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The number of tuberculosis (TB) cases in India could well be two to three times higher than the current estimates, says a study from London’s Imperial College, suggesting that the actual number is going “vastly under-reported”.
The findings are disconcerting as India already has the highest number of tuberculosis cases, accounting for a quarter of all cases worldwide. But even this is under-reported suggests the latest study, indicating that there was an “additional” 2.2 million TB cases in the private sector in 2014.
The study is one of two India-oriented research papers that will be published in The Lancet Infectious Diseases on Thursday. The other study was on antibiotic use in India.
Private role
The under-reporting of TB was because people opt for private health care, who fail to report to public health officials, the study said. And this, scientists warn, could fuel drug resistance, where the medicine given to treat TB becomes ineffective.
Tuberculosis is a bacterial infection, spread through inhaling tiny droplets from the coughs or sneezes of an infected person. In 2014, 9.6 million people (reported and unreported cases) fell ill with tuberculosis and 1.5 million died from the disease, a note on the study said.
Nimalan Arinaminpathy, lead author of the research from the School of Public Health at Imperial told BusinessLine in an email interaction, that of the six million odd cases, globally reported in 2014, India reported over 1.6 million. “There is an additional burden of TB that is 'invisible' to public health authorities - much of this burden is managed by the private sector. So the 2.2 million should be regarded as additional to the 1.6mn reported by India,” the author said. The team arrived at the estimate from a calculation of nationwide sales of tuberculosis drugs across the private sector.
In fact, the Government had mandated private doctors to notify them when they treat a TB patient at their clinics. Arinaminpathy, however observed, that making TB a notifiable disease was a valuable step, but was not sufficient for such a large and fragmented private healthcare sector as in India. “We already know that the private sector is only reporting a small fraction of their TB cases, but the present study highlights that the problem is bigger than we had previously recognised,” the researcher said.
Against the backdrop of drug resistance, the author pointed out that tuberculosis treatments need to be taken for six to nine months. But patients feel better within a couple of weeks and often stop taking the medication, when in fact, completing the course was key to effective treatment. Mumbai, for example, faces a worrying epidemic of drug-resistant TB and many would argue the private sector has a role in this, the researcher said.
Arinaminpathy said that the findings highlight the need to re-double efforts to address the burden of tuberculosis in India, and urgently increase surveillance in the private sector, besides improving its cooperation with the public sector in India.
The study was funded by the Bill and Melinda Gates Foundation (BMGF), with other collaborators being IMS Health Inc; Central TB division (Government of India) and the India offices of the World Health Organization and BMGF.
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