MDR- TB A Slow Killer

In the year 2018, out of 305 people diagnosed positive in Hoovina Hadagali, 57 of them had multi-drug resistant TB.

India has the highest number of tuberculosis cases in the world. It also has the second highest number of multi-drug resistance tuberculosis (MDR- TB) cases in the world which constitutes one- fourth of the total cases in the world. Surveys conducted under the Revised National Tuberculosis Programme (RNTCP) shows that the occurrence of MDR- TB is both in newly diagnosed and relapsed cases across the country. With inadequate laboratories and facilities, this number has been on the rise.

The latest statistics by the government of India say there have been almost 34 thousand new cases of MDR TB in India in the year 2016, in which, 13 hundred and 38 were from Karnataka. Karnataka hence stands at the 10th position for the most number of MDR TB incidences among all the states in India.

Bellary district has the highest number of MDR TB cases in Karnataka, wherein Hoovina Hadagali in the year 2018, out of 305 people diagnosed positive, 57 of them had multi-drug resistant TB.

Hanumantha, a resident in Hoovina Hadagali, said, “It’s been two years since I was diagnosed for MDR- TB. I have undergone medication for TB but not for MDR- TB as I cannot afford it. Now, I do not take any medicines. Due to the disease, I have become very weak and cannot work anymore”.

Though sputum tests for TB diagnosis are free at government hospitals, most new TB cases are multi-drug resistant cases and multi-drug resistant TB requires long and expensive treatment procedure with a laboratory infrastructure to perform Drug susceptibility testing (DST) which is only available at the district government hospital.

According to the Indian Journal of Medical Ethics (IJME), researchers say the cost of treatment for MDR- TB can go up to 2 lakh rupees. This is unaffordable, by the large rural population suffering from the disease, In India.

Drug susceptibility testing (DST) is performed through solid or liquid culture and requires a series of tests that need a lot of time which can sometimes extend up to 12 weeks. Therefore these tests need to be performed in separate, well-equipped laboratories that are not available at the hospitals at the taluk level. This has led to several patients in the taluk to drop out of the treatment.

Radhamma, a resident in Hirehadagali, said, “I went to the general hospital a year ago, they said I have a disease that can only be treated in the Bellary district hospital. I am the only person in the family who earns money, by making bidis. My husband is bedridden. Who will take care of him if I go away?”.

She added that her income is not sufficient for their everyday needs, let alone for the treatment. Hence, she never went forward with the treatment.

Under the revised national tuberculosis control programme (RNTCP) drug susceptibility tests can be performed only in 257 districts in the country.

There are only 74 RNTCP certified laboratories in the whole country for drug susceptibility testing. But with the growing number of MDR cases in India, the number of laboratories needs to increase and be available at the places with the most affected; that is the rural areas.