At 4.08, Karnataka’s estimated tuberculosis prevalence to notification (P:N) ratio is far higher than the national average of 2.84. This means for every notified case of the highly infectious disease, the actual prevalent number of cases in Karnataka is 4.08. March 24 is observed as World TB Day.
According to the National TB Prevalence Survey of India 2019-2021, the first of its kind in the country in 55 years, Chhattisgarh (5.30) had the highest P:N ratio, followed by Bihar (4.15), Karnataka (4.08), Northeast States (3.74), Tamil Nadu (3.67), and Kerala (3.33).
The P:N ratio is an important aspect, which explains for each case notified, how many TB cases go undetected. This is a critical parameter to evaluate how effective States are at detecting and notifying TB cases. The higher the ratio, the more the number of cases that are being missed out.
Another startling finding was that nearly 52% of the patients did not seek healthcare in Karnataka. They either ignored their symptoms or did not recognise them (symptoms) or indulged in self-treatment. Overall, nearly 64% of patients did not seek healthcare in the country. While the highest was from Haryana (88%), the lowest was from Kerala (46%).
Private notifications
While over half of all tuberculosis (TB) patients seek care in the private sector, case notifications from the private sector are way behind the targets set by the government. In 2022, there were 24.24 lakh new TB case notifications in India, of which only 7.35 lakh were from the private sector. Karnataka reported 80,412 case notifications in 2022 of which only 20,921 were from the private sector.
Although this is a marginal rise from the 19,744 reported in 2021, private notifications have never crossed 37% of the target set by the government. Karnataka reported a total of 72,636 case notifications that year.
Notifiable disease
TB has been a notifiable disease in the country since May 2012. Despite awareness regarding mandatory TB notification, a significant number of private practitioners do not report the cases and this has led to cases being missed out of government data. Missing cases which are lost to follow up are one of the prime reasons for quick spread of the infection.
After incentivising private notifications, the Union Health Ministry, for the first time criminalised non-reporting of TB in early 2018 and as per the government notification, doctors, hospital authorities, chemists, and druggists could face a jail term for not notifying TB cases.
TB screening
State Deputy Director (TB) Anil S. said private notifications are gradually increasing over the years. “Althoug many patients do not want to reveal the infection mainly because of stigma, the State’s efforts to detect TB are being intensified. From 963 TB examinations per lakh population last year, we touched 1,640 examinations per lakh population this year,” he said.
Dr. Anil said the State has set a target of reaching 2,000 examinations per lakh population in every district next year.
David B., who is involved in advocacy on access to medicines for people co-living with HIV and TB, said although a lot of good work is being done in some pockets of Karnataka and among select high-risk populations, the compliance to drug adherence is a cause for concern. “One of the main reasons is the gap between prevalence estimates, footfall, and private notifications. It is imperative to prevent the spread of the infection by robust private notifications. Unless notifications improve, focus on latent TB might not yield desired results,” he added.
