TB cases in In­dia could be much higher: Study

DNA Sunday (Mumbai) - - FRONT PAGE - Maitri Porecha Maitri. porecha@ zee­me­dia. es­sel­group. com

New Delhi: Num­ber of pa­tients suf­fer­ing from tu­ber­cu­lo­sis in In­dia could be much more than those pre­vi­ously es­ti­mated by the Govern­ment of In­dia, ac­cord­ing to a new study pub­lished in Lancet In­fec­tious Dis­eases Jour­nal. The study, based on sale of TB cure medicines dur­ing 2013- 14, es­ti­mates the num­ber of pa­tients seek­ing treat­ment with pri­vate physi­cians could be two to three times higher.

The study claims that up to 22 lakh pa­tients may have sought treat­ment with pri­vate doc­tors in 2014, spend­ing upto Rs 395 crore as out- of- pocket ex­penses. Th­ese pa­tients would have es­caped the purview of the Na­tional TB Con­trol Pro­gramme, run by the GoI and went un­ac­counted for. Only over a lakh TB cases were re­ported by pri­vate doc­tors to the govern­ment dur­ing that year, though it is manda­tory for them to re­port cases. In 2014, as per GoI records, 14 lakh TB pa­tients had ap­proached pub­lic hos­pi­tals to seek care un­der Re­vised Na­tional Tu­ber­cu­lo­sis Pro­gramme ( RNTCP). The study took into con­sid­er­a­tion the na­tion- wide drug sales data of 189 branded anti- TB medicines, con­tain­ing com­po­nents such as Iso­ni­azid, Ri­fam­pacin, Etham­b­u­tol and Pyraz­i­namide, among oth­ers. The re­searchers then ar­rived at an es­ti­mate of how many pa­tients may have been put on such treat­ments by pri­vate physi­cians dur­ing the year, by analysing the vol­ume of drugs sold. “An av­er­age of 22 lakh pa­tients sought med­i­ca­tion from pri­vate sec­tor doc­tors that year. Our es­ti­mate was 8 lakh pa­tients, and the new num­bers – close to three times higher – are glar­ing. The un­der- re­port­ing oc­curs as pri­vate physi­cians fail to re­port cases to the govern­ment,” said Dr Su­nil Kha­parde, deputy direc­tor gen­eral ( TB), Min­istry of Health and Fam­ily Wel­fare.

“Th­ese pa­tients also ended up spend­ing over Rs 395 crore as outof- pocket ex­penses for drugs alone in 2014, when the govern­ment was of­fer­ing free treat­ment in pub­lic sec­tor. The an­nual bud­get of RNTCP is Rs 640 crore, which is spent on pa­tient care as well as on drugs,” said Dr Kha­parde.

Ut­tar Pradesh is the worst hit, with 2.45 lakh pa­tients get­ting treated un­der RNTCP and al­most a dou­ble – around 5.6 lakh – re­ceiv­ing treat­ment in the pri­vate sec­tor un­der the 9- month TB drug reg­i­men. Ma­ha­rash­tra is a close sec­ond with 1.33 lakh pa­tients get­ting treated un­der RNTCP, and 1.8 lakh pa­tients seek­ing pri­vate care.

“In terms of vol­ume of TB care given by pub­lic and pri­vate sec­tors, Bi­har recorded 3.5 times more pa­tients ap­proach­ing the pri­vate sec­tor than the govern­ment’s RNTCP. Ut­taran­chal comes a close sec­ond with 3.4 times re­ceiv­ing treat­ment in pri­vate sec­tor,” said Dr Ni­malan Ari­nam­in­pa­thy, lead au­thor of the re­search, from the School of Pub­lic Health at Im­pe­rial Col­lege Lon­don.

The study fur­ther re­veals that in 2014 pri­vate physi­cians pro­cured nearly dou­ble the vol­ume of drugs as com­pared to the govern­ment un­der the RNCTP.

It was es­ti­mated that in 2014, 96 lakh peo­ple fell ill with TB across the globe and 15 lakh died. The ac­tual num­bers could be much higher as there could be un­der­re­port­ing in many coun­tries, thanks to poor sys­tems. In­dia has the high­est num­ber of TB cases in the world.

The study on TB — a bac­te­rial in­fec­tion, spread through in­hal­ing of tiny droplets from the coughs or sneezes of an in­fected per­son — has been jointly con­ducted by GoI’s Cen­tral TB Divi­sion, World Health Or­gan­i­sa­tion ( WHO), School of Pub­lic Health at Im­pe­rial Col­lege, Lon­don, IMS Health and Bill and Melinda Gates Foun­da­tion.

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