TB is prevalent in India. However, the lack of awareness makes it a lasting problem. It has been found that persons suffering from TB, don’t even recognize the presence of the bacteria that causes TB in their bodies. As a result, the person affected cannot seek medical assistance and the TB switches from latent to active. This is a matter of grave concern.
As per the Ministry of Health and Family Welfare’s data, India continues to record the maximum number of TB cases, with the statistics showing uneven results. Almost 21.4 Lakh TB cases were notified in India in 2021, 18% higher than the previous year. However, considering meeting India’s health goals, the government has ushered in a campaign to eliminate TB by 2025, calling everyone to join hands in accomplishing this goal.
Since then, state governments all over the country have joined hands with the Union to fuel the initiative into a TB-free reality. However, no proposition can help achieve its end goal unless the people of the country unite to fight this menace. Amidst the adverse conditions and growing mutations of Mycobacterium Tuberculosis, there is an urgent need for us to ponder upon the challenges and avoid the common mistakes we make while dealing with TB management to achieve the goal of TB elimination from India by 2025.
We need to avoid the following common mistakes we make while managing TB.
- Delayed detection of the disease
At a primary care level, patients are given multiple rounds of antibiotics, but tests for TB are rarely ordered. In the global scenario, India is lagging in its national decline rate of TB cases. The reason is simple and the message is clear – how do you cure a disease when you fail to detect it? The Mtb bacteria if goes undetected, damages the respiratory system rapidly and suppresses the response of the immune system.
At the primary care level, a person rarely gets investigated with TB even if he/she visits a practitioner with classic TB symptoms. Instead, they are given drugs to treat cough. Even if the diagnosis is done correctly, treatment standard in India at the private level is not up to the mark yet. Hence, it is common to see TB patients make mistakes in a scenario of a lack of awareness in the country.
Bhakti Chavan, a survivor of TB and a resident of Mumbai was prescribed cough medicines when she had symptoms of TB. The detection got delayed in her case because of multiple reasons. One was that she had stomach pain and then swelling on the right side of the neck, which are not the most common symptoms of TB. Hence, she never visited the right doctor at the right time. There are many more such examples, which indicate the delayed detection of the disease in patients. There is a need to revamp the thought process, seize the fear of the disease, avoid mistakes and believe that TB can be eliminated if we are equipped and aware enough.
- TB Diagnostic gaps in the country
Even if a patient visits the doctor in time, the diagnostic gaps in the country make it difficult for them to get the right kind of treatment. At the primary care level, a person rarely gets investigated with TB even if he/she visits a practitioner with classic TB symptoms. Instead, they are given drugs to treat cough. Even if the diagnosis is done correctly, treatment standard in India at the private level is not up to the mark, yet. Hence, it is common to see TB patients make mistakes in a scenario of a lack of awareness in the country.
Not all doctors recommend the right detection tests for TB and hence, it is important to reach out to the right experts at the right time.
According to a study – “Quality of tuberculosis care in India: a systematic review”, doctors in India often order non-specific tests such as total and differential blood counts (TC/DC), erythrocyte sedimentation rate (ESR), and chest X-rays. While these tests are helpful, they don’t confirm TB. Relying on X-rays could be a bad idea in the case of TB. Experts believe that tuberculosis can only be confirmed by microbiological tests such as sputum smear microscopy.
In India, there is growing concern that tests such as Mantoux (tuberculin skin test) and IGRAs (e.g., TB Gold, TB Platinum) are being misused for active TB diagnosis. However, the Standards for TB Care in India (STCI) states that both TST and IGRAs should not be used for the diagnosis of active TB in highly endemic settings like India.
- Ignoring the comorbidities in TB patients
The Central Tuberculosis Division, Government of India provides a detailed explanation of TB and Comorbidities classifying them under, TB and Nutrition, TB and HIV, TB and Diabetes and TB and Tobacco. The doctors often ignore checking if the patient is a smoker or an alcoholic. This could be misleading for the patients. It could lead them to begin with a treatment regimen which might not be suitable for them. Studies show that it is important to ask about TB symptoms among other family members at a primary level as well.
- Use of Irrational TB Regimes
Studies show that even if the diagnostic hurdle is overcome, TB treatment in the private sector doesn’t follow a standard that needs to be followed. When private practitioners initiate anti-TB treatment (ATT), they tend to use drug regimens that are not recommended by WHO or the Standards of TB Care in India (STCI), which is said to be a big mistake.
It is also not required to extend the duration of treatment beyond six months unless there is evidence of treatment failure or complications. Besides, drug dosages should be based on body weight, and daily dosing is preferable.
Hence, it becomes necessary to visit the right kind of practitioner to avoid such common mistakes.
- Not adhering to treatment course
The patients must adhere to the course of ATT to ensure high cure rates and to prevent the emergence of drug resistance. Most times, they start a treatment regimen but leave it in between. This is because patients do not receive enough counselling about the importance of completing the full course of ATT.
On the practitioners’ part, it is important to notify all TB cases to the local health authorities so that they can seek help from the public sector. And on the patients’ part, it is important to understand that incomplete treatment can never lead to the complete removal of the TB-inducing bacteria from their bodies.
Points to Ponder
TB patients and practitioners make the above common mistakes in the country. But the challenges for Tuberculosis control in India are not limited to these. The trend of Multidrug-resistant TB and Extensively drug-resistant TB cases in India requires immediate attention from health and policymakers nationwide. A practicable framework that addresses all the issues related to the disease appears to be the only way to step out of the afflictions caused by the disease.
The Annual TB Report 2022 of the National Tuberculosis Elimination Program (NTEP) shows phenomenal achievements in the prevention and control of the number of cases of TB. However, the challenges that come in the way of eliminating TB from India by 2025 are still there. But as the strength of India lies in the heart of unity, a little awareness and caution developed in each individual might help us attain this goal.