(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:

Charge of DOTS brigade

As the march of DOTS expansion continues in India, seven states and one centrally administered territory had achieved a hundred percent coverage at the end of second quarter of this year. These states are Himachal Pradesh and Delhi in north, Rajasthan in west, Kerala and Tamilnadu in south and Sikkim and Manipur in east of the country. The centrally administered territory is Chandigarh. This indeed is an encouraging development.

However on the other end of spectrum are the states of Jammu and Kashmir, Uttranchal, Chattisgarh, Meghalaya, Tripura, Mijoram, Nagaland and Arunachal Pradesh, which have yet to begin DOTS implementation.

Even in the Hindi heartland states of Uttar Pradesh, Bihar and Madhya Pradesh the presence of Revised National Tuberculosis Control Programme (RNTCP- implementing DOTS in India) is only marginal. The health systems in these states are not as robust as they are in the states that have achieved full coverage. The DOTS brigade needs the wholehearted cooperation of politicians, bureaucrats, health care providers and public in order to make an impact in these resource deficient states.

JOINING THE DOTS 

India's new programme for controlling TB is working, but not yet fast enough for the millions affected.

A story in The Economist dated June 22,2002 analyses the current scene of TB control in India

Lala is a young man but not a healthy one. Weight loss has pinched his face, giving it the shape of India; his silences end in coughs. Lala stopped taking medicine for tuberculosis (TB) because he started feeling better and ran out of money at roughly the same time. Now the disease is back and he can no longer afford treatment. He may be among the half-million Indians who will die this year from TB, which kills five times as many as malaria, striking mainly those in their prime. 

These are avoidable tragedies. Tuberculosis is almost always curable, and the cure is not expensive. When death happens on an Indian scale it is because the health system is not working. Few Indians, knowing as they do that their state is riddled with cracks just the right size for people like Lala to fall through, are surprised when it does.

This is one failure that the Indian state has recently roused itself to correct. Since 1998 India has introduced on a large scale the internationally approved method for tackling TB. The Revised National Tuberculosis Control Programme (RNTCP) now covers 460m of India's billion people, and is expected to reach 800m by 2004, but continued success is not assured. The programme demands much from a public-health service that takes in a scant 1% of GDP and misspends much of that. TB controls "is basically a management problem," says Thomas Frieden, who helped India expand the programme and is now New York City's health commissioner.

How much can one expect from sprawling, chaotic India, where patients often live miles from roads and the public health system, notorious for absentee doctors and missing drugs, and is often a last resort, even for the poor? At least 80% of qualified doctors are in the private sector; their numbers are exceeded by 1.25m unqualified practitioners. None has much stake in DOTS, which takes away their customers.

"RNTCP can control only half the problem, not the full problem, until it reaches the private sector," argues M. M. Singh, head of India's Tuberculosis Association. Others think that people will use the public system once word spreads that it offers good, free care. Converting private doctors to DOTS, they say, is less important than getting the scheme to the half a billion people who still have no access to it.

The full text of the story is available at:
http://www.stoptb.org/material/news/press/Economist_020622.pdf

TB and Poverty linkages: Indian Council of Medical Research (ICMR) Bulletin

Ever year, TB costs India Rupees 13,000 crore ($ 260,00,0000)

An article published in ICMR Bulletin, March 2002 edition which examines the economic impact of tuberculosis in India says that every year TB costs India more than Rupees 13,000 crore while patients have to shell-out Rupees 645 crore ($ 129,00,0000) annually on private care. Patients suffering from tuberculosis incur a total loss of Rupees 3469 ($99) on expenses for diagnosis and treatment. The article written by Mr. M. Muniyandi and Dr. Rajeswari Ramachandran of Tuberculosis Research Center, Chennai notes that lost work time and lost income from TB morbidity are 3-4 months and about 20 per cent of annual household income and the potential cost of lost productivity due to TB is in the order of 4 to 7 per cent of GDP.

Studies carried out in different parts of the country have discovered a high percentage of TB related debts-67 per cent of rural and 75 per cent of urban patient have incurred debts on account of treatment of TB-it said.

The adverse effects of TB were greatest for poor people, mainly because their income depends exclusively on physical labor and they had no savings to cushion the blow.

