Yelburga registered 392 TB cases and 23 deaths in 2019. The number of TB notification from Koppal District is 217 cases per one lakh population. Late detection is one of the major causes of a vulnerable tb patient’s death.
Tuberculosis affects thousands’ life in several parts of North Karnataka. Mortality rate of Yelburga is more than 6% due to persistence of tuberculosis (TB). In Yelburga General Hospital, doctors prescribe chest radiography and microbiological examination of sputum to nearly ten patients every day.
First-line TB also know as drug-sensitive tuberculosis (DSTB) turns into drug-resistant tuberculosis (DRTB) when a TB patient does not complete his/her medication course of 6 months. A 48-year-old-lady from Tummaraguddi village, Renamma Rathore had been suffering from multi drug-resistant tuberculosis (MDR-TB) for the past six months until March. She was diagnosed with DSTB in 2017 when a chronic cough lasted more than ten weeks. She was then taken to a private hospital for a check-up, and she started taking medicines. In 2019, she was diagnosed with MDR-TB when she stopped the regimen, noticing an improvement in her health.
Renamma Rathore says, “Those tablets increase my appetite. we cannot afford to have 4-5 meals every day. I can only manage to eat twice a day as I don’t get time. I have to go farming early in the morning. When I come back, I also have to look after my husband. My husband cannot move because he met with an accident 30 years ago.”
Renamma’s husband Kamappa Rathore was a daily wager in Bengaluru. The 60-year-old man lost his legs and got back injuries when he had an accident while working at a construction site. He can neither walk nor move without somebody’s support.
TB Medicines like Bedaquiline affects a patient’s electrocardiogram. Renamma had a prolonged QT interval on ECG. Therefore, she was out of medication for a few days. Praveen Kumar, the TB supervisor of Yelburga, explains, “We stopped Renamma’s TB regimen for two weeks. We’ve been asking her to visit Ballary TB Hospital for the ECG test, but she hasn’t gone to the hospital.”
He adds, “Her condition is sensitive. She can pass away at any time if her prolonged QT interval on ECG does not come below 470 milliseconds.”
As Renamma’s QT interval remained the same and she lost to follow up, she succumbed to the disease a few weeks ago.
Similarly, an 18-year-old college-goer Nagraj Lamani from Mudhol village has also been suffering from MDR-TB since September 2019. Though an Asha worker visited Nagraj’s house once a day for Directly Observed Therapy, Nagraj refused to continue taking medicines after three months of his diagnosis with DSTB.
Nagraj says, “When my coughing almost disappeared, I stopped the medication because I then did not know the drug regimen of tb. Now I eat 4-5 times a day and also take all the drugs on time.”
He adds, “I also go to the anganwadi to have a nutritious meal in the afternoon. Now I am following everything that the doctor has instructed me.”
In 2018, the state recorded the highest tuberculosis death rate in public sector hospitals at 6.2 per cent. Notified number of tb cases from Karnataka is more than eighty thousand.
In 2019, Koppal detected over 1,000 tuberculosis cases along with 182 deaths. The district also recorded 24 deaths of TB patients who had HIV as well. Yelburga ranks 4th in the district for TB death rate. The taluk recorded 6.5 per cent of the mortality rate due to tuberculosis last year.
World TB report 2019 shows that India accounts for around 27 per cent of a total 130,000 drug-resistant tuberculosis cases which means it kills an estimated 1,200 people every day.
In rural areas, other causes of the mortality rate due to TB are late detection, People Living with HIV (PLHIV), diabetes, consumption of alcohol and tobacco, improper treatment, inadequate nutrition etc.
An N95 mask can prevent tuberculosis bacteria from spreading one person to another. A TB patient can transmit over one thousand bacteria if he/she does not wear a face mask. Some other factors to reduce the mortality rate are maintaining hygiene and sanitation, living in a well-ventilated house etc. In rural areas, the locality where the tuberculosis patients stay is uninhabitable. Moreover, it’s dirty and stinky.
Even though the government conducts awareness campaigns, provides facilities such as Rs 500 to each TB patient every month, treatment and medicines at free of cost, afternoon meal at anganwadi and social supporting schemes; they do not cooperate. They try to hide symptoms of the disease from the health workers.
Asha worker, Shilpa Hiremath says, “When we ask people whether they have TB symptoms, they deny it. They fear if they tell us, we will keep them out of the village and they’ll be treated differently by other villagers.”
She adds, “Last year one MDR-TB patient from Balutagi village died because he didn’t stop drinking and smoking even after the doctor’s restriction.”
Reducing stigma from the community is one of the biggest concern of the TB authorities. District Tuberculosis officer of Koppal, Dr Mahesh M G says, “Many TB patients refuse to the treatment because of stigma. They don’t want to be identified with tuberculosis.”
He suggests, “To reduce the stigma, community awareness campaigns like “TB champions” has to organize frequently. TB can lead a patient to a gradual decline if he/she is negligible of the disease, and it can even end his/her life.”
Consequently, a 70-year-old MDR-TB patient Imamsab Kudari from Talikeri village suffered for three years until his death in 2019.
Rajamma Kudari, Imamsab’s daughter-in-law, says, “Doctor suggested him to have less oily food but he had all the restricted food like murmuri, mirchi bajji etc. without our knowledge. He did not even take his medicines on time. When Asha akkas forced him for Directly Observed Treatment, he not only frightened them but also asked them to not come home.”
She also explains, “Before two months of his death, he did not move from the bed. We looked after him. When we tried to feed him, it rolled down from his mouth, or he just puked.”
Yelburga General Hospital that covers more than 90 villages has been facing some challenges due to poor infrastructure, and they do not have enough number of doctors. Despite being a 100-bed hospital, they have an availability of nearly 50 beds. The hospital does not have a separate toilet for women, either.
Dr Mahesh M G says, “Although there should be 14 doctors in Yelburga Hospital, we are now left with only two doctors. The government is ready to appoint doctors, but they are not eager to move to the remote areas.”
Awareness is the only key to prevent tuberculosis in backward places. The medical health officer has to take the accountability to educate people from remote areas and complete their treatment.
A Senior TB Specialist of National Tuberculosis Institute, Bangalore Dr S. K. Tripathi suggests, “If the government cannot reach out slums, there are some private NGOs such as Joint Effort for Elimination of Tuberculosis (JEET), PATH etc. If a patient visits a private hospital, an NGO has to ensure that the patient is taking the medicines on time.”
He adds “If the patient lost to follow up, the programme officer of that particular area has to get the patient back to the treatment and ensure that they complete the regimen.”
In remote areas, wall posters, radio and street plays on tuberculosis may help to create awareness among people. World Health Organization aims at a 95% reduction in TB death cases by 2035 under Sustainable Development Goals 3.