India needs Made in China lessons to tackle its tuberculosis burden, which is the highest in the world, says Dr T Jacob John, chairman of the New Delhi-based Child Health Foundation.
Speaking to The Hindu from Vellore on Monday, Dr John, who established the pulse polio immunisation three decades ago, said India must declare tuberculosis as a health emergency and tackle the disease on a war footing as failure to do so will make it an uncontrollable disease in the next three to five years. Tackling tuberculosis has to go beyond the realm of treatment and move into its control, Dr John added.
“Twenty five years ago, the number of cases in India and China were on par. But China has brought down the numbers quite remarkably,” he said. China’s tuberculosis burden has gone down by half – the overall prevalence rate per 100,000 population dropping from 215 in 1990, to 108 in 2010. The rate of decline was 2.2% per year between 1990 and 2000, and 4.7% per year between 2000 and 2010, according to World Health Organisation.
India accounts for an estimated 2.2 million of the 8.6 million new TB cases that occur each year globally and harbours more than double the cases as any other country, according to WHO.
Dr John stressed that focus on treating TB alone cannot control the disease. “You need additional intervention, and an efficiently-run primary and secondary healthcare system, which we don’t have in India,” he said, adding that the system is both unorganised and inefficient in notifying the disease.
“In 1993, when WHO came up with DOTS (Directly Observed Treatment, Short-course) programme, all low and middle-income countries affected by tuberculosis adopted it and superimposed the model on their reasonably efficiently functioning healthcare system. We did not have this system, or the foundation, on which DOTS could be built,” said Dr John.
Among the key concerns in tackling TB is misdiagnosis and also that only 50 per cent of all cases are caught by DOTS, he said. “We don’t have a functional notification system,” he said, adding that in India there are only estimates and no real numbers to work on.
“We have a big crisis on hand now, which is further complicated with drug-resistant tuberculosis. We have a narrow window of three to five years for taking war-like steps to control TB, else it will be an uncontrollable disease in India,” he said. While declaring a health emergency will attract better funding, a new TB control programme with an external agency to evaluate success or failure are among the steps that the government should be taking, he said.
The mission-like zeal to tackle polio and the robust network that ensured every case was recorded is what is needed now to check TB numbers in India, Dr John said.
Total TB cases notified in 2014 (Source: WHO) |
China: 8,26,155 |
India: 16,83,915 |
