Increasing cases of Tuberculosis in Mundargi taluk

Mundargi Taluk Hospital has been seen many cases of Tuberculosis. With every passing year, the number seems to increase. Tabasum, the registrar of Mundargi Taluk Hospital, continues to jot down the number of cases every month, some positive and some negative. One register has just the numbers, with the patient’s identities hidden away, whereas another has the names of those who have fallen victim to one of the world’s deadliest diseases. Every month, on an average, at least fifty patients come to the hospital, as suspected patients of the disease. Some are test as positive carriers of the disease, whereas some breathe a sigh of relief after being tested negative. Once in a while they also encounter cases of Multidrug resistant Tuberculosis (MDR-TB).

One third of the world’s population is estimated to be infected by Mycobacterium Tuberculosis, but only 10% of the infected people succumb to the disease. The rest of the infected population is clinically latent to the disease, says a report by the European Journal of Immunology, published by Wiley Online Library.[1] A study conducted by the University of Arizona on Tuberculosis Research in India and China states that India alone accounts for 23% of the Tuberculosis patients across the globe, and holds the 15^th position in terms of incidence per 100,000 populations.[2]

Tuberculosis or TB is an air-borne disease caused by the bacteria Mycobacterium Tuberculosis.[3] The disease is prominent in HIV (+) patients. Once infected, a patient has on average a 10% life-time risk of developing TB disease. The classic symptoms of active TB are chronic cough with blood- containing sputum, fever, night sweats and weight loss[4]. When an infected person coughs or sneezes, minute particles of sputum flies into the air, infecting more people in the area. The bacteria normally affect the lungs of the patient, but with time it spreads through the blood into kidney and other organs.

According to a report authored by Charles Patrick Davis and published by medicinenet.com, there are mainly two types of Tuberculosis (This research has also been published in rxlist.com). It says, “There are many types of tuberculosis, but the two main types are termed active tuberculosis infection and latent tuberculosis infection. Active TB is when the disease is actively showing symptoms and can be transmitted to other people; latent disease is when the person is infected with Mycobacterium tuberculosis bacteria, but the bacteria are not showing symptoms (usually due to the body’s immune system suppressing the bacterial growth and spread). In case of latent, the person infected has no TB bacteria in their sputum. People with latent TB usually cannot transfer Mycobacterium tuberculosis bacteria to others unless the immune system fails…”[5]

According to a report under the Revised National Tuberculosis Control Programme, various factors cause the increase in TB cases in India. Blood transmissions throughout the years have been uncontrolled, which has led to spread of latent TB in the country. Latent cases may become reactive after some time. Poverty is another reason for the increase of TB cases in India. Immunity of people weakens due to the undernourished diet they can afford, thus reactivating TB. The transmission of TB also happens through family and community.

The National TB Programme (NTP) was launched by the Government of India in 1961. In 1993, NTP was revised and named Revised National TB Control Programme (RNTCP). RNTCP adopted the WHO recommended Directly Observed Treatment Short course (DOTS). This strategy was adopted to increase course completion rates. Under the scheme of DOTS comes the detection of the disease by sputum smear microscopy, drug supply by the government, treatment for at least six months under the observation of a healthcare worker, and reporting and recording of each case. The government of India also introduced DOTS-PLUS under which daily doses of medicine are provided to the patients by the ASHA workers.

[1] Published by: Wiley Online Library; Title: Control of latent Mycobacterium tuberculosis infection is dependent on CD8 T cells

[2] Published by: The University of Arizona; Title: Tuberculosis Research in India and China: From Bibliometrics to Research Policy

[3] (Tuberculosis)

Tuberculosis. Wikipedia.

[4] (Tuberculosis)

Tuberculosis. Wikipedia.

[5] Published by: MedicineNet.com; Title: Tuberculosis (TB)

ASHA or Accredited Social Health Activists are part of National Rural Health Mission initiated by the Government of India. The workers are selected from within the village on the criteria that they are in the 25 to 45 age group. They are the bridge between the patients and the medicine distributed by the Government.

According to a report by The Hindu[1], a total of 2,000 new TB cases have been detected in 20 districts of Karnataka. The scheme of DOTS-PLUS has been implemented in the districts and the taluks of Karnataka. In the taluk of Mundargi, the cases of TB have been increasing with each year.

