In contemporary conditions, more than 1,000 Indians will die from tuberculosis (TB). Another 20,000 will become infected with TB, and about 5,000 will actually develop the disease. More than 100 years after the discovery of tuberculosis bacteria, 50 years after the breakthrough of anti-tuberculosis drugs, and 40 years of organized TB control activities, India continues to have the maximum number of TB cases in the world. There are a total of 12 to 14 million TB cases in India; annually, about 2.5 million people develop TB; almost 5 lakh die from the disease. In fact, TB causes more adult deaths in India than many other diseases.Every year, TB forces more than 300,000 children out of school because of their parents’ tuberculosis; about 100,000 affected women are rejected by their families. The direct and indirect costs of TB are estimated to amount to Rs. 12,000 crore per year.The prevalence of TB is highest among adults, and higher among men than women. Once infected with TB bacteria, a person stays infected for many years, probably for life. About 40% of the Indian population is infected with TB bacteria. Of these, about 10% will become active cases when combined with malnutrition and/or illness. An HIV-positive person infected with TB bacteria has a 50-50 chance of developing TB. In comparison, an HIV-negative person infected with TB bacteria has only a one in ten chance of developing TB.This is especially important in India where about 4.58 million persons are infected with HIV. In the future, the additional TB cases attributable to HIV—about 140,000 annually— will stretch meager budgets and an over-burdened healthcare system.If HIV spreads more rapidly, tuberculosis may become uncontrollable for at least a generation.The National Tuberculosis Control Program - formulated in 1962 - was revised in 1993 to include the WHO-recommended DOTS strategy. The DOTS (Directly Observed Treatment, Short course) strategy seeks to achieve more than 85% cure rate and 70% detection of new infectious cases.However, a number of factors impede utilisation of appropriate TB treatment in India. More than half of TB patients delay seeking medical help beyond one month. Apart from worsening their condition, such persons are a continued source of infection.What is more, a large proportion of TB patients — 50-80% - first seek help from private doctors. A study in the Dharavi slum of Mumbai shows that 100 private doctors prescribed 80 different anti-TB regimens; most were inappropriate and expensive. Private doctors seldom refer their patients to government centers because of potential loss of income. The high cost of anti-TB drugs prevents patients from completing the course who turn to government services only as they become poorer and more ill. Inclusion of private practitioners in the TB control program is thus critical in ensuring success of the government’s TB control program. Moreover, the TB program continues to take second place to the AIDS program even though the need of the hour is to present an integrated approach to the two diseases.The writer is a nutrition and health researcher
