Wednesday, March 25, 2015

24 MARCH WORLD TB DAY

J P Nadda says public awareness and investments key to fight tuberculosis in India

March 24 was observed as The World TB Day.

In a function organised to mark the occasion of this day, Union Health Minister, J P Nadda shed light on the significance of the various stakeholders and people’s representatives in fighting against the deadly disease of tuberculosis in India. According to statistical report of WHO, around 25% of the Indian population is infected with Mycobacterium tuberculosis, TB bacteria and 2.2 million cases of TB have been reported in the country.

The Health Minister further stated that every stakeholder has their own constituencies of influences with their unique impact factor. With their involvement in the TB control programme, effective implementation of the projects and enriched policymaking has been successfully carried out.

With the execution of the Revised National TB Control programme (RNTCP), there has been a significant improvement in the treatment of tuberculosis and thus, saving millions of lives. However, there will be numerous challenges that might crop up in the future, explained Mr Nadda. Read about why India needs to pay attention to the nutritional needs of TB patients.

The function conducted in the Capital city, Delhi was attended by Anurag Thakur, MP; Dalbir Singh, President National TB Forum; Dr. Nata Menabde, WHO country representative; Health Secretary B P Sharma; DGHS Dr. Jagdish Prasad, senior officers of the Health Ministry and representatives from the civil society.

Here are few points that the Minister highlighted to control tuberculosis

#1 Five key factors to be initiated

Creating awareness among the masses regarding RNTCP, through innovation systems, effective surveillance, constant vigilance and sturdy monitoring. Here are 10 facts about TB you should know

#2 Inter-sectoral convergence

Inter-sectoral convergence is a crucial component of the Health Ministry’s policies. In this approach, various sectors and Ministries handling sanitation, water, environment, etc., will be brought on board for an all-inclusive and comprehensive policymaking for health issues.

#3 Interaction with Members of Parliament and their involvement

Interactions of the Health Ministry with Members of Parliament to keep them informed about the various initiatives taken up in this regard and seek their active involvement in creating awareness regarding not only the available cure but also spread message of preventive health. Read more about DOTS and its 5 basic measures to deal with tuberculosis.

#4 Launched a website and TB project

The Health Minister launched the website of the National TB Control Programme, released the RNTCP Annual Report 2015 along with the special issue on TB of the Global Policy Journal, and launched the project on ‘Innovative intensified TB cases finding and appropriate treatment at high burden ART Centres in India’.

Tuberculosis is an extremely dangerous disease that infects two patients every three minutes in India. The situation gets worse in a city like Mumbai where there are a number of people living in a cramped space, combined with poor hygienic conditions makes it a perfect breeding ground for the tuberculosis bacterium. So, in order to help you stay safe from the disease, here are 10 of the most important things you should know about Tuberculosis.

Fact # 1: Most of us have latent TB foci inside our lungs


We all are exposed to the organism early on in life and would have formed foci of infection in the lungs (primary TB). Our immune system would have contained the infection and prevented us from suffering from the disease. It is when our immune system becomes weak for some reason or is overwhelmed by the infection or any other cause, that we suffer the disease (reactivation). The organisms can travel from the foci of infection in the lungs to other sites leading to secondary infection (TB of lymph nodes, spine etc).

Fact # 2: By maintaining good health and immunity, you can prevent getting infected with tuberculosis.

Nutritious food, adequate sleep, exercise and leading a life with minimal stress go a long way in helping our immunity fight any infection well including TB. Work on improving your immunity by including diet rich in antioxidants. Have atleast 4-5 servings of fresh vegetables and fruits every day. If you cannot have it due to certain practical constraints, make sure you take your daily dose of antioxidants/multivitamins after consulting your doctor. Anti-oxidants help fight free radicals produced in the body due to any kind of disease/stress and help in cell repair. Here’s why nutrition plays an important role in keeping tuberculosis at bay.

Fact # 3: Fresh air and sunlight can help prevent TB

The microbes in TB thrive in cold, damp places. Whether you are at home or in the office, remember to open all your windows for a major portion of the day to let the sunlight and air in order to keep the bacterium at bay.

Fact #4: Tuberculosis primarily affects the lungs but can affect other organs too

Cough that lasts for more than 3 weeks, streaks of blood in the sputum (phlegm), low-grade fever, difficulty in breathing and unexplained weight loss are the commonest symptoms of TB of the lungs. TB of other organ systems present with varied symptoms. For example: TB of the skin could present with a non healing ulcer, TB of the spine could present with backache, stiffness or even swelling in the back/groin, TB of the intestines could present with abdominal distension and absolute constipation. Even a non-healing anal fistula could be due to TB. TB of the lymph nodes can present with swellings at multiple sites of the body. TB of the covering of the brain and spinal cord can cause TB Meningitis, especially in children.

Fact #5: With the BCG vaccine, you cannot be resistant to TB throughout your life

It also doesn’t help in secondary forms of TB. That said, one still needs to get the BCG vaccine soon after birth.

