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TB News from
India:
May-June 2006
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Health and Development Initiative-India, (www.healthinitiative.org), publishes
'TB News from India' (TBNI) once every two months. The objective
of newsletter is to highlight issues related to Tuberculosis
and HIV/AIDS control in India a nd
enlist political, public, professional and administrative support
for its cause. Health and Development Initiative-India is a
not-for-profit organiza tion and the news items have been quoted
from various sources for fair use and in public interest. Reproduction
of the material published is welcome provided a reference is
made to the original source of the news item and TB News from
India.
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Editorial Note: TB in the news
Tuberculosis (TB) is gradually catching the attention
of the fourth estate. On World TB Day, this year a number of
Indi an newspapers and media channels carried stories depicting
the progress of TB control programme as well as describing the
sufferings of tuberculosis patients. In this edition
of TBNI, we are presenting a selection of such stories.
A story in Daily News and Analysis (DNA) fr om
Mumbai talks about ‘new emerging population of tuberculosis
patients from the economically sound strata with high-profile
jobs’. Another story published in The Hindu reports the
concerns being expressed about low acceptance of the Revised Natio nal
Tuberculosis Control Programme (RNTCP), with its DOTS strategy
(Directly Observed Treatment, Short course), among a large section
of private medical practitioners in Kerala. Yet another story
reported by NDTV highlights the plight of TB patients in a Pune
hospital.
An eye catcher was the story ‘ TB: Still a Health Issue’ published in w ww.kuenselonline.com,
a daily news web site of Bhutan. The news item provides detailed information
about forward movement of DOTS services in India&# 8217;s
tiny neighbour kingdom. TB reporters are really going places
now.
These in-depth and incisive stories serve to portray ground realiti es
and deserve the attention of TB programme managers as well as
TB advocates. We hope that this appreciable initiative of print
and electronic media will be a perennial phenomena rather than
being a once-a-year event.
TB Is the New Scourge in Town
Haima Deshpande, DNA India (March
05, 2006)
City (Mumbai) based, 29-year old advertising executive, Rano Dixshit, could
not believe her ears when the doctor pronounced the verdict
of her frequent illness as tuberculosis. Despite assurance that
the illness was curable, Dixshit went into shock and needed
extensive counselling thereafte r.
It took four different medical opinions to convince finance consulta nt
Seethu Jagan (40) of his status as a tuberculosis patient. A
high flier in the lifestyle circuit, Jagan is still not convinced
he has the illness.
Meet the new emerging population of tuberculosis patients from the economically
sound strata with high-profile jobs. Affirming that the higher
economic strata is contracting the disease at a fast pace, the
founder memb er of the Mumbai District Tuberculosis Control
Society, Prof (Dr) KC Mohanty, pointed to lowering immunity
levels as the main culprit.
Though it was commonly believed that TB is a poor man’s illness,
there is equal affliction in all strata. Due to the hectic lifesty
le and consumption of food loaded with chemical residues of
insecticides, pesticides and preservatives, immunity levels
are going down. More affluent people are now being diagnosed
with TB of the glands, bones, joints, spine, reproductory organs
and the brain. It is three times more than the number f ive
years ago,” disclosed Dr Mohanty.
Smoking, alcoholism, stress and food habits play a predominant role in
lowering immunity levels, indicates a study conducted by Dr
Mohanty. “ ;At all the hospitals in the city where I provide
consultancy, we are seeing an increase in TB patients from the
higher income strata,” he said.
Mumbai’s slums, over-crowded public spaces and public transport due
to the ever growing migratory population have become fertile
breeding grounds for
TB bacilli. Stati stics of the Union Health Ministry
indicate that the disease is fast spreading. T he rate of infection
in Mumbai is 35 to 40 per cent.
The TB graph has also shot up as 85 per cent of the HIV / AIDS patie nts
contract TB. Both, Dixshit and Jagan continue to abstain from
work for long periods during the course of their treatment.
“I am devastated, I cannot imag ine how I could have got
TB,” whispered a weak Dixshit. A chain smoker, Dixshit
survived on hot beverages for long periods.
Though government figures point to 3.5 lakh clinical TB cases in Mum bai,
sources in the Health Ministry say the numbers are much more.
“A majo rity of the people from all strata carry the dormant
TB bacilli. Statistics of t he Union Health Ministry indicate
that an estimated 75 lakh carry the TB bacil li in Mumbai and
can be infected by it during their life time if immunity leve
ls are lowered,” revealed Dr Mohanty.
