TB News from India: January-February 2002 Issue

(TB News from India is published by Health and Development Initiative-India once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization 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)

Editorial Note

Stop TB, Fight Poverty : The Indian perspective

India carries a third of global TB burden. Every year two million people develop active TB. It accounts for nearly 4,50000 deaths every year and more than 1000 persons die of the disease every day. TB is inflicting enormous economic and social costs on the country. The estimated economic cost of TB is US $ 3 billion per year.

In India 240 million people live below the poverty line. Poverty alleviation remains a leading challenge before the government. Surveys reveal that almost 59% of households accounting for 526 million people have an abysmally low annual income of less than Rs 12500 (US $260)

Income poverty leads to ill health and ill health contributes to income poverty. The cost to an Indian patient for successful treatment of TB averages US $ 100 to US $150. Research shows that 20% of rural and 40% urban patients borrow money to pay for expenses due to TB. 

Effective TB control can help break the cycle of poverty and disease. Increasing public awareness about proven, effective interventions like DOTS and providing greater access and benefit of treatment to those with TB, will help put billions back into the economy. Projected incremental costs to the government for successful DOTS implementation throughout India are of the order of US $ 200 million per year, compared to the tangible economic benefits of at least US $ 750 million per year. The total expenditure on health has declined in last decade and stood at 1.11% of GDP in 1998-99. Indian government needs to increase its own expenditure on TB control. 

The three aims associated with World TB Day 2002 theme (Stop TB, fight poverty) , DOTS expansion, efforts to raise awareness among political leaders, decision makers and opinion leaders and mobilization of TB sufferers for demanding greater access to treatment are more relevant to India than any other country in the world.

Read the full text of article at: http://www.healthinitiative.org/html/toolkit/indperspective.htm 


1% in East Indian state of Bihar suffered from TB in 1998-99

A Times News Network story by Sachidanand Jha in Times of India dated 29th October 2001 says that according to National Family Health Survey-2 (NFHS-2) 1% population of undivided Bihar suffered from Tuberculosis (TB) in the year 1998-99. NFHS-2 was carried out in the year 1998-99 and its findings were made public in May 2001. The prevalence rate of TB was higher in rural areas (1035/100,000 population) than urban areas (629/100,000 population). An important finding of the survey was that incidence of TB increased rapidly with age. The incidence was 249/100,000 population in 0-14 years age group, 1372/100,000 population in 15-29 years age group and 2651/100,000 population among those aged above 60 years. It was also noted that prevalence of TB was much higher among males (1170/100,000) as compared to females (799/100,000). It was attributed to relative higher exposure of males to active TB cases and their smoking habits.
Read the full text of story at: http://www.timesofindia.com/articleshow.asp?catkey=-218817995&art_id318715&stype=1  

TB Drug Fails Test

A Tribune News Service story by Sushil Goyal datelined Sangrur in The Tribune dated, November 1 2001 reports that the failure of a batch of an anti-tuberculosis drug, Rifampicin (450 mg capsule), in a test conducted recently, has put a question mark on the quality of medicines being supplied to the government hospitals in Punjab and other states in the region. The Government Medical Store Depot, Karnal had, recently dispatched thousands of capsules of Rifampicin meant for curing TB, to the government hospitals. While the government is continuously urging TB patients to take right drug in right doses, on the other hand its purchase policy seems to be contradictory to it. The failure of the medicines in the test, have marred the spirit of the government's own slogan "right drugs in right doses", besides badly affecting the National TB Control Programme.

The Assistant Director-General (MS), Government Medical Store Depot, Karnal, has in a communiqué sent to the district TB authorities said that the senior district TB officer, Ghaziabad, had informed that rifampicin with manufacturing date as December, 2000, and expiry date as November 2002, had failed in the test. The Assistant Director-General has directed that the consumption of the drug should be stopped and the unconsumed quantity should be sent back to the manufacturer. 

The TB authorities in the Civil Hospital Sangrur had also received 3,000 capsules of rifampicin of the same batch but before they were distributed to the patients, the authorities had received the said communiqué from the Government Medical Store Depot, Karnal.

Read the full text of story at: http://www.tribuneindia.com/20011102/punjab1.htm#5  


The Times of India online carried a series of three articles by Rupa Chinai of Times News Network during October - November 2001. These articles performed an incisive analysis of Revised National Tuberculosis Control Programme (RNTCP) in the country and its linkages with HIV control.

Article 1
Revised TB control programme has few takers:

The article highlights the hardships faced by TB patients through the story of Raju, a forty-year-old slum dweller of Mumbai who is living with co-morbid AIDS and TB. Thousands of patients like him, suffering from AIDS and TB are unaware about the RNTCP (implementing DOTS in India), which has been acknowledged for its therapeutic quality. This lack of information is perhaps the biggest drawback of RNTCP. Even though it covers 40 percent of the country, not many patients, especially those who are poor and needy, know about it.

Apart from the lack of awareness, the RNTCP also suffers from another problem. " It continues to take second place to the AIDS programme even though the need of the hour is to present an integrated approach towards the two diseases " say health experts. Though it is well known that RNTCP can reduce death due to both TB and AIDS, no joint efforts have been made so far to combat this scourge.

