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