Clinicians implementing the Central Government’s DOTS (Directly Observed
Therapy Short-term) programme in the city feel that there must
be an emergency declared on the control of TB, in order to arrest
its fast spread . On April
30, 1993, the World Health Organisation had declared such an
emergency in London. India
i s a signatory to that resolution.
On line at: http://dnaindia.com/report.asp?NewsID3D1016292
Rise
in TB Cases in Sangrur District Of Punjab
Tribune
News Service (March 19, 2006)
There
is a significant rise of more than 45 per cent in the cases
of tuberculosis (TB), considering the calendar year 2003 as
a baseline, in the Sangrur district when the revised national
TB control programme (RNTCP) was implemented.
This
was disclosed by Dr Surinder Singla, In charge, District TB
Cen tre, Sangrur, while addressing a gathering at a camp on
the topic “Importa nce of public awareness about TB and
AIDS” at government dispensary at Bhindran village, about
8 km from here, yesterday.
Dr
Singla said that during the calendar year 2005 as many as 2623
patients suffering from TB had been put on treatment in the
district while the number of patients was 1786 in the calendar
year 2003 and 2392 in 2004. As per the nationwide survey, about
2570 TB cases occurred per million every year in northern states
of the country.
About
5400 TB patients out of the total population of 2.1 million
in the Sangrur district should be detected and put on treatment
every year.
Online
at: http://ww w.tribuneindia.com/2006/20060320/punjab1.htm#13
TB
Control Programme Has Few Takers in Private Sector
C.
Maya, The Hindu (March 26, 2006)
Thiruvananthapuram:
The low acceptance of the Revised National Tuberculosis Control
Programme (RNTCP), with its DOTS strategy (Directly Observed
Treatment, Short course), among a large section of private medical
practitioners in the State (Kerala) has emerged as a major concern
for heal th managers. A substantial number of TB cases are treated
in the private health sector and go without being notified.
While
the advocates of the national programme claim that a uniform
strategy, ensuring standard diagnosis and treatment protocols,
is absolutely essential for controlling TB in the community,
the private medical practitioners aver that a standardised treatment
approach cannot work for a ll TB patients.
Under
the RNTCP-DOTS strategy, fixed drugs are given in specific combinations
once a week to patients by a DOTS provider and each dose administered
to the patient is supervised to ensure treatment compliance.
T his concept of intermittent chemotherapy has been unacceptable
to most private medical practitioners, who still insist on a
daily drug regimen.
"The
spirit of RNTCP is that the system takes the responsibilit y
of curing the patient by ensuring treatment adherence. DOTS
strategy has achie ved a cure rate of over 85 per cent in the
State," points out a senior Hea lth Department official.
Physicians
in the private health care sector often deviate from standard,
internationally recommended tuberculosis management practices
and use non-recommended drug regimens, with incorrect combinations
of drugs, incorr ect dosage and duration of treatment and fail
to assure adherence to treatment.
"Most
private practitioners seem to be prescribing five first-l ine
TB drugs in combination with a second-line drug. This irrational
prescripti on of second line drugs will give rise to more drug-resistant
strains of the bacteria," says an RNTCP official.
However,
there are many chest physicians who feel that the RNTCP-DOTS
strategy is just another half-hearted public health initiative,
the success and the efficacy of which is very much suspect “Standardised
treatment 221; will leave many half-treated, who will continue
to spread the disease," says P. Ravindran, a former Professor
of Respiratory Medicine.
Full
story online at: http: //www.hindu.com/2006/03/26/stories/2006032606000300.htm
TB
Patients Face Hospital
Apathy
Imtiaz
Jaleel, NDTV (March 25, 2006)
It
was World Tuberculosis Day on 24th March, but it
didn't make any difference in Pune's Sasoon hospital. The city's
largest government medical college and hospital does not have
a single inpatient ward for TB patients. The neglect of TB patients
continues, since the hospital does not have a separate ward
and even the doctors do not seem to care.
Over
200 patients suffering from TB come every month for treatment
b ut most of them are turned away. Ganpat,
a daily wage labourer who needs urgent attention, was told t
o go to another government hospital 15 kilometres away for treatment.
It
is really very sad when poor patients come here and then we
tell them to go to another hospital. At times they are so critical
and poor that it's difficult for them to even reach there. The
hospital also doesn't have any ambulance to take them,"
said an intern.