Fact # 6: TB is a fully treatable disease

If the full course of medications are taken properly and regular follow-ups are done with the doctor, TB can be completely cured. The TB control program in India, was started as RNTCP (Revised national tuberculosis control program) in 1993. The program has made great progress over the last two decades. Having collaborated with private hospitals and medical colleges the reach of the program is 100% in India. The mainstay of the program is prompt diagnosis (by sputum testing and X ray of the chest), commencing the treatment as early as possible and making sure that the patient is compliant with the treatment (Directly observed treatment-DOTS). The main drugs used for TB are Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin. But always take these medicines under the doctor’s supervision because indiscriminate use can lead to jaundice and liver failure, kidney failure.The duration of the treatment varies from case to case and is at least for 6 months. Testing and treatment is available free of cost at all government hospitals, primary and community health centres.

Fact # 7: Not taking the full course of TB medicines as per the doctor’s prescription is one of the major hurdles faced by the TB prevention programs.

It can lead to the organisms developing resistance to the first-line drugs used in treatment causing MDR-TB (multi-drug resistant TB).

Fact # 8: Multi-drug resistant TB does not respond to standard TB drugs, is difficult and costly to treat

The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases. One of the best ways to prevent it is by completing the entire course of anti-TB drugs in the dosages prescribed by the doctor.

Fact #9: One of the major causes of infertility among women from the lower socio-economic conditions is genital TB

When latent bacilli in the lungs get reactivated, they often spread to different parts of the body including the genital tract. It can infect either the uterus and/or the fallopian tubes and usually does not show any symptoms. A very difficult disease to diagnose, only the culture from a tissue sample obtained from a genital tract can help.

Fact #10. Children including babies can suffer from TB, but often go undiagnosed\

According to the WHO, around half a million babies and children get ill with TB every year and 70000 die due to it. Children under three years of age, especially those who are malnourished and with compromised immune systems are particularly prone to the disease. However, the symptoms often go unnoticed causing higher mortality rates. To prevent TB in children, get them immunized with the BCG vaccine soon after birth. People in your family, including house-help, who would come in close contact with the children need to be screened. Also, breastfeeding the baby for at least six months increases their immunity against all infections including TB.

According to Press Information Bureau, tuberculosis in India continues to be the leading cause of death from communicable diseases. With 1,000 deaths per day or two persons succumbing to this deadly lung disease every three minute, 2.2 million TB cases occur in India every year. It is also estimated that there 3.5 million are sputum positive (presence of tuberculosis bacteria in sputum sample). However, with successful implementation of DOTS in India, there has been a significant rise in overall treatment rate. But before we get onto what is DOTS, here’s what you need to know. Read about tuberculosis — causes, symptoms, diagnosis, treatment and prevention.

Completing the TB treatment course – why is it important?


The symptoms of TB commonly resolve within few weeks of starting the treatment and many patients tend to discontinue their course of medication. However, you should not stop the treatment (even if you feel better), because the bacteria is still in your body and hence, the chances of recurrence is very high. Hence, completing your treatment course is of utmost important to cure tuberculosis completely.

If you follow the full course of TB treatment, the disease can be treated (nearly 100%) in a span of 6 months. Patients who follow their TB treatment in an irregular and unreliable way are at an increased risk of treatment failure, relapse of the disease and development of multi drug-resistant TB strains (which do not respond to standard TB drugs making it difficult and costly to treat tuberculosis).
Read about
latest treatment for extremely drug-resistant TB could be the answer to a TB-free India

What is DOTS?

DOTS – Directly Observed Treatment, Short-Course is the WHO-recommended strategy for tuberculosis control. It provides a definite cure for tuberculosis with a treatment course lasting from six to eight months. It is available free of cost to the patients in government hospitals in the whole nation.

In India, the Revised National TB control programme (RNTCP) shifts the responsibility for cure from the patient to the health system. DOTS has been shown to prevent the occurrence of multi-drug resistant tuberculosis (MDRTB). It also reverses the trend of MDRTB in the suspected population and can cure TB even in HIV-positive patients. Here are complications of tuberculosis you should know about.

The basic five components of the DOTS approach are -

#1 Political commitment

Starting from the national level to district level and even below, includes increased and sustained financing, legislation, planning, human resources, management and training necessary for success of the programme.

#2 Detecting cases through accurate diagnostic tests

Sputum smear microscopy is used first followed by culture and drug susceptibility testing (DST). This remains the recommended method of TB case detection. Properly equipped laboratories with trained personnel are necessary to ensure this.

#3 Supervised treatment to ensure compliance

Standardized treatment procedures are followed all across the country for TB patients by following WHO guidelines on patient categorization and management. Supervised treatment -the core of the DOTS programme – includes direct observation of therapy (DOT) wherein a patient takes the drugs directly in the presence of health workers or other trained persons. This helps patients to take their drugs regularly and complete treatment. Did you know genital tuberculosis could be a major cause of female infertility?

#4 An effective drug supply and management system

An uninterrupted and sustained supply of quality-assured drugs is essential to TB control which can be achieved by providing compulsory and free medicines to the patients.

#5 Monitoring and reporting

Continuous monitoring of the system is also essential to ensure the programme is successful.

On an average, more than 1.25 lakh patients are treated every month under India’s DOTS programme. Out of 531 districts, 446 districts are covered under National Tuberculosis Control Programme. 292 out of them are Short Course Chemotherapy (SCC) districts. SCC is a treatment given for a total period of six to eight months in two phases – Intensive phase and Continuation phase. Anti-TB drugs include Streptomycin (S), Isoniazid (H), Ethambutol (E), Rifampicin (R) and Pyrazinamide (Z). Here is why India needs to pay attention to the nutritional needs of TB patients

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