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India to miss goal of 75% reduction in TB deaths by 2025: Experts’ report | India News

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NEW DELHI: India is not on course to meet the goal of a 50% reduction in TB incidence and 75% reduction in TB deaths by 2025, a paper by several experts has concluded. Analysing data up to 2018, the paper points out that deaths were down by just 8.3% and incidence by 5.3% since 2015. For the goal to be met, reductions by 2020 would have to be 35% and 20% respectively.
India’s National Tuberculosis Elimination Programme (NTEP) is focused more on the treatment rather than on social determinants of TB such as under-nutrition and living conditions which lead to a large number of new TB cases being added each year, the paper pointed out.
It also said that it has been shown that less than 50% of new TB cases were registered for treatment. The biggest chunk, over 40%, of new cases, were lost due to poor access to diagnostic services. Once diagnosed, several thousands are lost to follow up at every stage, till just about 37% of new cases achieve recurrence-free survival.
The paper published recently in the journal Respiratory Medicine pointed out that poor people were often forced to seek expensive treatment in the private sector, especially in areas with poor access to government facilities. In states with better functioning public health systems like Kerala, 78% of TB patients were treated in the public sector compared to just 36% in Bihar. This matters because the loss to follow up of new patients is 4% in the public sector and 19% in the private sector, noted the paper.
Studies show that in 40% of patients treatment remained incomplete for a number of reasons including distance, inability to afford repeated visits, the waiting time, behaviour of staff, non-availability of drugs and adverse effects. About 15% recorded as lost to follow up were found to have actually died. The authors stated that in developing countries non-compliance with anti-tuberculosis therapy is more often due to the health system’s shortcomings than to the patient’s failure to comply.
Pointing out that poor living conditions, livelihood and under-nutrition translated into biologic risk factors such that the TB infection progresses to disease and often adverse outcomes, the authors urged action on these social determinants to improve outcomes.
“Food is an oral polyvalent vaccine which is available over the counter and can be safely dispensed to men, women and children. The recent Global TB report does mention that under-nutrition accounts for 2.2 million cases in the world annually, more than those contributed by HIV and diabetes combined,” said one of the authors, Dr Anurag Bhargava. In TB, under-nutrition increases the risk of more severe disease, death, malabsorption of anti-TB drugs and relapse after cure, he added.

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