TB cases in India under-reported, says WHO

Aarti Dhar, CNS Correspondent, India
[First published in The India Saga]
A latest global report on TB has said that TB cases in India are under-reported with 6.1 million new TB cases notified to the national authorities and reported to the World Health Organisation (WHO) in 2015. Notified TB cases increased from 2013 to 2015, mostly due to a 34% increase in notifications. India made TB a notified disease in 2012. TB remains one of the top 10 causes of deaths worldwide in 2015. The WHO Global TB Report 2016 has revised the number of incident (new) cases of TB in India to 2.8 million cases in 2015 and 2.9 million cases in 2014 as against the earlier estimated figures of 2.2 million cases in 2014.

Only 56% of incident cases were officially reported in 2014 and 59% in 2015 in India, the report says. The updated estimate of the number of TB deaths in India,  excluding those in people living with HIV (PLHIV) is now put at 478000 in 2015 and 483000 in 2014. In the 2015 global TB report the estimate for 2014 was 220000. Globally, 6 countries accounted for 60% of the new cases in the latest report. These are India, Indonesia, China, Nigeria, Pakistan and South Africa. In 2015, there were an estimated 480000 new cases of multi resistant TB (MDR-TB) and an additional 100000 people with rifampicin-resistant TB (RR-TB). India, China and the Russian Federation accounted for 45% of these total 580000 cases. There were an estimated 10.4 million new (incident) TB cases worldwide in 2015 with an estimated 1.4 million TB deaths in 2015 in the same year, and an additional 0.4 million deaths resulting among PLHIV. However, the silver lining is that TB treatment averted 49 million deaths globally between 2000 and 2015, but important diagnostic and treatment gaps still exist.

The report further says that globally there was a 4.3 million gap between incident and notified cases, with India, Indonesia and Nigeria accounting for almost half of this gap. We cannot reach the goal of the End TB Strategy if annual decline in TB incidence does not accelerate to 4-5% by 2020. Worldwide, the rate of decline in TB incidence remained at only 1.5% from 2014 to 2015, the report adds. "TB remains a serious problem across the WHO South-East Asia Region, and requires the fullest attention and strongest commitment of governments, donors and civil society leaders to be effectively addressed. TB is the single largest cause of death of any infectious disease in the Region, and remains responsible for incalculable suffering, premature mortality, impoverishment and foregone development,” said WHO Regional Director Dr Poonam Khetrapal Singh. To get on track to achieve the SDG 2030 target and Global End TB Strategy targets by 2035, which includes reducing TB deaths by 95% and cutting new cases by 90%, countries across the Region must significantly scale up key interventions made in recent years.

While recommending integrating TB programmes with existing health systems, thereby amplifying the effect these interventions have, Khetrapal said that “Though countries have been making efforts to end TB and the number of TB deaths and TB incidence rate continues to fall, at the current trend the Region would not be able to achieve the SDG targets. A newer and bolder approach is needed to bend the curve faster and sharper to achieve the global targets. This means intensifying measures to ensure early diagnosis and treatment, such as active case-finding and enhancing access to cutting-edge diagnostic tools. Adopting newer approaches of case diagnosis, community based treatment and treatment of latent infection.’’ To make all this happen, funds must be allocated accordingly, while political commitment must be fortified.  Moreover, governments should provide national TB programmes the operating capacity to be agile and responsive in their efforts, while TB control leaders should adapt and apply global TB strategies with care and diligence, she added.
[First published in The India Saga]

Aarti Dhar, Citizen News Service - CNS
October 21, 2016