Editorial: Missing TB cases in India

Although tuberculosis killed 1.3 million people across the globe in 2012 and nearly 8.6 million developed the disease, the world is on track to reach some important targets of the 2015 Millennium Development Goals. According to WHO’s global tuberculosis report 2013 released recently, the incidence rate has been falling, and the mortality rate since 1990 has been reduced by 45 per cent. Yet, at 37 per cent, the reduction in prevalence during the same period is far below the half-way goal. In all likelihood, India may be responsible for the slow reduction in global TB prevalence. At 2.8 million (26 per cent), the country has the highest caseload. But the true incidence and prevalence would be higher if those approaching the private sector and remain unreported are also taken into account. The government’s landmark decision last year to make TB a notifiable disease by the public and private sectors was meant to correct this anomaly. If implemented in earnest, every case detected would get reported and the actual extent of the disease will become known. Unfortunately, very little has been done to ensure that the private sector complies with the requirement. The government reluctantly made TB a notifiable disease, and has shown little interest in implementing the order.

WHO has taken special note of these missed out people. Globally, three million people who developed TB last year have been missed out by the national notification systems, it notes. If detecting and notifying all adult TB cases is found wanting in India, it is far worse in the case of children below 15 years. WHO has estimated that TB incidence among children is over half a million across the world. But its recently released road map for childhood tuberculosis clearly indicated that the actual burden would be higher. WHO’s 2006 guidance on TB management in children indicated that about one million TB cases the world over occur in children. Though children can contract TB at any age, those under five are especially vulnerable, particularly those from households where an adult has been recently diagnosed with active pulmonary TB. Young children are more susceptible to getting infected and face an increased risk of progression to disease; they also acquire the more severe forms of the disease. It is for these reasons that WHO had recommended contact tracing. Though India’s Revised National TB Control Programme (RNTCP) has also approved contact tracing of young children from such families, its implementation is at best sub-optimal. Thus, while RNTCP estimates children with TB to be 10.2 per cent of the total TB caseload, only seven per cent of the cases were registered in 2011.

Published in The Hindu on November 7, 2013