Central TB team finds several lacunae in Karnataka's case detection

In 2019, 8 per cent of the 90,264 people who contracted Tuberculosis (TB) -- 6,647 -- died of it. State health department officials cite data to say that the number of deaths have decreased. However, data revealed that in 2020, the state reported 67,451 cases while in 2021 so far, 56,734 cases have been reported, which are far fewer cases than those reported in 2019.

Hence, consequently fewer deaths have also been reported. While in 2020, 5,668 (8 per cent of the cases) succumbed to the bacterial disease, in 2021, 3,801 (6 per cent) died.

The lacunae in TB detection was exposed in a recent visit by the central TB team to Haveri district where only 71 per cent of the TB cases registered in 2020 were successfully treated and there was minimal referral of patients (0.9 per cent of the OPD) with chest symptoms for TB testing. Only 34 Primary Health Centres (PHCs) out of 68 PHCs have lab technicians, which is affecting case detection.

The seven-member central team also found that though there are 443 health facilities in the district, only 76 of them are notifying TB cases to the National Tuberculosis Elimination Programme (NTEP). Karnataka has an ambitious goal of eliminating TB by 2025, which seems far-fetched to be achieved in four years with decreasing case detection.

"Health workers continue to work on all activities other than TB," the team observed in their presentation to the state health department. TB staff had been reengaged in TB activities after the Covid pandemic ebbed.

The central team also remarked, "DR-TB (Drug resistant TB) committee is not in place. For a DR-TB ward, one to two beds have to be allocated in the district hospital." The team also visited Ballari district.

Among the challenges it recognised in Karnataka is the fact that the Patient-Provider Support Agencies (PPSA) -- an agency to manage end-to-end private-sector engagement and monitor the needs of private-sector patients which has been recommended as an effective model to reduce the burden of TB in India -- are still awaiting approvals in 12 districts.

Other issues the team noticed is the shortage of CBNAAT cartridges and other lab consumables required for TB testing, lack of approval for reagent rental model uptake, vacancies at the state TB cell, key vacancies at the district level (50 per cent PHCs in Haveri, for example, are without a lab technician), and unavailability of diagnostics, drugs and additional HR for effective rollout of Programmatic Management of Tuberculosis Preventive Treatment (PMTPT programme).

However, Dr Ramesh Reddy, Joint Director, TB, state health department, said deaths were high because those caused due to other comorbidities were being counted as TB deaths.

"Deaths due to comorbidities like HIV, diabetes, malnutrition, chronic alcoholism, accidents, suicide, cancer, and chronic obstructive pulmonary disease (COPD) are also included under TB deaths. Instructions have been issued to all districts to do death audits and submit them to the state. Because of poor death audits, we (TB wing) are getting more deaths," he said.