WHO: India home to more than half of multi-drug resistant tuberculosis cases

India accounts for more than half the cases of South East Asia’s multi-drug resistant tuberculosis that kills in thousands every year, particularly claiming patients who   frequently change doctors and fail to complete the two-year treatment regimen.

The number of multi drug resistant tuberculosis patients alone was estimated as 63,000 in 2010, the World Health Organisation said in its 2012 TB report for South East Asia, released on Thursday ahead of World TB Day on March 24.

The prevalence of MDR-TB is estimated to be 2.3 per cent among new cases and 12-17 per cent among repeat treatment cases in India.

Because of its large population and high annual incidence, India ranks second among 27 MDR-TB high-burden countries, after China.

The union health ministry started supporting treatment of drug resistant TB in a limited way in 2007. As of September 2011, as many as 34 states are providing MDR-TB diagnostic and treatment services and 5,810 drug-resistant patients are on treatment.

While treatment for MDR-TB usually takes 18-24 months, one-third of the patients die owing to the heavy dose and attendant complications. Inconsistent treatment breeds drug-resistant strains that increasingly defy current medicines.

Cross infection

“Irrational treatment by the private sector is one cause. But cross infection of existing patients with drug resistant strains due to poor infection control at health posts, hospitals and in public transport is also a sure way of acquiring drug resistance TB,” Nerges Mistry, director of Mumbai-based The Foundation for Medical Research, told Deccan Herald.

India is the world’s highest TB burden country accounting for a quarter of all new TB cases. More than 3,70,000 people die of TB in India every year, which translates to 1000 TB deaths per day.

“But despite the heavy disease burden there appears to be a stigma associated with  visiting DOTS centre in government hospitals and clinics. As a result many people hop from one doctor to another and do not complete their treatment regimen,” said Ashok Kumar, deputy director general in charge of the government's revised national TB control programme.Treatment with first line drugs needs to be continued for 6-9 months for remission whereas resistance cases need prolonged treatment.

Absence of a reliable diagnostic system further complicates the scene as the common diagnostics like sputum microscopy and chest X-ray can only detect half of all active TB cases and cannot pick up MDR cases at all.