Analyse the reasons behind the high prevalence of tuberculosis in India. Suggest certain measures that can be taken for tuberculosis prevention and control.
(GS-2, Health, 250 words)
Approach:
- Introduce your answer by elaborating on tuberculosis and its current status in the country.
- In the body, mention various factors responsible for the high prevalence of TB. Also, suggest measures for TB prevention and control.
- Conclude your answer accordingly.
Model Answer:
Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis which most commonly affects the lungs. India accounts for around 27% of TB cases worldwide. This is the world’s highest country-wise TB burden. According to WHO’s Global TB Report 2022, India’s TB incidence for the year 2021 was 210 per 100,000 population. Given this, tuberculosis remains one of India’s most pressing and challenging problems.
The reasons behind the high prevalence of tuberculosis in India includes:
- Undernutrition: It is the most widely prevalent risk factor, accounting for the “highest population attributable risk for TB in India”. Almost 40% of new TB cases annually in India are due to undernutrition. It is also responsible for increased TB disease severity, higher mortality, and poor treatment outcomes. The rationale is that undernutrition weakens the body’s defence against infections and increases the risk of drug toxicity and TB relapse.
- Poverty: Poverty is a powerful determinant of tuberculosis. Poverty is also associated with poor general health knowledge and a lack of empowerment to act on health knowledge, which leads to the risk of exposure to several other tuberculosis risk factors.
- Non-access to diagnosis and treatment: The burden of tuberculosis is exacerbated in rural areas due to limited access to healthcare facilities and the poor quality of treatment available.
- Low immunity: Low immunity is regarded as one of the common reasons why TB infection breaks into TB disease. People suffering from HIV, stress, diabetes, and damaged lung conditions; alcoholics and smokers whose general health condition is poor also have a high possibility of getting the disease.
- Socio-economic deprivation: Socioeconomic deprivation can be described as lacking social and economic necessities. This is a complex concept that includes a combination of factors, such as lack of education, low income, overcrowding, and unemployment, among others. The structural determinants and the conditions in which people live are responsible for an important part of health inequities and the increased risk of tuberculosis.
- Increasing drug resistance: The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs. Multidrug resistance continues to emerge and spread due to the mismanagement of TB treatment.
Measure that can be taken for tuberculosis prevention and control:
- Early diagnosis: Early diagnosis and treatment is the most effective way to prevent the spread of tuberculosis. WHO has released a Standard on Universal Access to Rapid TB Diagnostics, recommending the use of molecular diagnostics as the initial test. These are highly accurate, detect resistance to drugs, are cost-effective, and reduce treatment-related delays.
- Managing environment: As TB is an airborne infection, TB bacteria are released into the air when someone with infectious TB coughs or sneezes. Hence, good ventilation, natural light and good hygiene can prevent the spread of bacteria.
- Nutrition support: According to recent reports in The Lancet and The Lancet Global Health, nutritional support has helped prevent both tuberculosis among household contacts and mortality among TB patients in a trial in Jharkhand. Therefore, for eliminating TB in India, addressing the problem of undernutrition is key.
- Increasing awareness: There is an urgent need to advocate educational activities and awareness among the patients and the more vulnerable population about the causes, transmission, and preventive measures to deal with tuberculosis.
- Treating drug resistance tuberculosis (DR-TB): Decentralized DR-TB treatment services should be made available. Further increasing the availability of drugs like Bedaquiline and Delamanid for the management of DRTB should be ensured.
- Other measures:
- Pursue overarching poverty reduction strategies and expand social protection.
- Improve living and working conditions for those in prisons and other congregate settings.
- Promote healthy diets and lifestyles, including reduction of smoking and harmful use of alcohol and drugs.
India has set a target to eliminate tuberculosis by 2025. To achieve this government has taken various measures such as National TB Elimination Programme (NTEP), Nikshay Poshan Yojna, Ni-kshay Mitras, etc. Further, adopting the Health in All Policies (HiAP) approach which takes into account the health implications of decisions seeks synergies, and avoids harmful health impacts will immensely benefit tuberculosis care, prevention and control.
