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India bears a disproportionately large burden of the world's tuberculosis rates, as it resides to be the biggest health problem in India. It remains one of the largest on India's health and wellness scale. India is the highest TB burden country with World Health Organisation (WHO) statistics for 2011 giving an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 8.7 million cases . Compared to Canada, there are about 1,600 new cases of TB every year , which does not largely sum up, even closely, to the amount India suffers through. Citing studies of TB-drug sales, the government now suggests the total went from being 2.2 million to 2.6 million people nationwide. Tuberculosis is the biggest health issue that lies around India, but what makes is worse is the newly and recently discovered global phenomenon of TDR-TB - Totally Drug-Resistant Tuberculosis. This issue of drug-resistant TB started off with XDR-TB, and moved on to MDR-TB. Gradually, the lowest but most dangerous and strongest of them all has situated itself in India as TDR-TB.

"Within India, the Journal—using government data obtained through the Right to Information Act—has reported that India's drug-resistance rate is likely much higher than the 2% to 3% of TB cases reported to the WHO"^[4]

Epidemiology

In 2007, the prevalence of TB per 100,000 people was relatively high in Asia, and was highest in sub-Saharan Africa.

Tuberculosis is one of India's major public health problems. According to WHO estimates, India has the world's largest tuberculosis epidemic. Many research studies have shown the effects and concerns revolving around TDR-TB, especially in India; where social and economic positions are still in progression. In Dr. Zarir Udwadia’s report originated from the Hinduja Hospital in Mumbai, India explicitly discusses the drug-resistant effects and results . An experiment was conducted in January, 2012 on four patients to test how accurate the “new category” of TDR-TB is. These patients were given all the first-line drugs and second-line drugs that usually are prescribed to treat TB, and as a result were resistant to all. As a response, the government of India had stayed in denial, but WHO took it as a more serious matter and decided that although the patterns of drug-resistance were evident, they cannot rely on just that to create a new category of TDR-TB.

"Paul Nunn, coordinator of WHO's STOP TB department in Geneva, described the cases as “a wake up call for countries to accelerate provision of proper care, particularly for multi drug-resistant patients”. ^[10]

Symptoms

The bacterium that causes TB is called Mycobacterium tuberculosis. Inactive tuberculosis means that one can even unconsciously and unknowingly acquire the bacteria for tuberculosis within them but not even know about it because it us inactive. Whereas, active tuberculosis is the start of the bacteria developing, and the signs and symptoms begin to be visible. This is when tuberculosis is active within you, and is a serious issue leading to even more serious results. Although the TB bacteria can infect any organ (e.g., kidney, lymph nodes, bones, joints) in the body, the disease commonly occurs in the lungs. ^[3]

Common symptoms include:

• coughing that lasts longer than 2 weeks with green, yellow, or bloody sputum
• weight loss
• fatigue
• fever
• night sweats
• chills
• chest pain
• shortness of breath
• loss of appetite

Causes

There is a specific bacterium that evolves inside your body to result in tuberculosis, known as mycobacterium tuberculosis. This bacterium is only spread throughout the body when a person has an active TB infection. One of many causes of acquiring TB is living a life with a weak immune system; everything becomes fragile, and an easy target. That is why babies, children and senior adults have a higher risk of adapting TB ^[3]. The bacterium spreads in the air sacs, and passes off into the lungs, resulting in an infected immune system.

In addition, coughing, sneezing, and even talking to someone can release the mycobacterium into the air, consequently affecting the people breathing this air. It has been stated that your chances of becoming infected are higher if you come from – or travel to – certain countries where TB is common, and where there is a big proportion of homeless people ^[3]. India, being the largest country with diagnosed patients, falls under this cause because it stands recognized as consuming a higher chance of gaining TB.

Those listed are all the bodily and personal causes of acquiring TB, but tuberculosis in India is rich in its high rates because of the pollution dispersed throughout the country. Pollution causes many effects in the air the people breathe there, and since TB can be gained through air, the chances of TB remain high and in a consistent movement going uphill for India.

Another major cause for the growth of TB in India has to do with it currently still standing as a developing country. Because its economy is still developing, the citizens are still fighting for their rights, and the structure of the country lies in poor evidence that it is not fit as other countries still. TB rises high in India because of the majority of people not being able to afford the treatment drugs prescribed to diagnosed patients. “At present, only the 1.5 million patients already under the Indian government's care get free treatments for regular TB. That leaves patients who seek treatment in India's growing private sector to buy drugs for themselves, and most struggle to do that, government officials say.” ^[4] Consequently, high priced treatment drugs and the struggles of “poor patients” also brawl through the poor treatment they receive in response to acquiring TB. “It is estimated that just 16% of patients with drug-resistant TB are receiving appropriate treatment” . Lastly, as high pricing is linked to the economic standings of India, which is linked to poor treatment, it all underlines the lack of education and background information practitioners and professionals hold for prescribing drugs, or those private therapy sessions. A study conducted in Mumbai by Udwadia, Amale, Ajbani, and Rodrigues, showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis .

Treatment

India has a large burden of the world's TB, one that this developing country can ill afford, with an estimated economic loss of US $43 billion and 100 million productive days lost annually directly due to this disease . Treatment in India is on the rise just as the disease itself is on the rise. To prevent spreading TB, it's important to get treatment quickly and to follow it through to completion by your doctor. This can stop transmission of the bacteria and the appearance of antibiotic-resistant strains. It is a knowingly fact that bacterial infections require antibiotics for treatment and prevention, thus, commonly you will see that patients diagnosed with tuberculosis have certain pills and antibiotics carried around with them. The antibiotics most commonly used include isoniazid, rifampin, pyrazinamide, and ethambutol. It is crucial to take your medication as instructed by your doctor, and for the full course of the treatment (months or years). This helps to ward off types of TB bacteria that are antibiotic-resistant, which take longer and are more difficult to treat^[3]. In India’s case, the particular type of TB infections are majority resistant to regular antibiotic treatment (MDR-TB, XDR-TB, TDR-TB), therefore, not one or two medications will help, rather a combination of different medications must be taken for over a coarse of 18-24 months, depending on how deep the infection is. Since the 1960s, two drugs — isoniazid and rifampicin — have been the standard TB treatment ^[8]. In addition to antibiotics, a vaccine is available to limit the spread of bacteria after TB infection. The vaccine is generally used in countries or communities where the risk of TB infection is greater than 1% each year ^[3], thus, the country of India; whose TB infection rate is at a peak (world’s third highest TB infected country), and is consistently growing, and giving 20% of the world’s diagnosed patients a home. ^[9]

The Indian government’s Revised National TB Control Programme (RNTCP) started in India during 1997. The program uses the WHO recommended Directly Observed Treatment Short Course (DOTS) strategy to develop ideas and data on TB treatment. This group’s initial objective is to achieve and maintain a TB treatment success rate of at least 85% in India among new patients^[2]. “In 2010 the RNTCP made a major policy decision that it would change focus and adopt the concept of Universal Access to quality diagnosis and TB treatment for all TB patients”.^[10] By doing so, they extend out a helping hand to all people diagnosed with TB, and in addition, provide better quality services and improve on therapy for these patients.

Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated “within the confines of government sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis”.^[9] As this confirming result of hypothesis is at a conclusion by Udawadai, et al., it is given that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever.^[4]

References