In what should come as a warning signal for the government, India's annual burden of tuberculosis cases could stand at over 3.8 million, roughly twice the 2.2 million a year estimated in 2014, a new study has claimed.
Fresh data from the study, conducted jointly by the Indian government, the Imperial College of London and the Bill & Melinda Gates Foundation, contends that the anomaly is due to the massive under-reporting of TB cases – partly due to deficiencies in the monitoring system and partly due to the ;lack of coordination between the public and private healthcare systems.
The study further confirms that more Indian TB patients seek treatment in the private sector than the public sector. This excludes drug-resistant TB cases.
The findings were published on Thursday in The Lancet Infectious Diseases journal.
TB, a major global public health challenge, is a bacterial infection which is spread through inhaling tiny droplets from cough or sneeze of an infected person.
In 2014, 6.3 million TB cases were reported worldwide, with India accounting for over 25 pc of them - the highest for any country.
However, the new findings suggests that that the actual number of cases in India is under-reported.
In the absence of quality surveillance data on privately treated patients, state and national level estimates for 2013 and 2014 for the number of TB cases in India’s private healthcare system were found by calculating nationwide sales of TB drugs across the private sector.
The study made use of the commercial drug sales data sold in India between 2013 and 2014, collected by the organisation IMS Health.
Using data of drug sales collected it was found that India's TB burden in 2014 was 3.8 million instead of 2.2 million.
Researchers estimated the treatment volume, or the total patient-months of treatment for TB in the private sector, taking into account the proportion of prescriptions for a given drug that were for TB, as well as the proportion of total drug sales.
There was double the difference of TB treatment in the private sector as in the public sector across the nation.
Dr Arinaminpathy, lead author of the study, warned that under-reporting could have worrying implications for the emergence of drug-resistant strains of TB.
“Multi drug-resistant TB (MDR-TB) is a global worry, and the large number of cases of TB estimated in our study further fuels concerns about how we can control drug resistance. In the private sector, evidence suggests that patients are sent off with their medication without advice or support. As patients feel better within a couple of weeks they often stop taking the medication in between. However completing the course is key to effective treatment.”
All we can say is that there is an urgent need to not only make efforts to address the burden of TB treated by the private sector in India, but also to make improvents in surveillance of the private sector, as well as improve its cooperation with the public sector in India.