State’s TB notifications dip drastically

Doctors fear disease progression, drug resistance in patients with delayed diagnosis

June 21, 2020 02:14 am | Updated 02:20 am IST - Mumbai

The COVID-19 outbreak and the resultant lockdown have severely hampered the State’s battle against tuberculosis (TB) as the notification of new cases has dipped drastically since March.

The trend being witnessed across the country indicates that a large number of TB cases are going undetected, and many patients may be on the verge of disease progression.

Data retrieved through Nikshay, India’s TB notification module, shows Maharashtra’s notifications from the public and private sectors fell to 14,824 in March, when the nationwide lockdown was declared. The number slipped to 7,959 in April and 7,276 in May.

In comparison, there were 18,370 new TB notifications in January and 17,763 in February. While the figures change every day as Nikshay is updated, there has been a 60% decline in notifications between January and May.

‘Aggressive approach’

State TB officer Dr. Padmaja Jogewar said the drop can be attributed to several factors, such as outpatient departments (OPDs) not being fully functional, health staff being deployed for COVID-19 duties, drop in TB testing, patients not stepping out due to fear or unable to visit healthcare providers, and delay in compiling data.

“We now have to adopt an aggressive approach in detecting cases,” said Dr. Jogewar, adding that healthcare workers undertaking door-to-door screening for COVID-19 are referring people with TB-like symptoms for TB testing.

Chest physician Dr. Zarir Udwadia said since the start of the lockdown, hospitals and clinics have had to focus on treating COVID-19 patients, relegating patients with other diseases like TB to the sidelines. At Hinduja Hospital in Mahim, where Dr. Udwadia practises, OPD visits across specialities dropped by 85% from 32,000 in April 2019 to 4,800 in April this year.

“The pandemic and the prolonged lockdown have adversely affected every aspect of TB care. Irregular, erratic, unsupervised and interrupted treatment is likely to occur, which is the recipe for treatment failure and possible amplification of drug resistance,” he said.

According to Dr. Udwadia, weekly counts of reported cases dropped by 75% in the country in the three weeks since the lockdown started. An average 45,875 weekly cases were recorded before that. China, too, reported a 20% drop in its TB case detection rate this February as compared to the same period last year.

Dr. Nerges Mistry, director of Foundation for Medical Research, said the follow-up of patients has been hampered with many suffering adverse drug reactions. “The movement of migrants has also led to a slight decline. We will know in the next few months how things pan out as they return,” she said.

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