THE BURDEN OF TUBERCULOSIS
Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis. The bacterium primarily affects the lungs, causing Pulmonary tuberculosis (pulmonary TB), but can also affect other part of the body, causing extra-pulmonary TB.
The bacteria spreads through droplets when a healthy individual inhale the air by a pulmonary TB-infected person while coughing. However, only 5-10% of the total population infected by M. tuberculosis develops the disease tuberculosis (TB). Other risk factors for the disease include poverty, low-nutrition, diabetes, low sanitation & hygiene practices, smoking and alcohol consumption.
Globally, tuberculosis (TB) is one of the top ten causes of death, with the highest percentage of these deaths reported from developing countries. According to the 2019 Global TB Report by WHO published in 2020, out of the 10 million people who developed tuberculosis (TB) in 2018, two-thirds were from eight countries – with India being home to the highest percentage (27%) of persons affected by TB.
The Government of India aims to make India TB-free by 2025. However, the challenge is far greater than what can be assessed, including but not limited to, abysmal or absent effective health care system in rural areas, HIV-induced TB incidences, lack of proper nutrition and hygiene, and widespread poverty which inhibits access to education, awareness, and a proper healthcare regime. The enormity of the challenge calls for a multi-stakeholder and multi-dimensional approach, involving empowerment at the grassroots-level, awareness about the disease and its treatment, involvement of the Non-Government Organizations (NGOs), medical professionals, and caregivers in not only curing the present cases but also in preventing the occurrence of new ones. An early diagnosis coupled with prevention of new cases is the key to tackling the TB menace in India.
TB – PREVENTION, TREATMENT, AND CARE
TB prevention begins at birth with the BCG vaccine, which protects against the disease for the first 15 years of life. However, it has limited efficacy for adults exposed to the infection. An early diagnosis and continued treatment are the keys to effective disease management, stalling further spread of the infection to other adults.
It is estimated that a person infected with TB can infect up to 10-15 adults within a year. However, the person is no longer contagious within two weeks starting the TB treatment.
Awareness about the symptoms and the treatment of TB helps individuals seek help and get treated. Awareness and education take center-stage in TB prevention in rural areas and slums where both education and access to healthcare is limited or non-existent. Contact tracing, maintaining good personal hygiene and clean surroundings, and intake of nutritious food help in preventing TB and supporting its treatment.
How Are we TACKLING THE TB MENACE?
GLRA-India had been working for leprosy affected individuals across India for almost 30 years when the dreaded disease of TB started raising its head and struck India in epidemic proportions, in the early 1990’s. Around the same time, leprosy was beginning to reduce its grip on the Indian population owing to the introduction of WHO’s Multidrug Therapy (MDT) in the year 1982. This helped us shift our focus and resources on tackling TB and serving those affected by it without compromising our on-going efforts on leprosy. Given the vast network in urban slums and rural areas that we had developed over the years, and the reach we had in the most remote areas in India, we were confident that we could help in fighting the disease and serve the under-served communities in the far-flung areas of India. Thus, began our association with individuals affected by TB.
However, GLRA-India’s approach in treating TB affected individuals goes much beyond just medical rehabilitation. Besides the active case identification, treatment suggestions and follow-up, GLRA-India actively pursues the social re-integration of individual facing alienation from the community owing to the infectious nature of the disease. It is also common for TB-affected individuals to lose their livelihood, which is a further block towards their successful rehabilitation. In the wake of this, we have adopted WHO-Community-based Rehabilitation (WHO-CBR), ensuring participation and inclusion of the TB-affected in the community, after being disease-free.
Though the WHO-CBR guidelines were originally formulated for rehabilitation, continued care, and support of the disabled, and to stimulate their participation in the society, we are one of the few NGOs to adopt this for re-integration of TB-affected individuals.
In the past, under the Revised National TB Control Programme, to reach the grassroots, we support 20 NGO partners across 11 states for early case detection and treatment. To implement innovative projects, we have been partnering with the Global Fund (Axshya India), with USAID-supported IMPACT Project and EKFS Germany funded., Home-based Care for MDR TB patients in slums of Delhi, Mumbai, Kozhikode and Kolkata, and many more such as TB control among prison inmates in Gujarat, e-compliance projects in Jaipur, and TB control among truckers in Delhi, Lucknow, Agra & Jaipur.
While each project and the work done on ground have been great learning experiences, the TB projects undertaken in West Bengal deserve a special mention. In the past 10 years, through several projects in the state involving active case search, capacity building, engagement of non-qualified private providers, notifications, and novel initiatives such as silico-tuberculosis and prison TB, we have been able to reach 267000 TB-affected people in these underserved communities. Of these, 88% have been successfully cured and are now back in the community, leading a healthy life.