire S, Rathod S. Effectiveness of DOTS therapy under RNTCP-DOTS strategy in paediatric TB-experience from Western India. Journal of Evolution of Medical and Dental Sciences. 2017 Jul 20;6(58):4316-21.

Khaparde SD. The national strategic plan for tuberculosis step toward ending tuberculosis by 2025. Journal of Mahatma Gandhi Institute of Medical Sciences. 2019 Jan 1;24(1):17.

Mandal S, Chadha VK, Laxminarayan R, Arinaminpathy N. Counting the lives saved by DOTS in India: a model-based approach. BMC medicine. 2017 Dec 1;15(1):47.

Mukerji R, Turan JM. Exploring Manifestations of TB-Related Stigma Experienced by Women in Kolkata, India. Annals of Global Health. 2018;84(4):727.

Padmapriyadarsini C, Shobana M, Lakshmi M, Beena T, Swaminathan S. Undernutrition & tuberculosis in India: Situation analysis & the way forward. The Indian Journal of Medical Research. 2016 Jul;144(1):11.

Purty AJ, Anandan V. Expanding the role of Medical Colleges in RNTCP towards End TB strategy: Scope and Challenges. Indian Journal of Community Health. 2018 Mar 31;30(1):4-6.

Purty AJ. Detect–Treat–Prevent–Build: Strategy for TB Elimination in India by 2025. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2018 Jan;43(1):1.

Rao VG, Bhat J, Yadav R, Sharma RK, Muniyandi M. A comparative study of the socio-economic risk factors for pulmonary tuberculosis in the Saharia tribe of Madhya Pradesh, India. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2018 Jun 1;112(6):272-8.

Sachdeva KS, Mase SR. The end TB strategy for India. Indian Journal of Tuberculosis. 2019 Jan 1;66(1):165-6.

Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, Sarin R, Paramasivan CN, Kumar P, Nischal N, Khatiwada S. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. The Indian Journal of Medical Research. 2017 Apr;145(4):448.

Srinivasan S, Easterling L, Rimal B, Niu XM, Conlan AJ, Dudas P, Kapur V. Prevalence of Bovine Tuberculosis in India: A systematic review and meta‐analysis. Transboundary and emerging diseases. 2018 Dec;65(6):1627-40.

World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis. World Health Organization; 2016.

Yadav R, Sharma N, Khaneja R, Agarwal P, Kanga A, Behera D, Sethi S. Evaluation of the TB-LAMP assay for the rapid diagnosis of pulmonary tuberculosis in Northern India. The International Journal of Tuberculosis and Lung Disease. 2017 Oct 1;21(10):1150-3

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