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Assignment- Part B
Word count: 1711
Tuberculosis in India
Introduction
Tuberculosis (TB) is a communicable disease that is a public health issue and is commonly observed in poor areas of developing countries such as India. TB is caused from the infection of bacteria known as Mycobacterium tuberculosis [1]. According to the latest global TB report from WHO, in 2018 seven million new cases of TB were recorded and India with a population size of 1,353 million, had a high TB incidence of 2,690 thousand [2]. In comparison to other developing nations, India is the biggest contributor to increasing number of patients with active TB. More than one-third of the world’s population is affected by TB. This public health related problem is a large global issue and India has the world’s largest TB epidemic. Moreover, an increased number of people have resistance to anti-TB agents (antibiotics) [3]. The number of infected individuals is greater than the number of patients receiving treatment. This new category of drug-resistant TB patients is a national and global health challenge [4]. For the prioritization of an infectious disease threat such as TB there is a need to analyze the situation and develop methodologies.
Tuberculosis infection and review
The bacteria can infect various body organs such as the lungs, the kidneys or the spine. This condition can be fatal for the person if left untreated. TB can be spread from one person to another via droplet aerosols, for example, when a patient with an active TB status sneezes, particles ca
ying the pathogen can spread in the air and a person that comes in close contact with the affected person can inhale them and acquire the infection. However, the spread of infection is not transmitted by sharing food and physical contact with the affected person such as, shaking hands.
Early intervention is necessary for the early management and control of the spread of TB infection, especially in developing countries. During the initial stages of TB spread, India remained in denial for a long period and this led to the spread of infection in multiple regions of the country. Numerous factors have been governing the development and treatment policies for handling the TB situation in India. New policies are being developed and, those cu
ently in place require substantial revisions. Factors can involve both social and economic ones. The social factors entail demographics and the culture in the country including, inequality within society, the concern about the lack of awareness about the severity and complexity of the disease and the monetary funding required to handle the TB epidemic spread [5]. The economic factors are the ones being analyzed on a much larger scale and, are associated with productivity and growth and the economic status a country might hold for handling such a crisis. The lack of modern medical resources for treatment is another hurdle in the progress for treating and eradicating this public health related issue. In effect, a major limitation in India for the treatment of TB infection is being classed as a developing nation. Both the education and the income of the patient treated for a communicable disease have serious effects on the quality of care in managing TB in a poor nation. These two important factors will be described here in detail with their effect on the management of TB.
Effect of education factor on tuberculosis disease
In India, a disease such as TB can be stigmatized. A major and plausible factor on TB disease is the lack of education and the overall understanding in regards to the diseased condition. For instance, in most regions of India, especially in rural areas, there is a high illiteracy rate. Educational resources are limited and a low means of primary healthcare support exists in these regions. The education of community members such as health workers and patients is important in developing nations. Several aspects of TB disease that require clear communication through a sound education are: symptoms, treatment and spread (mode of transmission) of TB.
A recent survey was conducted in order to assess the knowledge levels su
ounding TB disease [6]. The study found that: a high knowledge exists for the spread of TB with, 77% of Indian people surveyed understanding that coughing and sneezing are modes of TB transmission; a good number (66%) knew that TB is communicable; and, the availability of drugs to treat TB is high (93%). This study relates the TB knowledge with infection prevention behavior such as placing hand over mouth when coughing. Another study found that knowledge about TB varies in different geographical locations and overall a poor knowledge exists in north west India [7]. Poor educational knowledge of a bacterial disease can negatively impact the awareness of TB. For example, that a mode of transmittance of TB is coughing was known by only 50% of patients which raises alarm among scientists and health care providers. In future, the Indian government needs to shift their focus on providing educational programs including a door to door communication approach in rural settings.
Effect of income factor on tuberculosis disease
The quality of TB care can be less if individuals come from low income family. Recently, a study describes the gaps and the numerous opportunities of pharmacies to prescribe anti-TB medicine to patients of a low income status [8]. In future, pharmacies can provide anti-TB medicines on a global scale including high burden countries like India.
