Earlier this fortnight the news media reported the death of a 51-year-old laboratory technician employed by Mumbai’s Sewri TB hospital. She died from multidrug-resistant tuberculosis, an infectious disease made worse by diabetes, a chronic illness, for which she had not been properly treated.

Her death illustrates a large and looming co-epidemic of TB-diabetes in India. TB is a catastrophic public health challenge in this country. TB kills approximately 700 Indians every day — more than any other infectious disease and more than in any other country though many remain unaware of the fact.

Diabetes is a more recent, emerging national challenge as India develops economically, leading to dietary changes that is turning calorie heavy and nutrition light. A sedentary lifestyle is also to blame.

TB is caused by bacteria that typically affect the lungs. It spreads from person to person through the air when someone sick with TB coughs. Diabetes weakens the immune system, and all evidence point to diabetes tripling the risk of developing TB. In most cases TB is curable with proper medical treatment; but diabetics do not respond as well to that treatment.

I recently returned from the first Global Summit on Diabetes and Tuberculosis, which was co-hosted by the International Union Against Tuberculosis and Lung Disease, the World Diabetes Foundation and the Indonesia government. The summit brought together the world’s leading experts, policymakers, and business and civil society leaders to present a status update on the co-epidemic and to commit to stopping it. Delegates issued the Bali Declaration, a landmark document we hope will catalyse a global response against TB-diabetes, including here in India.

This is important as India is one of the six countries — along with China, Brazil, Indonesia, Pakistan and Russia — that the World Health Organisation classifies as a high-TB-burden country that also has a high burden of diabetes.

New data presented at the summit by Anand Madhab, CEO of Jagran Pehel, showed the extent to which TB-diabetes may be harming people in India. From September 2014 to September 2015, Jagran Pehel's public health programmes conducted screening for TB and diabetes in Bihar, Uttar Pradesh and Jharkhand. They identified 1,448 people who had TB. Of these, one in four was also a diabetic.

A directive from the Ministry of Health’s Revised National TB Control Programme in 2012 recommended routine screening of all TB patients for diabetes, so that patients who have both TB and diabetes can be diagnosed early and treated successfully. But the recommendation is being implemented in a limited number of locations. This needs to be urgently scaled up across the country.

A more recent joint national TB-diabetes collaborative framework also recommends screening all diabetes patients for TB, but implementation in yet to start.

These actions will require close collaboration between actors in the Ministry of Health responsible for TB and those responsible for diabetes--a collaboration that needs strengthening.

As the Centre moves forward with a vital new campaign called 'TB Free India', we face an important challenge -- of providing effective screening and quality treatment for all people impacted by TB including the rising numbers of people simultaneously affected by diabetes.

The laboratory worker’s death was preventable. The national framework to screen TB patients for diabetes and vice versa must be implemented across the nation to avoid many more such deaths in the years ahead.

(The writer is Deputy Director of the Department of Research, International Union Against Tuberculosis and Lung Disease)

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