States told to arm primary health centres in fight against TB

In an effort to meet its ambitious target to eradicate tuberculosis (TB) by 2025 — five years ahead of the target fixed by the World Health Organisation (WHO) — the Union Ministry of Health and Family Welfare has directed all States to expand TB diagnostics services to all primary health centres (PHCs).

Vikas Sheel, Joint Secretary (Revised National Tuberculosis Control Programme), Union Ministry of Health and Family Welfare, wrote to all State Mission Directors on September 19 to expand the sputum smear microscopy services at the PHC level by December. The national TB programme also envisages expansion of the service at that level.

As of now, TB diagnosis under RNTCP is done primarily using sputum smear microscopy in more than 14,000 Designated Microscopy Centres (DMCs) spread across the country. While at least 25,650 PHCs have been established in the country (as on March 31, 2017), most don’t offer this service. The samples from such PHCs are sent to the nearest facility that has a DMC. Because of this, there might be a significant loss of presumptive TB cases, the letter states.

According to the communiqué, establishing microscopy centres will prevent sample loss owing to lack of referral links for sputum examination, thus leading to improved case detection. All States have been directed to map the non-DMC PHCs and designate all PHCs, including those in urban areas, as microscopy centres.

In PHCs where a laboratory technician is already available, microscopes should be provided and, if required, the technician trained. In PHCs that do not have laboratory technicians, recruitment should be expedited, and microscopes and training provided subsequently, the letter states.

TB burden in India

India has an estimated 27 lakh TB patients, of which only 13 lakh have been captured in government data, according to a top official in the Central TB division. “In 2015, the incidence was 217 per lakh population. It has come down to 211 per lakh in 2017, going by the data collected. To bring that down to 44 per lakh by 2025 is a challenge, but we are working towards it,” the official said.

According to the Global TB Report of 2017, the estimated incidence of TB in India is 28 lakh — about a quarter of the world’s TB cases. In 2017, India re-estimated its national figures, incorporating information from a wide range of sources and making it more accurate than previous estimates.

‘Mapping of PHCs soon’

In response to the Union Joint Secretary’s letter, Karnataka is all set to start mapping of all its PHCs. State Joint Director (TB) M. Manjula told The Hindu that Karnataka has 748 Designated Microscopy Centres and 2,325 PHCs.

“While 310 DMCs are in PHCs, 56 are in medical colleges, 20 in district hospitals, 10 in major government hospitals, 146 in taluk hospitals, and 206 in community health centres,” she said.

In 2017-2018, the number of new TB cases notified in Karnataka stood at 80,000, and treatment was initiated within 15 days in 90% of the cases. From January to June in 2018, around 45,000 cases were notified, and treatment initiated within 15 days in 80% of the cases, Dr. Manjula said.

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Printable version | Mar 5, 2021 8:14:26 PM | https://www.thehindu.com/news/national/karnataka/states-told-to-arm-primary-health-centres-in-fight-against-tb/article25022660.ece

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