Globally, Tuberculosis (TB) is the second biggest global pathogen killer after HIV/AIDS. The World TB day observed on March 24 every year is marked out to build public awareness that tuberculosis today still remains an epidemic in much of the world leading to death statistics of nearly one-and-a-half million people each year and mostly in developing countries. The day commemorates the day in 1882 when Dr Robert Koch discovered the cause of tuberculosis, the TB bacillus. A century after Koch’s discovery in 1982, the International Union Against Tuberculosis and Lung Disease (IUATLD) proposed that March 24 should be officially known as World TB Day and the involvement of the World Health Organization in 1996 added the global thrust of the campaign to get political commitment towards addressing this public health issue. Though the toll that TB has taken on a global scale has decreased in developed countries, its impact on the health, social and economic aspects of countries in the third world is still high. In India today, two deaths reportedly occur every three minutes from tuberculosis. The other area of concern is that TB is in inter-related to the other major infection: HIV/AIDS. India’s TB burden throws up mind boggling numbers: Every year, 1.8 million people develop the disease or get the infection, of which about 800,000 are categoried as easily contagious while the death toll stands at 1,000 every day. The disease is a major barrier to social and economic development for it is estimated that a 100 million workdays are lost due to this illness. Society and the country also incur a huge cost due to TB—nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs.
Considering the toll taken by TB on lives in the country, the WHO-recommended Directly Observed Treatment, Short Course (DOTS) strategy was launched in India in 1997 after pilot testing from 1993-1996. Since then DOTS has been widely advocated in the country. India’s Revised National TB Control Programme (RNTCP) is the largest TB Control Programme in the world with more than 100,000 patients on treatment every month. Under the RNTCP, it is projected that more than 15,000 suspects are being examined for TB, free of charge every single day in India. The diagnosis of these patients and the follow-up of patients on treatment is achieved through examination of more than 50,000 laboratory specimens. Each day, about 3,500 patients are started on the treatment process, stopping the spread of TB in the community. In order to achieve this, more than 600,000 health care workers have been trained and more than 11,500 designated laboratory Microscopy Centres have been upgraded and supplied with binocular microscopes since the inception of the RNTCP.
This year’s theme of “Stop TB in my lifetime” is a continuation of the theme of last year and puts the spotlight on action on Government agencies and others to spread awareness and implement health and socio educational initiatives to put TB deaths at zero level. One of the Millennium Development Goals set out by the UN was to reduce the number of people contracting TB. According to Sam Nuttall of the Stop TB Partnership, an umbrella organization fighting the disease and organizer of World TB Day, a separate target set to reduce the death rate in Africa by half, in time for 2015 is not going to be met. This is due to the huge number of people in poor health who become more susceptible to the illness that links it further with HIV/AIDS infection , as well as cramped living conditions and limited access to treatment.
The emergence of drug-resistant TB still remains a major threat to worldwide treatment and control and demonstrates the its continued prevalence in the modern world. In Manipur too, the prevalence of HIV/AIDS infections, the lack of awareness of TB in remote areas presents challenges in the fight against this disease. The most common aspect also is that patients who are on DOTS often stop the treatment regimen thinking that they have been cured. More attention needs to be given towards rendering treatment adherence and to put in follow up mechanisms for people on DOTs so that there is no room for people to fall off the treatment radar and end up getting into relapse mode.