Tuberculosis is a major public health problem in developing countries like India. Dr Robert Koch discovered TB bacilli, the causative agent of Tuberculosis on March 24, 1882. The World Health Organisation held the first “World TB day” to commemorate the 100th anniversary of Dr Robert Koch’s discovery on March 24, 1982.
Epidemiology: Tuberculosis remains a major cause of morbidity and death from infectious diseases for children of all ages globally, particularly in young children. As per the Global TB Report 2021, about 3.06 lakh children(0-14 years of age) are estimated to suffer from TB every year, accounting for about 11 per cent of total estimated TB cases reported to the NTEP. In India, childhood Tuberculosis remains a staggering problem, contributing to approximately 31 per cent of the global burden. Over the last decade consistently, children constitute 6-7 per cent of all the patients treated under NTEP annually pointing to a gap of 4-5 per cent in total notification against the estimated incidence.
Over 22 crore people screened for TB in 2021 across the country for early detection and treatment of TB Under the new initiative Pradhan Mantri TB Mukt Bharat Abhiyan, more than 40,000 Nikshay Mitra supporting over 10.45 Lakh TB patients all over the country.
During the Covid19 pandemic, a significant reduction was observed in the total number of Drug-resistant TB(DR-TB) patients who started treatment as compared to 2019. In 2020 and 2021, there was a reduction of 14 per cent and 9 per cent in the number MDR patients put on treatment.
As per Nikshay, the total number of reported deaths among DS-TB patients notified in 2020 was 76002(4.3 per cent of the total notifications of 2020) which is 15.4 per cent of the estimate for the country, thus emphasising the importance of establishing a “TB Death Surveillance and Response” system in line with the maternal mortality surveillance to improve the coverage and real-time resolution of lacunae including the system related factors.
Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.
The National TB elimination program (NTEP) has consistently boosted its capacity to address TB. The programme has encouraged best practices and success stories designed and implemented at various levels of healthcare delivery, whether as a response to a particular health outcome.
Comorbidities like malnutrition, diabetes, HIV, and passive smoking impact a person with TB in predisposition and severity.
Prevention is one of the four critical pillars (Detect – Treat – Prevent – Build) of India’s National Strategic Plan for Elimination of Tuberculosis (NSP 2017-25) that focuses on preventing the emergence of TB in a vulnerable population.
The program has offered TB Preventive Therapy (TPT) for more than a decade, albeit limitedly to children below the age of six years and People living with HIV/AIDS (PLHIV) for the past few years. However, to reinforce the goal of Ending TB by 2025 by accelerating preventive measures like the TPT, the NTEP has taken a monumental leap in 2021 by expanding the policy to offer TPT to all household contacts (HHC) of index pulmonary TB patients irrespective of their age, and other risk groups.
To overcome the challenges a long treatment entails, a new shorter TPT regimen with three months of weekly Rifapentine and Isoniazid (3HP) has been recommended as an alternative to six months of daily life Isoniazid regimen (6H). These policy decisions and their implementation are summated with the release of (Programmatic Management of TB Preventive Treatment (PMTPT) in India.) To establish pathways for early detection of children with TB symptoms and track them for early diagnosis and treatment initiation, the programme, in collaboration with the Rashtriya Bal Swasthya Karyakram(RBSK) and Rashtriya Kishor Swasthya Karyakram(RKSK), launched the “Collaborative Framework to Address the Burden of Tuberculosis among Children and Adolescents.” This integrated framework endeavours to enhance community awareness of childhood TB, generate demand, and promote disease prevention and early health-seeking.
Paediatric Drug-Resistant Tuberculosis: The dearth of paediatric DR-TB data remains a challenge both globally and nationally. Only 12,200(11 per cent ) of the target of 1,15000 was achieved globally for the pediatric age group. MDR-TB in children reflects MDR-TB in adults and, therefore, is common in settings where the MDR-TB pool exists in adults. Transmission of drug-resistant TB(DR-TB) in children is mainly from close contact with a confirmed MDR-TB patient (usually an adult or adolescent) and less commonly through previously inadequate TB treatment.
Indian Academy of Paediatrics(IAP) has helped in this regard by building paediatricians’ capacity in the public and private sectors through Continued Medical Education sessions (CME) and training workshops.
Under the NTEP following schemes are currently ongoing:
◄ Nikshay Poshan Yojana(NPY)
◄ Transport support for TB patients in notified tribal areas
◄ Honorarium for Treatment Supporters
◄ Notification & Treatment Outcome.
Author:
Dr Sudha Rudrappa,
Former Professor and HOD, Pediatrics,
Medical Superintendent, Cheluvamba Hospital,
Mysore Medical College & Research Institute,
Mysore
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