BW Exclusive | Tuberculosis Related To Socio-economic Status Of Patients: Dr Bornali Datta, Medanta Hospitals

As per the India Tuberculosis (TB) Report 2022 released by the central government recently, 2021 witnessed a 19 per cent increase in TB patients’ notification and the total number of incident TB patients (new and relapse) notified during 2021 were 19,33,381 as opposed to that of 16,28,161 in 2020. 

The report states the fight against TB encountered setbacks in the pandemic years. However, the report adds that the pandemic also forged pathways to ingenious solutions, health-system strengthening, and the ever-expanding reach of the public health programme delivery. 

According to World Health Organisation (WHO) Global TB Report 2022, African and South-East Asia regions accounted for 82 per cent of the combined total of TB deaths in HIV-negative and HIV-positive people in 2021 and India accounted for 32 per cent of such deaths. As per the same report, India also accounts for 28 per cent of all estimated incident TB cases worldwide.

Experts say that even after decades of the fight against TB, free medicines and screening programs under the NTEP (National Tuberculosis Elimination Program) the disease still exists at large in the country. 

Dr Bornali Datta, Director, Respiratory Medicine, at Medanta Hospital says that “We have been fighting Tuberculosis for centuries. It's the oldest illness known to man and it's not just a medical illness. It's an illness related to the socio-economic status of a person.”

She further says that developed countries are not dealing with TB anymore because their overall economy is higher, and the quality of life and the GDP is much better. “Whereas for us, the developing world, it is closely related to the patient's socio-economic status,” Dr Datta adds.

Dr Datta enumerates that fighting TB with just excellent diagnostic methods or treatments is not enough and we cannot completely eliminate TB this way. Why? Because the nature of the illness is infectious, she says and the treatment is quite long.  “It's human nature and behaviour that is the impediment as patients take the medicines for two months and think that they are better and leave their medicine course although they should take it for six months. And many of these people are also inherently poor which also acts as a constraint.”

She explains that TB is mostly found in cities because there is overcrowding in the cities and TB is an infectious disease, implying that people will get it much more in clustered places. “People also don't have money for good nutrition that will help them fight TB. So due to a host of reasons such as socioeconomic conditions, cultural behaviours and stigma, we have not been able to win the battle against tuberculosis,” Dr Datta opines.

Edited Excerpts:

Where do you think the responsibility of corporate hospitals lies when it comes to eliminating TB from India?

TB is such a scourge that unless all stakeholders such as the private, corporate hospitals, NGOs, and the community don't get together we will not be able to defeat it. The national target of TB elimination by 2025 has provided a huge impetus for everyone to join in because the government alone cannot do it. The corporate hospitals are placed very well and they can do a lot apart from just seeing clinical patients and giving them proper clinical services for TB care. 

For example, Madanta's model for screening and diagnosing TB patients for the last eight years has been quite unique. As we have actually gone right into the remote peripheral districts through a mobile medical van equipped with digital X-ray and molecular diagnostic devices like CBNAAT (GeneExpert). And we have also formed a team with the government, it's working seamlessly at the moment. We have had three vans that have covered all 22 districts of Haryana in a cyclical manner. Corporate hospitals can follow this model or models of other hospitals to join the fight. 

Do you think the government’s goal of achieving TB elimination by 2025 is anywhere possible?

2025 is not about necessarily achieving elimination, it's about a huge impetus towards doing everything we can to bring it right down, the elimination is less than 10 cases per 100,000. Now we are at 316 cases per 100,000 and WHO has said that we have gone back by 10 years in the fight against TB due to COVID. So it's not going to happen anytime soon but having said that intensive activity and collaborative effort can make this stack come right down. 

And what’s impressive is that the 2025 goal has led to every stakeholder being engaged with activities. The private sector and the public sector earlier didn't show this kind of active engagement to fight TB but now we have so many corporate and government partners who give us vans, and community health workers support and I think if we keep pushing this, the trajectory will eventually change.

Can we actually put a timeline on eliminating TB from India?

In 2019, India had the highest notification of TB cases in India and then unfortunately, Covid hit us and pushed us further back in the fight but now we are recovering. We are probably still looking at at least a decade of sustained intensive work to be on the right track to eliminate it if not completely eliminate it. If you see, HIV now is completely under control. TB is very different, no doubt. But it's doable, with sustained and intensive activities from all across sectors and communities. 

What is your message for TB patients or how do you counsel them in your daily practice?

As pulmonologists, 40 to 50 per cent of our clinical practice is still tuberculosis. The first thing I want to tell patients is, don't worry, they will be fully cured. It is an infectious disease and there is excellent treatment available but one has to take their medications every day. That means no missing doses and one has to complete the six months of treatment or whatever it may be. We are always available to the patients for any symptoms, side effects, or any queries they have related to their mental health. 

Mental health issues are also associated with it because of the stigma as many young people in the prime of life feel that six or twelve months of their lives are wiped out, and some of them have drug-resistant TB that might even last longer. So they get quite anxious and desperate. And hence they should seek medical advice. It's important to keep mental health intact either with family support or with medication with healthcare support.