NEW DELHI: Delhi recorded the highest incidents of pulmonary tuberculosis cases in India, according to a survey report released on Thursday. The National TB Prevalence Survey 2019-2021 mentioned that cases the lowest in Kerala.
The survey conducted after six decades and released to mark World TB Day by the Union Health Ministry also found that 64% of India’s TB symptomatic population was not able to seek healthcare services between 2019-2021.
The first of its kind nationwide study since 1955-58 conducted to know the actual disease burden at a national level found that the prevalence of TB among Indians aged above 15 is 312 cases per one lakh, more than double the global average of approximately 127.
It found that the prevalence of TB among the population aged 15 and above is 31.7%. It also showed that pulmonary TB prevalence in women is lower (154 per lakh) than men (472 per lakh).
The survey said 64% of the symptomatic population did not seek healthcare between 2019-21.
The survey also revealed that the prevalence of microbiologically confirmed pulmonary TB (PTB) among those aged 15 years and above in India was 316 per lakh population, with the highest PTB prevalence of 534 per lakh in Delhi and the lowest prevalence of 115 per lakh in Kerala.
The prevalence of PTB infection among the surveyed in India was 21.7 per cent, the report pointed out.
According to the survey, the prevalence of all forms of TB for all ages in India was 312 per lakh population for the year 2021.
The highest prevalence for all forms of TB was 747 per lakh in Delhi and the lowest was 137 in Gujarat.
The prevalence of all forms of TB among population aged 15 years and above was 31.4 per cent.
The survey found that COVID-19 has impacted the community level chest X-ray abnormality in general and would have impacted the TB prevalence.
The survey enumerated 4,85,010 people and assessed them for eligibility for participation in the survey, of which 3,54,541 (73.1 per cent) were found eligible.
Of those eligible, 3,22,480 (90.9 per cent) participants consented for the survey and were screened by at least one method.
"A considerable amount of prevalent TB cases were contributed by patients with past history of TB. Hence, NTEP (National Tuberculosis Elimination Programme) needs close follow-up of patients completing treatment for early detection of recurrent TB and plan interventions for preventing recurrence of TB. NTEP needs to prioritise scale up of molecular test and chest X-ray screening under programme conditions for increasing the efficiency of case finding and early diagnosis of TB," the report said.
The survey also found that the prevalence-to-notification ratio of pulmonary TB for people aged 15 years and above in India and the state groups is about 2.84.
The highest ratio was observed in Chhattisgarh and the lowest was observed in Gujarat.
"We need to prioritize the interventions in high prevalent states and plan for elimination in low prevalent states," the report recommended.
More interventions for men like occupation screening for TB, nutritional interventions for malnourished, old age screening and interventions for promoting smoking and alcohol cessation needs to be scaled up for better control of PTB to address the factors which have more contribution towards the PTB burden, it said.
The reasons were ignoring symptoms (64%), not recognising symptoms (18%), self-treatment (12%) and couldn’t afford (2%).
The total number of new and relapsed TB patients notified in India during 2021 were 19,33,381 as against 16,28,161 in 2020, the report showed.
Despite the brief decline in TB notifications observed around the months corresponding to India's two major COVID-19 waves, the National Tuberculosis Elimination Programme (NTEP) reclaimed these numbers, the report stated.
"There has been a slight increase in the mortality rate due to all forms of TB between 2019 and 2020 by 11 per cent in the country," the report said.
In absolute numbers, the total number of estimated deaths from all forms of TB excluding HIV, for 2020 was 4.93 lakhs (4.53-5.36 lakhs) in the country, which was 13 per cent higher that of the year 2019 estimate.
As per the Global TB Report 2021, the estimated mortality rate among all forms of TB was 37 per lakh population in 2020.
Poverty is both a risk factor and a consequence of TB, and it disproportionately affects the households with low socio-economic status causing a financial burden on them, thereby resulting in detrimental outcomes like delayed care seeking, increased default rates and poor treatment outcomes, the government report said.
One of the reasons for poor compliance to the treatment is the cost that the disease imposes on individuals and families affected.
Such costs could lead to financial catastrophe, and in India, around 18% of the general population experience such catastrophic healthcare expenditure, the report stated.
A recent systematic review (2020) estimating the direct and indirect patient costs of drug-sensitive and drug-resistant TB care in India reports that 7 to 32 per cent of DS-TB patients and 68 per cent of DR-TB were experiencing catastrophic costs for TB care in India, the report highlighted.
The pandemic had affected the measures of TB control programmes globally and more so in the high burden countries impacting care-seeking and treatment services, the report said.
(With PTI Inputs)