Millennium Post

Tuberculosis and its malign

Containing and ultimately eradicating tuberculosis is possible through policy intervention and meticulous implementation

Despite several initiatives that have attempted to eradicate the curse of tuberculosis, achieving a TB-free society is still a distant dream. As we commemorated another March 24 as World Tuberculosis Day, the grim reality of societal suffering from tuberculosis looms large. Numerous remarkable endeavours by myriad governmental, non-governmental, and private social organisations worldwide have not successfully contained tuberculosis and it continues to dominate as a prime infectious killer.

'Delhi End Tuberculosis Summit', held at New Delhi, was a passing event that failed to yield any concrete result. But through this platform, Prime Minister Narendra Modi affirmed his commitment to ending tuberculosis by 2025, even though the global target for it is 2030. India has consolidated its strong buttress for a tuberculosis support plan in eradicating the disease.

However, a remarkable outcome of the summit was that it set stage for the September 2018 UN high-level meeting on tuberculosis where it would be discussed in the UN General Assembly (UNGA) for the first time. Earlier, at the beginning of this year, around 100 representatives including ambassadors, deputy ambassadors and counsellors had participated in the World TB Day commemoration at the UN headquarters at New York to discuss actions towards initiating the first-ever UN General Assembly high-level meeting (UNHLM) on TB.

TB is primarily caused by the Mycobacterium Tuberculosis, which mostly affects the lungs. Prolonged fever, cough, night sweats, weight loss are symptoms identifying tuberculosis. A weak immune system, poor nutrition, unhygienic environment and contagious bacterial infection are some of the major causes that build up a platform for the disease to breed. Experts reveal that Mycobacterium Tuberculosis spreads through the microscopic droplets present in the air. After an infected person comes in contact with an uninfected person and coughs, sneezes, spits, laughs or speaks, the microscopic droplets are released into the air, making a direct medium of transfer of infectious bacteria to the uninfected one.

Although unpleasant to accept, it is true that India leads with the highest number of deaths in the world due to tuberculosis. On the global benchmark, last year, India alone accounted for around 33 per cent of global TB deaths among HIV-negative people. And, around 26 per cent of the combined total of TB deaths in HIV-negative and HIV-positive people. However, experts reveal that people living with HIV are 20 to 30 times more prone to developing this disease than those without HIV. More than 10 million new cases of TB are diagnosed each year, and almost two million people die from the disease. Globally, 1.7 billion people are estimated to be infected.

This global infectious killer is not restricted to adults. According to a World Health Organisation database report, tuberculosis in children is also one of the major causes of suffering. In 2017 alone, around one million children were diagnosed and around 2,50,000 children died due to this socially-maligned disease. This estimate is with HIV negative children. And, children who die having both TB and HIV co-infection are internationally classified as death from HIV. Pulmonary TB is the most common type of TB in children between the age group of 1-4 years.

Today, experts opine that Multi Drug-resistant Tuberculosis (MDR-TB) and Extensively Drug-resistant Tuberculosis (XDR-TB), the advanced stages of tuberculosis, is a growing concern. The bacteria in these advanced stages develop high resistance to the anti-microbiological drug that is used to cure the disease and are practically incurable by the standard first line of treatment imparted to patients. This has become a major challenge within the medical fraternity throughout the world. Highly drug-resistant TB threatens to give birth to extremely fatal diseases, especially in countries with limited resources. Drug-resistant TB is a serious emerging problem, and boosting the body's own immune system against the disease is a stringent step in the battle against the antibiotic resistance developed by the bacteria.

As per a latest research revelation, a new type of blood test has been found to accurately predict the development of this disease up to two years before its onset in people living with active TB, through measurements of a combination of four-gene signatures in the blood, says Professor Gerhard Walzl, leader of the Stellenbosch University Immunology Research Group, Tygerberg, South Africa. "This study is the first step, and now the impact of this test on the prevention of TB will have to be tested in multicentre clinical trials," he added.

Governmental, semi-governmental and non-profit organisations worldwide are fighting to create a benchmark in eradicating this curse. However, in order to control and eliminate TB permanently from the grassroots level, the governing bodies from village panchayats to the national-level have to coordinate effectively with adequate planning and execution. Providing free medicine and aid is not enough – masses have to be educated about its symptoms, suffering, and precautions. Alongside advance policies and a target-oriented approach, governments have to ensure adequate implementation to ensure a concrete output.

In a country like India, with a high burden of tuberculosis patients, tremendous effort needs to be made with comprehensive implementation of its plans to completely eliminate TB.

Even though the Union Health Minister J P Nadda has fast-tracked many new initiatives that aim to achieve all the core tenets of Universal Health Coverage, articulated in its National Health Policy (NHP), of providing free medicines, improving diagnostics access and strengthening and channelising a smooth health care system for its easy access and benefit – healthcare officials must get to the ground and chalk out proper implementation plans. A multifaceted approach is integral to contain this venomous epidemic.

(The author is Chief Sub-Editor with Millennium Post. The views expressed are strictly personal)

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