Saturday, April 13, 2024

Combatting tuberculosis challenges in Tribal India

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As a deadly disease that appears to ‘consume’ or waste away the body mass (hence earning it the moniker of ‘consumption’ in the 17th Century), tuberculosis (TB) is still one of the major reasons for ill health and a leading cause of death worldwide. Caused by Mycobacterium tuberculosis, this communicable infectious disease primarily affects the lungs and it spreads through the air when someone with active TB disease coughs, sneezes, or even speaks and others nearby breathe in the bacteria.

Understanding tuberculosis
According to the World Health Organisation, TB is the second leading infectious killer after COVID-19 (above HIV and AIDS) causing around 1.3 million deaths in 2022 alone. And India accounts for around 25% of the global TB burden.
Some common symptoms of TB disease include a persistent cough that lasts three weeks or longer, coughing up blood or phlegm from the lungs, chest pains, weakness, weight loss, fever, and night sweats. Luckily, a course of anti TB medications lasting between six to nine months can help with treating the disease and helping the affected people live better lives.
Despite many efforts such as the BCG vaccine and good treatment options, TB remains a major global health problem, especially in developing nations where poverty, malnutrition, HIV/AIDS, and lack of access to healthcare fuel its spread. Some strains of TB developing drug resistance could also contribute to the high disease burden.

More TB among tribals
This high burden appears to be more prevalent in the tribal population in India, according to a 2024 review in the journal Lung India. Experts reviewed around 914 articles published between January 2000 and March 2023 on tuberculosis to understand the disparity in the prevalence of TB across various populations. The review found that the prevalence of TB was found to be higher in the tribal communities than the national prevalence.
The tribal population makes up around 8.9% of the entire Indian population and there are several discrepancies in the health status of the former to the latter. This can be attributed to several factors such as

1. Health services cannot cater well to the patients due to inconvenient operating hours.

2. The community is not as involved with healthcare organisations
3. Non-tribal health staff are unable to engage and converse effectively with the tribal population due to cultural barriers

4. Low incentives for community health workers such as the ASHAs which lead to poor motivation and commitment.

5. Shortage of essential medicines at health facilities

6. Lack of qualified doctors and medical staff

7. Delays in receiving test results.

8. Inadequate screening and preventive treatment for those exposed to TB patients.

9. Lack of residential facilities for health staff affects how the services are provided.

Apart from these, there are socio-cultural factors, such as belief in faith healing, poor nutrition and housing, poor knowledge about government schemes, addiction, difficult terrains, and lack of transportation facilities which also contribute to the higher prevalence of TB in the tribal population.

Experts in the review estimate a high TB prevalence of 894.4 cases per 1,00,000 people among tribal populations, with Jabalpur in Madhya Pradesh having the highest burden. Pulmonary TB is more prevalent among tribals at 703 cases per 1,00,000, compared to 316 cases per 1,00,000 in non-tribal populations. This review underscores not only the disparity in healthcare access between tribal and non-tribal communities but also highlights a knowledge gap regarding population-level TB prevalence data.

Combating TB burden
Efforts are underway to reduce the TB burden in India’s tribal populations. The health and tribal affairs ministries launched the Tribal TB Initiative in 2021 prioritising TB hotspots in tribal areas. The “Aashwasan” campaign in 2022 focused on COVID-19 awareness and finding out TB cases.
A National Technical Support Unit for Tribal TB was established by the Piramal Swasthya Institute with USAID support, collaborating with central TB and tribal affairs divisions. They are looking at high-transmission tribal areas so as to provide the necessary preventative therapies for the highly contagious disease.
Along with the Nikshay Poshan Yojana nutrition support, incentives for offering treatment, private providers, and transport services in notified tribal areas have been introduced. Under the Tribal Support Scheme, notified TB patients in tribal regions receive a one-time Rs.750 financial incentive.
These initiatives aim to bridge gaps in TB care access, case detection, and support systems for tribal communities severely affected by the disease burden.

(The author, Dr G. Uday Kiran, is a Consultant – Pulmonary Medicine and Respiratory Sciences, in Manipal Hospitals, Vijayawada.)

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