Full
story online at: http://www.ndtv.com/template/template.asp?category3DNatio nal&template3Dhealth&slug3DTB+patients+face+hospital+apathy&i
d3D86152&callid3D1
India Reports Rise in HIV Infections to 5.2 Million
(April
7, 2006)
NEW
DELHI (Reuters) - India reported a rise in HIV infections
in 2005, a top health official said, with more than 5.2 million
people now thought to be living with the virus, the second largest
number in any country after South
Africa
That
was an increase of 72,000 from 2004, with high risk groups like
prostitutes and homosexuals the biggest cause for concern, officials
said.
Federal
health secretary P.K. Hota said that with the increase, especially
among high-risk groups, the government should push for legalizing
homosexuality and liberalizing laws dealing with prostitution.
"We'll
pursue those provisions of law that criminalize this behavior,
push people underground and dehumanize them further. We have
to g ive them a voice and stop the dehumanization," Hota
told Reuters after an AIDS seminar.
But
UNAIDS, the United Nations anti-AIDS agency, said pushing for
changes in homosexuality and anti-prostitution laws could be
difficult in conservative India where sex is not discussed openly
by most people.
The
continued rise in infections overshadowed a rare glint of good
n ews last month in an Indo-Canadian study published in the
medical journal Lance t.
It
reported a drop of more than a third in the prevalence of the
HIV virus among 15 to 24-year-olds in the southern states of
Tamil Nadu, Maharashtra, Karnataka and Andhra Pradesh.
These
states, which are home to 75 percent of people living with HIV
in India, have
been the focus of the country's anti-AIDS efforts -- apparently
with some success.
However,
northern states like Rajasthan, Biha
r, Uttar Pradesh, and Punjab,
as well as ea stern Orissa, are in danger of being lulled into
complacency by their comparative ly lower rates of infection,
Broun said.
Full
Story online at: http://today.reuters.co.uk/news/newsArticle.asp x?type3DhealthNews&storyID3D2006-04-07T151521Z_01_DEL261346_RTRIDST_0
_HEALTH-AIDS-INDIA-DC.XML&archived3DFalse
India
to Implement National Action Plan against TB-HIV
India under the Revised National TB Control Programme
(RNTCP) aims at widening the scope for providing standardized,
go od quality treatment and diagnostic services to all tuberculosis
patients.
It
is known that about 50 - 60 % of HIV-positive people are more
pro ne to contracting tuberculosis. Hence, the Union Health
and Family Welfare Minister Anbumani Ramadoss plan to tackle
this issue and multi-drug resista nt cases. He said this after
releasing the RNTCP Status Report for India,
2006. He said that various measures are taken to tackle TB-HIV.
In
the first phase, the six high-HIV prevalent States of Maharashtra,
Tamil Nadu, Andhra Pradesh, Karnataka, Manipur and Nagaland
were identified for implementation. The services are being provided
for HIV-infected TB patient s by involving Voluntary Counselling
and Testing Centres and the RNTCP Designated Microscopy Centres
and non-governmental organizations.
The
Ministry is conducting community-based surveys among new and
re-treatment cases in Gujarat
and Maharashtra to estimate the number of people who ha ve become
resistant for drugs. Other states will also be strictly monitored
to help the Government by observing the trends in resistance.
According to the statistics drug resistance in new cases is
less than 3% and in old cases it is about 10 %.
Full
story online at: http://ww w.medindia.net/news/view_news_main.asp?x3D8861
Also
visit: http://www.navhindtimes.com/stories.php?part3D&Story_ID 3D03259
Corporate Houses Jo in the Battle
against TB
Times News Network (March 27, 2006)
Corporate
institutions are waking up to the need for fighting tuberculosis
according to the World Economic Forum (WEF), which works with
the Indian government and industry to fight the disease.
While
Tata Steel has evolved a workplace policy on tuberculosis, Reliance
Industries and the Aditya Birla group are investing in combating
t he disease among the employees and in the community through
advocacy and treatment, said a WEF functionary, on the occasion
of the world TB day. “We are also trying to harness the
co-operation of companies like Nov artis and Lupin which make
anti-tuberculosis drugs,” said Dr S P Kamble, the Global
Health Initiative official of the Geneva-based organisation.
