Why in the News?
According to the WHO Global TB Report, India's TB incidence (new cases emerging each year) reduced by 21%.
More on the News
- The report highlights TB to among top 10 causes of death worldwide and leading cause of death from a single infectious agent.
- Other key findings
- Global: 1.23 million died from the disease in 2024.
- Global TB Incidence Rate: Net reduction of 12% from 2015-2024.
- Global TB Deaths: Net reduction of 29% from 2015-2024.
- India: India's TB mortality rate has decreased from 28 per lakh population in 2015 to 21 per lakh population in 2024.
- Global TB Burden is highest in India (25% TB patients).
- India accounted for more than 32% of the global number of people estimated to have developed MDR/rifampicin-resistant (RR)-TB in 2024.
- Global: 1.23 million died from the disease in 2024.
- India accounted for 25% of deaths caused by TB among people with and without HIV.
About Tuberculosis (TB)
- It is a contagious airborne disease caused by a bacterium called Mycobacterium tuberculosis. It is preventable and curable.
- Types based on site of Infection:
- Pulmonary TB: Most common form affecting the lungs, and is contagious spreading through airborne droplets through coughing or sneezing.
- Extrapulmonary TB: Occurs outside the lungs, affecting organs like lymph nodes, bones, brain, kidneys, or the pleura, less contagious and spreads within the body from lungs.
- Spinal TB (Pott's disease): Affects the spine and can cause severe back pain and mobility issues.
- Types based on Response to Drugs:
- Drug-sensitive TB: This form of TB responds well to the standard first-line anti-TB medicines such as isoniazid and rifampicin.
- Drug-Resistant TB: Some forms of TB do not respond to standard medicines.
- Multi Drug Resistant (MDR-TB): Form of TB that does not respond to rifampicin and isoniazid, the two most effective first-line TB drugs.
- Extensively Drug-Resistant (XDR-TB): In this type of TB, the stronger medicines may not work.
Factors leading to TB Control in India
- Key Government Initiatives:
- National TB Elimination Program (NTEP): Revised National Tuberculosis Control Programme (RNTCP) renamed as NTEP in 2020 aims to eliminate TB in India by 2025.
- National Strategic Plan (2017-25) for Ending TB in the country by 2025.
- Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA): Launched in 2022, with the objectives to provide additional support to TB patients.
- Nikshay Poshan Yojana (NPY): Launched in 2018 by the Ministry of Health and Family Welfare, provides financial assistance of ₹1,000/- per month to each notified tuberculosis (TB) patient for nutritional support.
- Addressing Infrastructure Gaps:
- Strengthening Public Health Infrastructure: Expansion of TB diagnostic centres, microscopy labs and treatment centres under NTEP.
- Digital Health & Monitoring Systems: Launch of Nikshay Portal, web-based patient management and surveillance system under NTEP.
- Introduction of Newer Therapies: New treatment regimens like BPaLM (Bedaquiline + Pretomanid + Linezolid + Moxifloxacin) have transformed TB care, especially for drug-resistant TB.
- Better Diagnosis: Universal Drug Susceptibility Testing (UDST) implemented under the NTEP to ensure every diagnosed TB patient is tested to rule out drug resistance.
- Harnessing Advanced Technologies: The use of artificial intelligence (AI) and Molecular diagnostic technologies (nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS)) has strengthened early detection and monitoring of TB cases.
Challenges in Eradicating TB in India
- Gaps in Diagnosis particularly in Remote and Rural Areas: Rural regions often lack advanced diagnostic facilities leading to delayed or missed diagnosis. E.g. Active case findings of 250 from 1250 individuals in Gurez valley of Kashmir.
- Digital divide: According to the India TB Report, many peripheral health units lack adequate computer infrastructure, reliable internet, or data entry operators, which hinder use of NIKSHAY.
- Socio-Economic Disparities: TB disproportionately affects the poor, malnourished, migrant workers, tribal communities and urban slum dwellers. E.g. According to a study over 60% of migrant workers in Delhi live in very precarious conditions.
- Looming Malnutrition: As per a study Starvation related malnutrition has been demonstrated to increase the incidence of TB by six to eight times.
- High MDR-/RR-TB Case Burden: E.g. India accounts for more than 32% of the global number of people estimated to have developed MDR/RR-TB.
- Frequent Drug Shortages: E.g. In 2023, Maharashtra reportedly received only 25,000 tablets of Cycloserine in a month when its requirement was around three lakh tablets.
- Systemic Factors: Human resource shortages, TB health visitors, counselor's shortage. E.g. Microbiologists (67% vacancy), Lab assistants (43% vacancy).
- Environmental and Living Conditions: In Mumbai 8-10% of the residents in the denser, less light-filled and more poorly ventilated complexes had tuberculosis compared with 1% of residents in a better ventilated project.
- Others: High burden of co-morbidities like diabetes (In Tamil Nadu, a study found that 25.3% of TB patients had diabetes, and 24.5% had pre-diabetes), natural disasters (floods, droughts), large unregulated private healthcare sector etc.
Conclusion
TB elimination requires a sustained, multi-sectoral approach that strengthens public health infrastructure, ensures uninterrupted drug supplies, addresses social determinants of health and promotes community awareness. A people-centered, technology-driven and nutrition-focused strategy focusing on last-mile delivery, reducing stigma, safeguarding vulnerable populations, and improving coordination across government departments is essential to make India TB-free.
