Editorial: A distant dream

The 2025 target set by the government nearly a decade ago for the complete elimination of TB appears a tall order given the ground realities

Malnutrition is the culprit in many diseases. Tuberculosis, an infectious disease caused by bacteria, is one of them. In a country like India, where undernutrition is rampant, particularly among children, eradicating TB continues to be a major challenge. The 2025 target, set by the government nearly a decade ago for the complete elimination of TB, appears a tall order, given the ground realities. The World Health Organisation’s latest Global TB Report reveals that India has the world’s largest TB epidemic; at 2.6 million, the country has the highest number of TB cases, accounting for 26% of the global burden. The disease results in a staggering economic loss of $23.7 billion a year. Even these figures are considerable underestimates as not all patients are notified. Grossly inadequate diagnostic facilities and delayed detection are the major areas of concern in the fight against the disease. The sooner treatment commences, the quicker the cycle of airborne transmission is halted. With under-investment in public health and the TB programme, the public sector is over-stretched. Because of the deficiencies in the public sector, nearly 80% of Indian TB patients choose to incur large out-of-pocket expenses and seek treatment with unregulated private practitioners. India also has the dubious distinction of being home to the largest number of Drug Resistant TB cases in the world, some with the most alarming resistance patterns. This form of TB is very expensive to treat.

Even though an estimated 500 million people in the country, mostly children and vulnerable household contacts, are infected by the bacteria, treatment of latent TB infection (LTBI) is a low priority. Identifying and treating them with simple prophylactic drugs before they get active disease would have a huge impact. Nearly four lakh Indians die of TB every year, a majority of them preventable if patients had access to the diagnostics, drugs and support. Poverty and malnutrition are responsible for up to 40% of incidence in the country. A good diet not only reduces the incidence of the disease among vulnerable people living with infected people, but it also brings down mortality in TB patients. Unequal access to economic opportunities, limited healthcare, poor sanitation, crowded living conditions, malnutrition and illnesses such as diabetes or HIV are all associated with increased risk of tuberculosis. In India, the National Tuberculosis Elimination Programme (NTEP) recognises the need to improve nutrition and under the ‘Nikshay Poshan Yojana’ an amount of Rs 500 is given every month to those diagnosed with TB. This is grossly inadequate to take care of the nutritional requirements. The NTEP guidelines recommend that a tuberculosis patient consume 2,800 calories every day. The Nikshay Poshan is a half-hearted attempt at addressing one of the root causes of the problem. The scheme has also been dogged by systemic challenges. Unfortunately, TB is so deeply rooted in India that elimination in the next decade is unlikely.

---