Further examples of how a low income affects TB infection involves a description of poverty regions in India. The slums present in major metropolitan cities, such as Mumbai, Delhi and Kolkata, have a higher ratio of people living in a one-room setting [9]. A crowded living a
angement contributes to the rise of TB infected individuals since household members can be in close proximity to infected individuals. The poor ventilation in home dwellings is also responsible for causing the longevity of the presence of infection in the su
ounding air. Poor working hazards, overcrowded homes and poor ventilation are all attributing factors for developing TB disease.
The higher rates of TB can also be attributed to the fact that patients are of a low income group status. Due to lack of financial support and means, many of the infected individuals are unable to afford the high priced medications required for the treatment. A recent government initiative was launched to treat TB patients [10]. However, despite the increased efforts from the government, many people still lack access to anti-TB medications. The issue of poverty and lack of financial resources are contributing largely to malnutrition [11]. Financial factors include: a poor educational system; unhygienic living conditions; the high incidence of substance abuse; and, other infections such as HIV are of high prevalence. These financial factors elevate the overall burden of the TB disease.
A social stigma is associated with patients ha
oring a TB positive status since they can be observed to be socially marginalized on larger grounds with a crude isolation faced by these individuals [12]. Recently, the government has revised its policies for TB infection. The social and economic factors are the foundational grounds which encompass these policies and plans when they are being implemented. The DOTS program has been launched by the government that provides the patient with the appropriate treatment and thus, promotes patient autonomy [13]. Government plans working on social issues in society, by supporting various non-governmental organizations that are supporting the main framework in managing delivery of healthcare services to these individuals. In addition to government initiatives, the Tuberculosis Association of India that is a voluntary organization has been working on this cause, in collaboration with the government. The main goal is to work in various TB centers throughout the nation and provide the required medical supplies, information and other health support material [14]. The TB association has also helped with the close monitoring of patients with an active status and thus, helpful in the early identification of infected citizens in particular communities. Greater patient autonomy is required in the process to hear the point of view of the patient on an individualised basis. This is very important from the point of view of reducing overall burden of TB for the population as a whole. A recent review found that costs to the patient of treating TB reveal that the financial burden of illness is relatively greater for patients in poorer countries that lack universal healthcare coverage [15]. The cost to the patient of treating multi-drug resistant TB is greater than treating drug-susceptible TB. Moreover, the financial burden of TB can result in income loss which is a large financial risk for patients [16]. An increase in poverty results in a risk in TB whereby the poor in India have a greater risk [17].
A Brief Summary of Plans for Tuberculosis in India
The government of India has come up with new strategic plan to combat against the rising TB issue. Specifically, a National Strategic Plan (NSP XXXXXXXXXX [18]. The NSP aims to completely eliminate the public health issue of TB from India, that is a TB free nation with no reported deaths. In order to reduce the rate of mortality and mo
idity the Indian government has outlined a four stage plan: detect, treat, prevent and build [19]. Specifically, the plan includes: i) identification of population groups that pose high risk of spreading TB infection and, the region or population group that may be sensitive to drugs or be resistant to anti-TB medicines (a high risk of spreading TB to the common masses); ii) treating the condition by providing the affected population with anti-TB medications and, offering the system approach and support on social grounds which, is formulated based on regimens on drug resistant TB [20]; iii) prevention via healthcare (such as helping patients adhere to the medications, nutritional support for patients and providing the means to sustain and improve immunity), schemes designed to treat the susceptible group of the community and, control of air-borne infections [21]; and, iv) build to strengthen relevant policies and infrastructures involved in this process, by providing an additional capacity for various human resources with focus placed on people living in slum dwellings, in refugee camps, night shelters and, old aged home care facilities [22]. In summary, TB disease is a serious public health issue which requires new approaches to combat this threat in developing nations.
References
[1] Martinez, L, Shen, Y, Mupere, E, Kizza, A, Hill, PC, Whalen, CC. (2017). “Transmission of Mycobacterium tuberculosis in households and the community: a systematic review and meta-analysis”. Am J Epidemiol, 185(12): XXXXXXXXXX.
[2] World Health Organization. (2019). “Global tuberculosis report for 2019”.
[3] Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, Sarin R, Paramasivan CN, Kumar P, Nischal N, Khatiwada S. (2017) “Index-TB guidelines: guidelines on extra-pulmonary tuberculosis for India”. The Indian Journal of Medical Research. 145(4): 448.
[4] Saravu K. and Pai M. (2019). “Drug-resistant tuberculosis: progress towards shorter