Full
story online at: http:/ /economictimes.indiatimes.com/articleshow/1465081.cms
TB:
Still a Health Issue in Bhutan
Bishal
Rai, Kuenselonline, (March
25, 2006)
A
34-year old monk from Trongsa took his last dose of medication
at Gidakom's Tuberculosis treatment centre, packed his belongings,
and left for home yesterday.
The
monk who is studying in India,
had started getting mi ld fever in the evening and had dry cough
with blood in sputum. “The loc al medical centre could
not detect anything so I decided to do the check up in Thimphu,” the monk told Kuenselonline.
Doctors
at the Jigme Dorji Wangchuck national referral hospital confirmed
the monk had contracted TB and admitted him at Gidakom.
Later,
TB doctors and trainee teachers gathered at the National Institute
of Education in Paro to observe international TB day and draw
attention to this important disease that claimed about 50 Bhutanese
lives annually. According to doctors, about 1,300 suffered from
different types o f TB annually of which 60 percent were in
the most economically productive age g roup of 15-54 years.
The
Paro dzongkhag's district medical officer, Dr. Tapas Gurung,
sa id the disease was very common and everyone had close encounters
with it. “TB is neither urban or rural phenomenon and
affects all genders and all ages,” he said.
The
institute's director, Namgay Om reading the Health Minister
Lyo npo, (Dr.) Jigmi Singay's message, said that although the
number of sick and dyi ng was not alarming at this juncture,
it had to be kept in mind that these num bers have the potential
to explode due to increasing number of HIV/AIDS infectio ns
in the country.
Like
other medical services, TB treatment is free under DOTS progra
mme launched in country in 1997. DOTS is available in all 29
hospitals and 172 BHUs.
The
Gidakom TB centre has 15 patients that comprised of students,
c ivil servants, housewives and monks. According to Dr. Tejnath
Nepal at Gidakom,
the centre treated about 90 patients a year.
Since
the inception of the TB control programme in 1976, case detec
tion rate was at 73 percent, curing at 76 percent, treatment
success at 89 perce nt and the death rate was at 5 percent according
to Dr. Lungten Z Wangchuk of the national TB control programme
on the status of TB in the country.
Yet
it is still a major problem,” she said. It was recorded
that there were 83 cases and 67 incidences in every 100,000
people .
Full
story online at:
http://www.kuenselonline.com/modules.php?name3DNews&a mp;file3Darticle&sid3D6699
New
International Standards for Tuberculosis Care Published
Led
by the American Thoracic Society (ATS) and the World Health
Organization (WHO), a consortium of international health agencies
have published on the World Wide Web the first International
Standards for Tuberculosis Care (ISTC).
"The
purpose of the ISTC," said Philip C. Hopewell, M.D., who
co-chaired the committee that produced the standards, "is
to establish a widely accepted level of care that all practitioners,
public and private, should achieve in managing patients who
have, or are suspected of having, tuberculosis."
The
ISTC is designed to address the care of patients of all ages
with any manifestation of the disease, including multi-drug
resistant and extra-pulmonary tuberculosis and tuberculosis
combined with HIV infection. The ISTC is also designed to guide
providers everywhere, regardless of the circumstances of their
practice.
The
committee, however, was especially concerned about reaching
healthcare providers working outside national and local tuberculosis
control programs. These providers, according to Dr. Hopewell,
are less likely than their government counterparts to follow
proven methods for evaluating and treating patients with tuberculosis.
"In caring for patients with tuberculosis, these providers
assume an important public health function,&q uot; said Dr.
Hopewell. "Providers have a responsibility to their patients
and to the community."
The
standards address this concern by requiring providers to evaluate
all those who have come into contact with the patient and to
report new cas es of tuberculosis and the outcome of existing
cases to local public health authorities.
The
ISTC can be found on the Web sites of both the ATS (http://thoracic.org/) and the WHO (http://www.who.int/tb/en/).
Health and Developm ent Networks Has Published
A Comprehensive Report on the Stop TB E-Forum
Health
and Development Networks (HDNet) has published a comprehensive
report on the Stop TB e-forum, an open online discussion launched
on World TB Day 2005 that focuses on the role of frontline care
providers in the fight against TB. The e-forum has become a
lively platform for exchanging views a nd ideas on a variety
of TB issues, having attracted hundreds of contributions from
participants in more than 30 countries representing every region
of the world.
Download
the document at:
http://www.stoptb.org/resource_center/assets/documents/TB_Corr.pdf<
/a>
Dr.
Dinesh Kumar Sharma: dineshkumarsharma@gmail.com
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