Urging for more funds for improving health services, the report said that India was spending only 0.9 per cent of the GDP on the health sector as against an average of 2.2 per cent by other developing countries.

You can read the full article at: http://icmr.nic.in/bumarch02.pdf 

Under-trial dies of TB in Punjab

A news item datelined Ferozepore, August 7 2002,published in The Tribune, Chandigarh says that a 72-year-old under-trial prisoner lodged in the Central Jail, died of tuberculosis (TB) last night. This is the sixth incident of death in the Central Jail since the beginning of this year.

According to information received from the local Sub Divisional Magistrate's office, Maridu, a resident of Rukna Begu village was booked under Section 420 of the IPC on June 30 this year and was under judicial custody. He was suffering from TB, a chronic disease, from the past many years. The jail authorities admitted him to the Civil Hospital yesterday morning when he suffered from a chest pain and had some breathing problem. But he died late in the evening. 

Link to the story: http://www.tribuneindia.com/2002/20020808/punjab1.htm#27 

New TB vaccine ineffective in HIV cases

A news item published in Times News Network dateline Pune July 26, 2002, says that doctors associated with Serum Institute India Limited (SIIL) have advised not to administer doses of the newly launched BCG vaccine to those children whose mothers have tested sputum positive and HIV positive. 

According to SIIL medical director Dr S. Bharadwaj, the chances of protecting an HIV-infected child from tuberculosis are minimal.

While pointing out that the efficacy of the indigenously developed vaccine is 83.8 per cent compared to other BCG vaccines with 80.3 per cent efficacy, he said the newly launched vaccine is best suited for children less than six years of age.

"The effects of the vaccine given to a child above six years may not show the desired results," he added.

Link to the story:
http://timesofindia.indiatimes.com/articleshow.asp?artid=17095483&sType=1 

Surge in HIV positive cases in Kerala

An IANS news story from the capital of Kerala; Thiruvananthapuram published in Times of India dated 19th July 2002 says that the image of Kerala as a state with healthy people has come under a cloud with a large number of HIV positive cases that have been steadily increasing.

Health Minister P. Sankaran said that HIV positive cases in Kerala are on the increase, with Thiruvananthapuram district having the highest number of cases.

He said: "The number of HIV positive cases in the state is anywhere between 70,000 and 100,000. The districts of Kozhikode and Thiruvananthapuram lead because of the large size of the expatriate population there. Most of those who appear to have contracted the disease get it from Mumbai."

The project director of the state AIDS Control Society, M.N. Gunawardhan, said: "We have launched a programme where people have been categorised into high risk and low risk categories.

"The high risk group consists of truck drivers, plantation workers and similar categories of people. We conduct regular classes for them and review the impact. For the low risk group, we run an awareness campaign with the NGOs. We also conduct classes for school students in the state".

Reports indicate that the HIV positive figures in the state could be highly deflated as it is hard to believe that the number of full-blown cases of AIDS in Kerala is a mere 819.

"Availability of funds is not a problem. We get aid from the federal government and other agencies. The real problem is reaching out to the masses", said Gunawardhan, who is also joint secretary for health in the state administration.

Read the full text of story at:
http://timesofindia.indiatimes.com/articleshow.asp?artid=16488819&sType=1 

Web-call: A visit to TB-INDIA website (www.tbindia.net)

The website aims to disseminate information about TB, improve TB care and allow NGOs to and physicians to interact. It has a sizeable amount of information for physicians with an emphasis on diagnosis, treatment, control; TB & HIV related issues and a section on drug resistance. A compendium of facts on TB under the FAQ section provides comprehensive answers to certain common but intriguing queries. There is a link to abstracts from the Indian Journal of Tuberculosis, which mostly consists of research papers on the newer developments in TB in the Indian context. Online help in order to facilitate the treatment category, a quiz and slide show are some of the highlights of the site. The links section lists some fairly good websites on the disease. This India based website surprisingly has no information on the team behind the concept, which is a dampener on the credibility of the information provided. 

This is a good site for those who encounter TB patients on a regular basis and would like to learn more about the finer points of diagnosis and treatment of the disease.