"This high mortality for a disease that is treatable is of concern. TB mostly affects people who are in the 25-55 age group, which is an important economically productive one. If we calculate the economic loss to the country because of TB deaths- with people in economically productive age group falling ill and some even dying of TB- then it could be a huge economic burden as well. If we add secondary costs, then it would be way more," said Dr Swaminathan. "But more important than economic loss are those individuals who die of a preventable and treatable illness. We must do our best to understand the data and do proper analysis of TB deaths."
Dr Swaminathan shared an example from Tamil Nadu, a southern Indian state where the state government has partnered with National Institute of Epidemiology (an institute of Indian Council of Medical Research) to audit TB deaths and help improve clinical management of TB patients to avert such deaths in future.
Dr Swaminathan reflected that people need to get the right care at the right time. They may have TB disease but they also have other conditions, such as severe malnourishment, high blood pressure, diabetes, other co-morbidities, or they come from such a poor background that they cannot access the care they need. TB-related stigma lurks even today which further jeopardises equitable access to care and services.
Alcoholism is another major risk factor for TB, she said. "I have been to hospital wards and seen how people become sick or non-adherent to therapy due to alcoholism." If we can identify early on, other co-morbidities or conditions a person with TB has then we can perhaps try to tailor our care and services to help and support them finish their TB treatment.
She rued that "Very often hospitals refuse admission for TB patients for one reason or the other." Hospitals must not refuse admission to needy TB patients. She advises that TB related hospital admission and care should be covered with Indian government health insurance scheme so that hospitals get compensated for admitting and caring for a severely ill person. Once a person is admitted in the hospital then the medical management can try to address specific needs, such as nutritional support, insulin for those with diabetes, help quitting alcoholism, among others.
In tribal areas of India, TB patients are more likely to have severe malnutrition and severe anaemia. "I have looked at death reports from the tribal districts of India. Young female patients of 21-23 years of age have died of drug-sensitive TB with no underlying co-morbidities." A sincere TB death audit can help us avert such tragedies in future.
Dr Swaminathan hopes that in the next National Strategic Plan to end TB of government of India, we would find these gaps that put people at risk of TB death and address them effectively. We also need to have a similar approach in other southeast Asian countries as well, she said. "Reducing TB mortality significantly can be achieved."
Learnings must come from people on the ground
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