India a major contributor to under-diagnosis of tuberculosis: WHO
Ten countries accounted for 80% of the gap, with India, Indonesia and Nigeria topping the list, according to the study by the World Health Organization
New Delhi: India is one of the major contributors to under-reporting and under-diagnosis of tuberculosis (TB) cases in the world, according to the Global Tuberculosis Report 2018 released by World Health Organization (WHO) on Tuesday.
“Under-reporting and under-diagnosis of TB cases were major challenges. Of the 10 million people who suffered from TB in 2017, only 6.4 million were officially recorded by national reporting systems, leaving 3.6 million people undiagnosed, or detected, but not reported. Ten countries accounted for 80% of this gap, with India, Indonesia and Nigeria topping the list,” the report said.
India accounted for 32% of global TB deaths among HIV-negative people, and for 27% of the combined total TB deaths in HIV-negative and HIV-positive people in 2017, according to the report.
TB affected all countries and all age groups, but overall estimates for 2017 showed that 90% of cases were adults (aged ≥15 years), 64% were male, 9% were people living with HIV, of which 72% were in Africa.
Among these, two-thirds of TB cases were reported in eight countries — India (27%), China (9%), Indonesia (8%), The Philippines (6%), Pakistan (5%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).
The report highlighted that worldwide in 2017, 6.4 million new cases of TB were officially notified to national authorities and then reported to WHO. The number has been increasing since 2013, following four years (2009–2012), in which 5.7–5.8 million new cases were reported annually, mainly due to increased reporting of detected cases by the private sector in India, which increased by over 44% between 2013 and 2017, according to the report.
“We have never seen such high-level political attention and understanding of what the world needs to do to end TB and drug-resistant TB. We must capitalise on this new momentum and act together to end this terrible disease,” according toTedros Adhanom Ghebreyesus, director-general, WHO.
The report also highlighted that drug-resistant TB remained a global public health crisis. In 2017, 558,000 people were estimated to had developed disease resistant to at least rifampicin – the most effective first-line TB drug. The vast majority of these people had multidrug-resistant TB (MDR-TB) — combined resistance to rifampicin and isoniazid (another key first-line TB medicine).
“Only one in four people with MDR-TB were reported to have received treatment with a second-line regimen. China and India alone were home to 40% of patients requiring treatment for MDR-TB, but not reported to be receiving it. Globally, MDR-TB treatment success remains low at 55%, often due to drug toxicity making it impossible for patients to stay on treatment,” the report said.
Among the five major risk factors for TB, including alcohol, smoking, diabetes, HIV and undernourishment, a majority of TB patients in India, over 6 lakh, were attributable to undernourishment. For the last year, the Revised National TB Control Programme (RNTCP) and National AIDS Control Organization (NACO) captured data to evaluate TB case-finding activities among people attending ART centres. According to data reported by the RNTCP for 2017, an estimated 58% of people with HIV-associated TB were not reported to have reached TB care. Reasons for missing people with TB include poor access to services, weaknesses in service delivery, gaps in recording and reporting, and limited engagement of the private sector.
Meanwhile, the health ministry, on Wednesday launched a pilot for utilising the services of the Department of Posts for transport of sputum specimen for TB diagnosis in Karawal Nagar Delhi.
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