TB & “the Great Indian Spit”

Dr. P.S. Ramakrishnan
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Recently, The Hindu , Open Page carried a number of articles on tuberculosis, MDRTB and even XDRTB (Extensive Drug Resistant Tuberculosis) and this is in response to the one written by Dr. Satyajith Pattnaik. (28.04.2013.) He did not mention anything about the preventive aspects of TB.

An important aspect of DOTS (Directly Observed Treatment Short course) in the RNTCP (Revised National TB Control Programme) is to reduce the source of infection by converting a sputum +ve patient to sputum –ve stage, as it is noted that a sputum +ve patient can produce about 20 new cases of TB in a year. So it is very important in preventing the occurrence of new cases (incidences) of TB. There were instances of TB diagnosed in grandparents or parents after detecting it (Primary Complex) in their children or grandchildren.

The contaminated sputum, spat out by active TB patients, is one of the sources of infection to others; and the “GREAT INDIAN SPIT” the avoidable , unnecessary and ugly habit (INCREDIBLE INDIA ! ) should be the main reason for harbouring the largest number of TB patients, almost 1/3 of the total TB patients in the world, in India. China is behind us. From the public health point of view, even swallowing the sputum is safer than spitting out in the open, in the dwelling places of people. Irresponsible open spitting cannot be regarded as a cultural feat. It is equal to open defecation and that is due to the lack of toilet facility. It may be difficult to change a habit that has developed after years of practice.

KAP (Knowledge Attitude and Practice) is the only mechanism to change the wrong habit through health education. Overcrowding, poverty and illiteracy are the basic factors leading to the spread of infectious diseases. Once the common people are knowledgeable about these facts, they would have a change in their attitude towards TB resulting in the formation of healthy habit. Arrest of the Great Indian Spit by any means would lead to a reduction in the incidence of TB and then it becomes easier to control the problem; because prevention is better — easier, effective and less expensive — than cure.

( The writer is a former DHS and State TB Officer, Kerala )