Ahead of the World Tuberculosis (TB) Day on March 24, Karnataka’s TB detection has taken a beating due to short supply of cartridge-based nucleic acid amplification technique (CBNATT) test kits.
The State usually requires 20,000 CBNAAT cartridges every month, but has a stock of a mere 5,845 as on Friday. The diagnostic kits supplied every quarter to States by the Central TB Division have not been dispatched to Karnataka after December 10, 2020.
The State has 65 CBNAAT and 98 Truenat machines spread across districts. Truenat is another chip-based, point-of-care, rapid molecular test for TB diagnosis. Although the State has a stock of 1,27,000 Truenat chips, this facility is either not available in some districts or is limited to a few centres. Diagnosis in Bengaluru Urban has been severely hit owing to the lack of Truenat machines.
While health officials said testing and detection of new TB cases was going on, they admitted that the State had not received CBNAAT cartridges after December 10.
Attributing this to logistical issues, State Joint Director (TB) Ramesh Chandra Reddy told The Hindu on Friday that supply for all States is through the Central TB Division. “We have reminded the CTD that we need more stocks and they have assured us that they will dispatch shortly. We require around 20,000 cartridges monthly and nearly 2.5 lakh annually. The delay is due to logistical issues faced at the central level,” he said.
TB is a preventable and curable airborne disease, which affects the lungs and includes symptoms of cough for more than two weeks, night sweats, fever, loss of appetite and weight. Extra pulmonary TB, includes swelling of lymph nodes, and affects the abdomen, kidney and other organs.
TB and COVID-19
The country is now four years away from the 2025 TB elimination target. The COVID-19 pandemic has hit screening and detection of new cases, mainly because TB and COVID-19 have similar clinical symptoms.
In 2020, Karnataka failed to reach its TB notifications target set at beginning of the year. Of the target of 1.35 lakh, only 65,929 TB notifications were received in 2020, which is only 49% of the target set at the beginning of the year. There was a 28% drop in notifications, in comparison with 2019 when 91,997 cases were notified in the State, according to the Centre’s Nikshay portal.
Sylvia Karpagam, a public health doctor and activist, pointed out that the pandemic and unplanned lockdown has, in fact, been a major setback to many of the national health programs.
“Due to lack of public transport during the lockdown and also with many healthcare facilities converted into dedicated COVID-19 centres, we can expect multi-drug resistant TB cases to rise, which will be a setback for the national TB program. Also with the shutdown of several social security schemes, such as midday meals, ICDS pensions MNREGA and loss of livelihood, one can expect poor nutrition to increase both the risk of contracting TB as well as adverse outcomes,” she added.
Government versus private hospitals
According to the India TB Report 2019, Karnataka’s public sector hospitals have double the success rate in TB treatment compared to their private sector counterparts, at 80% and 40%, respectively.
The State recorded the highest TB death rate in public sector hospitals at 6.2%, which is higher than the national TB death rate of 4%.
In Karnataka on an average, 92% of all identified/diagnosed TB patients have been started on treatment. While 94% notified from the public sector have been started on treatment, 83.13% from the private sector have been treated, according to the report.
