Number of TB patients may be higher than official count

 The number of tuberculosis patients may be up to two to three times higher than the official estimate.

The discrepancy is because lakhs of people with TB symptoms are treated by private doctors, escaping the government's TB control programme that maintains the records.

The official estimates suggest India being home to 14-15 lakh TB patients, the highest in the world. But, a new public health research now suggests that even on a conservative estimate, the number could be as high as 36 lakh in 2014.

The number was deduced from the sale figure of 189 tuberculosis drugs, which are marketed only in the private sector.

These medicines are not used in the government’s revised national tuberculosis control programme.

If 40-60% of private sector tuberculosis diagnoses are correct and if the TB treatment in the private sector lasts for 2-6 months on an average, then an estimated 22 lakh TB cases were treated by the private sector alone in 2014.

In addition, more than 14 lakh TB patients were treated in the government clinics.
The researchers, who made the fresh estimate, include officials from the union Health Ministry’s central TB division and the World Health Organisation.

“We have little idea on the true scale of the problem in India, the country most affected by TB. This is because many patients in India use the private medical system as opposed to the state system,” said Nimalan Arinaminpathy, lead researcher at the Imperial College, London.

“However, this vast private system is largely unregulated, which means most cases of TB seen in the private healthcare system are not reported to public health officials,” he said.

Because of such under-reporting, the Health Ministry made TB a notifiable disease in May 2012, making it mandatory for private doctors, hospitals and pathology units to report TB cases to the government.

The responses were lukewarm in the first two years. Less than 3,000 cases were reported in 2012 and just under 39,000 cases were reported in 2013.

In 2014, the notification of tuberculosis cases by the private sector to public health authorities accounted for 106,414 patients, a level still far below the estimated one, they reported in the August 25 issue of the Lancet Infectious Disease.

The findings highlighted the need to tap the private healthcare sector for a successful TB control programme as frequent switching of private doctors has been found to be one of the key reasons driving multi-drug resistance TB in India.

In another study, a second group of researchers showed that pharmacists rarely referred persons with classic TB symptoms to doctors, but they also don’t dispense first-line anti-tuberculosis drugs.