This refers to the article “What went wrong with India’s TB control” (Aug.16). The writer has described TB, secondary diseases and our control programme in a superficial manner and in a way that is disconnected from ground realities. It is common knowledge that in most DOTS centres, free TB drugs for several weeks are given away and it is left to most patients to take the drugs. This is certainly not Directly Observed Treatment (DOTS). Our DOTS centres are least concerned with managing drug toxicity-related issues in weak patients. Unfortunately, most TB patients are from this category. The situation is further compounded by having an even “more complex” treatment regimen such as short-course, which reduces the burden on the DOTS centre while choosing to ignore the sufferings of weak TB patients due to toxicity of drugs. For TB patients, these factors make their treatment difficult and sometimes impossible, a main reason why the number of MDR/XDR TB cases remains high. The much celebrated decline in TB incidences should not be seen as the success of the DOTS programme.
Prof. John is simplistic in suggesting a critical method to detect and treat children having the infection. The simplest and most effective strategy for control is to feed all the children well, sufficiently well so that latent TB bacilli remain latent throughout their entire life. This is not an emotional statement; there is evidence to support this fact. This is sure to protect children from many other infections. .
The article was wonderful and aptly points out to the public health emergency that India faces. Investment in the health sector is a must. Here, India can take lessons from China whose control programme is seeing results.
The main factor is the mandatory web-based reporting system that has been in operation since 2005. It covers virtually every health facility in the country — the link is: http://goo.gl/SnvPBW
In addition, there is mandatory reporting of TB deaths. India suffers from underreporting and an inaccurate database, which are the major impediments.