Daily Current Affairs – 31st October, 2016Devendra Vishwakarma
Global TB Report 2016 and India
The Global TB Report 2016, recently released, has revised the estimates for the tuberculosis (TB) burden in India upwards. The country has 27 per cent of the global burden of incident tuberculosis and 34 per cent of global TB deaths. As per the 2015 estimate, the number of TB deaths has doubled to 4,78,000 — making TB one of the leading causes of death in India.
As a result the World Health Organisation (WHO) has decided to have the the first United Nations General Assembly session on the disease on lines similar to HIV-AIDS wherein the member states adopted a political declaration to fast-track progress in combating the HIV-AIDS epidemic.
Lack of political will has been cited as the primary reason by WHO to hold the special assembly session. There is a need to mobilise the government machinery effectively and efficiently. As per WHO, the inclusion of Minister of Health only has not proved to be very effective and hence it highlights the need to include Minister of Justice and Minister of Finance from the nations with high disease burden such as South Africa, India and Russia.
Reasons for the rising crisis
The number of deaths caused by TB and the incidence rate had been consistently dropping from the historical highs globally, but there has been a recent increase uptick that is much larger than previously estimated. In addition to the failure of political machinery, the other major reasons for this are as follows:
- Shortage of drugs
- Increasing Multi-Drug Resistant TB (MDR-TB) and Extensive Drug Resistant TB (XDR-TB)
- Total Drug Resistant TB acting as an assured death warrant
- Inadequate prescription by doctors and inadequate follow up of proper prescription by patients is aggravating the problem of antibiotic resistance
- Disease becoming expensive and difficult to treat
- Poor quality serological tests for diagnosis
- Delay in implementation of critical programmes under the Revised National TB Control Programme (RNTCP) such as expansion of the GeneXpert pilot programme, scaling up of drug sensitivity testing, and the introduction of a child-friendly paediatric TB drug.
- Poor quality treatment by medical practitioners
India’s Initiatives – Past and Present
Revised National TB Control Programme (RNTCP)
RNTCP was originally started in 1997 and then upgraded to be implemented for the period 2012-2017. It has the following components:
- Inclusion of the private sector
- Integration of HIV-AIDS along with TB eradication
- Maintenance of National TB Register to include the details of TB cases
- Use of WHO recommended Direct Observation Treatment Short Course (DOTS) and DOTS-Plus
- Focus on MDR-TB and XDR-TB
Project Nikshay is a web-based solution for monitoring the effectiveness of RNTCP. The app attempts to make the notification process simpler to reach more patients and doctors.
90% reduction in incidence, mortality and catastrophic health expenditure by 2035. This has to be ensured by reliable data and evidences.
Bedaquiline is being introduced at six tertiary care centres across India and will be given to patients with MDR-TB.
Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)
A revolutionary rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. This test is fully automated and provides results within two hours. It is a highly sensitive diagnostic tool and can be used in remote and rural areas without sophisticated infrastructure or specialised training.
Diagnosis: The rising menace of TB can be solved by early recognition of people having TB symptoms and put them on appropriate first line of drugs and there by eliminate it in first instance. The national TB programme has failed in identifying the people who show early symptoms.