Manjula Sajjan, Mundargi Block Health Education Officer, says that the patients are mostly from Below Poverty Level (BPL). They do not have the funds to maintain a healthy diet, which leads to the weakening of their immune system, making them prone to the disease. Another reason why Tuberculosis is on rise in Mundargi is that the patients leave in the middle of treatment. When the patients feel that they are getting better, they discontinue the treatment. Due to lack of awareness, they do not realise that the bacteria is not totally out of their body. This results in follow up cases adding up to the ongoing cases.

[1] Published by: The Hindu; Title: Nearly 2,000 new TB cases detected

Mailavua Harmappa Tippapur is a 68 year old widow, who was diagnosed with Tuberculosis in December 2017. She had chronic cough which led her to see a doctor in the village hospital of Kalkeri. For tests she was referred to the taluk hospital of Mundargi. She says she has been taking medicines daily under the scheme of DOTS-PLUS. She has to come to the center where ASHA workers give her the daily dose. She takes three tablets per day. She says that she has been feeling much better after taking the tablets since the past month. Mailavua says she won’t discontinue the treatment, as the ASHA workers keep telling her the disadvantages of discontinuing the course. If discontinued she will fall sick again.

Tuberculosis results in severe weight loss. So the people affected are not able to do manual labour. In Mundargi, most of the TB cases are of people who earn livelihood for their family. Due to the disease they are not able to continue their work, resulting in poverty.

The DOTS PLUS scheme of government might help reduce the cases of Tuberculosis. Sutesh Natigallapa Geggi, 43, is a resident of Hiwaddati who was cured of the disease with the help of DOTS-PLUS in 2017. He says that the daily dose of the medicine is very effective, as it helps the patient regain his strength. The ASHA workers are very supportive, and tell him the advantages of not leaving the course mid way. They also tell him how he can prevent the spread of the disease by covering his mouth when coughing or sneezing. Awareness of the schemes introduced by the government can be a huge step towards reducing the number of cases that surface each year. Most of the patients are infected by other infected people. If the people in the taluk are told how to protect themselves from getting infected, then the number of cases will reduce massively.

Vijaykumar Seethappa, member of Karnataka Janaarogya Chaluvali, says, “The main reason for the increase of TB cases in India is the lack of proper nutrition. Tuberculosis is a disease which can be prevented if the person’s immune system is strong, and a strong immune system is the result of proper provision of nutrition to human body. There are good programmes in India like DOTS-PLUS, but the nutrition needed to withstand the high dosage of medicines is not present. One of the bright aspects of DOTS is that it provides medicine to the patients at home. But if people are leaving the course half the way because they have to do their jobs and cannot sit at home, that means the system is not working properly.”

Daily newspaper Mid-day, in an article[1], mentioned that Finance Minister Arun Jaitley had allocated Rs. 600 crore for nutritional support to TB patients in the Union Budget 2018-19. The article says, “Under the scheme, Rs 500 per month will be provided to a TB patient undergoing treatment in the country. All TB patients registered within a centralised data, after inspection of their required documents, will get the amount in their bank accounts.” The amount does not suffice for a proper nutritious meal in India.

When asked about solutions, Vijaykumar adds, “Tuberculosis is a social disease. The basic solution to the increase in cases of Tuberculosis is the provision of nutritious food. The lower class of India suffers from malnutrition and in many cases this leads to Tuberculosis. The government needs to increase the budgetary funding for Health and Nutrition sector. Only then will India be able to fight diseases like Tuberculosis. The budget for Health and Nutrition sector should be increased to at least 5-6%. Good programmes like DOTS and DOTS-PLUS will not work if we say that we will give the patients good medication and not give them proper nutrition. When there is no sustenance in the body, it will not adapt to the medicine. The sector were India should concentrate is provision of food and medicine.”

Reduction in poverty can play a major role in eradicating the disease. If poverty is reduced, more patients will be able to get nutritious food, which will avoid chances of Tuberculosis. Awareness about the disease is very essential in small towns. The stigmas related to the disease prevent people from seeking medical help. They hesitate to visit the TB centers to get their medication, leading to the increase in the number of cases.

[1] (Union Budget 2018: Rs 500 Per Month Towards Nutrition For TB Patients)

Union Budget 2018: Rs 500 Per Month Towards Nutrition For TB Patients. mid-day.com.