The problems plaguing the system are best reflected in Raju's experience. The repeated visits he made to different tertiary care hospitals, the long wait for registration, inadequate supply of drugs, lack of counseling facilities and scant respect for DOTS are the main impediments. His experience with DOTS centers is no better. Here also the long periods of waiting, the irregular hours of staff members and their indifference towards poor patients add to the woes of these ill-fated patients.

The article also draws attention towards the possible role Non Government Organizations (NGOs) can play in providing social and emotional support to these patients.

Read the full text of story at:
http://www.timesofindia.com/articleshow.asp?art_id=1845498925&prtPage=1 

Article 2
Integrating AIDS, TB programmes need of the hour.

In Mumbai-India's commercial capital, the RNTCP operates through 300 DOTS centers housed in health posts, dispensaries and a few hospital run by the Mumbai Municipal Corporation. The critical challenge faced by the programme in the city is inclusion of patients from lowest socio-economic strata. The health staff at these DOTS centers is reluctant to include these patients (considered difficult to treat) as they may adversely affect the "successful cure rates" and thus cast a shadow on their 'performance'. These difficult patients include pavement dwellers, AIDS-TB cases and migrants. Health experts however feel that if such patients who are a challenge to the programme are calculatingly disregarded, the situation will continue to go downhill. These patients are important because if left untreated they could infect many other people. 

The programme is also facing problems on account of roping in private practitioners (PPs) in management of TB cases. Research shows that these patients first turn to PPs where they suffer irrational therapy, further depletion of health and indebtedness. The response of large public hospitals to the DOTS regimen has been slow as well. 

An Indian patient suffering from the dual diseases of AIDS and Tuberculosis needs access to effective TB services that are part of comprehensive treatment and care services. The reality however that such a patient stands straddled between the vertical pillars of the country's AIDS and TB programmes and ends up falling into void that lies between, the author laments.

Read the full text of story at:
http://www.timesofindia.com/articleshow.asp?art_id=209608132&prtPage=1  

Article 3
Conflicting treatment plans confuse poor patients:

India's 'warring' AIDS and TB control programmes that can not integrate at ground level are creating havoc for poor patients suffering from the dual diseases of AIDS and TB. In Mumbai neither programme seems to acknowledge the importance of other and ill trained, unsensitized health workers are driving poor patients away from treatment centers of RNTCP. Hospitalization of AIDS-TB patients remains a thorny issue, and neither programme seeks to smoothen their path.

The issue of HIV testing at DOTS centers is yet another contentious issue. While the TB programme believes it is neither recommended nor warranted, the AIDS programme on the contrary, says there should be counseling and voluntary HIV testing offered to all TB patients. The government hospitals, mean while, go ahead and do HIV testing of poor TB patients as a routine without offering counseling or seeking their informed consent. The inability of two programmes to coordinate on this issue worsens the suffering of AIDS-TB patients. When such a patient is referred to a DOTS center by tertiary hospital, their HIV status becomes known, and thus they are shabbily treated by the health staff, whose training has not sensitized them to AIDS patients.

The gains of DOTS are undermined by the verticalisation of health problems, and this is creating a nightmare of administrative problems at the ground level where every thing has to integrate, says Sheela Rangan, a Mumbai based TB Researcher.
Read the full text of story at: 
http://www.timesofindia.com/articleshow.asp?art_id=646913179&prtPage=1  


Resources for TB control-bridge the funding gap: WHO-World Bank

If the global community could raise an additional $ 900 million annually, deaths from tuberculosis could fall dramatically within a decade, and the disease could disappear during the lifetime of today children say Ms. Gro Harlem Brundtland and James D Wolfensohn Director General and President of World Health Organisation and World Bank respectively. Twenty-two countries are targeted for intensive TB control activities, because they bear the greatest burden. Most at risk are the severely impoverished African countries as well as Afghanistan and Pakistan.

For a decade now, WHO and World Bank have been working together to help some of the most populous countries in the world including China and India, to scale up their TB control programme. This partnership has shown impressive results. Cure rates in both these countries have improved.

"But we must speed up urgently", plead the two leaders. "There is an inexpensive cure that can be easily applied. We are on the right path but the funding gap for this effort needs to be filled".

Read the full story at: http://www.iht.com/articles/37400.html  

Web Call: Tuberculosis Control - India

Tuberculosis Control - India (www.tbci.org) is a website hosted by the Director General of Health Services, India and is meant to showcase the application of the Revised National TB Control Programme (RNTCP) in India. It provides an overview of the RNTCP and the Indian perspective on Directly Observed Treatment, Short Course (DOTS). The downloads page which has a repository of information on an assortment of TB related information in respect to the RNTCP and its implementation; it also contains standard guidelines for laboratories and NGOs. The "Key Facts and Concepts" has two interesting items in the form of an exhaustive PowerPoint presentation and a quiz on TB. There is a page, which traces the history of TB control in India from the sanatorium concept to DOTS. Anyone interested in getting an insight of the Government of India's view on TB Control should begin from this site. 
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Health and Development Initiative-India wishes you Seasons' Greetings 
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Visit Health and Development Initiative-India web site at www.healthinitiative.org  to view World TB Day 2002 tool kit