Editorial: India versus TB

Published in The Hindu on October 20, 2011

Although the number of new TB cases worldwide remains a matter of concern – the figure stood at nearly 9 million in 2010 – the incidence rate has been falling since 2002, according to a recent report of the World Health Organisation. Estimates of the year-wise number of deaths reveal a declining trend. Against this background, India presents a dismal picture. Last year, the case detection rate — the first and the most vital parameter — was only 59 per cent of all cases (both smear positive and smear negative). China, on the other hand, has made tremendous progress in this area — the case detection rate increased from 33 per cent in 2000 to 74 per cent in 2006 to 87 per cent in 2010. Prevalence was halved between 1990 and 2010 and the annual rate of decline, which was 2.2 per cent between 1990 and 2000, rose to 4.7 per cent in the next decade. The mortality rate was slashed by almost 80 per cent, and the incidence rate fell by 3.4 per cent, over the past 20 years.

The key factor behind China’s success is the mandatory web-based TB reporting system that has been in operation since 2005. This covers virtually every health facility in the country. In addition, all TB deaths are required to be registered in all the 31 provinces. These hard-nosed initiatives have enabled the country to measure the prevalence of even multi-drug resistant TB (MDR-TB). In stark contrast, underreporting of TB incidence for 2010 in India was as high as 41 per cent, in WHO’s reckoning. The reasons for this are not difficult to find. Data are collected only from the government-run institutions and there is no mandatory system for private practitioners to report every confirmed TB case. With many patients seeking treatment from non-government doctors, India’s contribution to the world’s notified cases in 2010 was surely much higher than WHO’s estimate of 24 per cent. It is well established that a flawed reporting system and an inaccurate data base undermine the formulation of effective policies. Many private medical practitioners fail to diagnose the disease; and even when they do that, they tend to follow a regimen that is not standard, thereby contributing to the emergence of more MDR-TB cases. Two people die very three minutes in laid-back India from this infectious disease. The government must give the highest priority to the battle against TB, emulating countries that have done dramatically better on this front.