Although several positive strides such as increased access to treatment and more accurate molecular diagnostics have been made by India towards the goal of eliminating tuberculosis by 2025, five years ahead of the global target, it continues to have the highest incidence of the bacterial infection. India accounts for 27 per cent of the total TB cases in the world, according to the recently released Global TB Report 2023 by the World Health Organisation.
The report noted two positive trends for India. One, there was an increase in reporting of TB cases, crossing even the pre-pandemic high with 24.2 lakh cases in 2022. Two, the coverage of treatment for the infection increased to 80%. The most important data point for India, however, was mortality due to TB.
What does the 2023 report say about mortality in India?
A sudden drop in mortality due to TB was noted in the 2023 report. This was owing to the WHO report accepting India’s Sample Registration System dataset as the basis for the calculations instead of the Global Burden of Disease report.
With the change in dataset, India’s TB mortality dropped from 4.94 lakhs in 2021 to 3.31 lakhs in 2022. This resulted in a reduction in India’s contribution towards global mortality from 36 per cent in the previous years to 26 per cent in 2022.
The Union Health Ministry in a statement said that the data in Global TB Report 2022, which presented the figures from 2021, was published as “interim” with an understanding that the inter-government agency will work with the technical team of the ministry to finalise the figure. India presented newer evidence, the in-country mathematical modelling for estimating burden, and data from the government’s Ni-Kshay portal that captures data for the entire duration between a person being diagnosed with TB and completing their treatment.
“There were more than 50 meetings between the technical teams of WHO and the Ministry of Health & Family Welfare… The WHO team intensively reviewed all data presented and not only accepted, but also appreciated the efforts made by the country. This year, the Global TB Report has acknowledged and published the revised estimates…” the statement said.
How many people get TB in India?
Nearly 2.82 lakh people got TB in India in 2022, meaning one person gets TB every 11 seconds in India, according to the report. India’s contribution to the global burden is 27%, which is down one percentage point from the previous year’s 28%.
What is more important is that there has been an increase in reporting of TB cases. The estimated number of cases in a country is based on a mathematical model, and there is a gap between that and the number of people who actually get diagnosed and put on treatment in a country.
The Global TB report 2023 shows that reporting of cases has improved in India, going beyond the pre-pandemic levels. This is despite the fact that India, along with Indonesia and the Philippines, accounted for 67 per cent decline in reporting of TB cases globally during the pandemic. India reported 24.2 lakh cases in 2022 similar to the 24.04 lakh cases reported during 2019.
The report also noted that India was the only country to have completed a National TB prevalence survey since 2019. “The survey was started in 2019, interrupted for several months in 2020 and then completed in 2021. Results from this survey were a key input to the estimates of TB incidence in India published in this report,” the WHO report said.
What does the report say about coverage of TB treatment in India?
The report acknowledged an increase in coverage of TB treatment in India, increasing by 19 per cent over the previous year. In fact, India was among only four countries among the 30 high-burden countries in the world that were able to achieve more than 80 per cent treatment coverage.
Globally, the report notes, the treatment coverage in 2022 reached the pre-pandemic levels of 70%.
The Union Health Ministry said that India has undertaken several initiatives towards TB elimination including active case finding, scaling up of more accurate molecular testing to block level, screening services made available through the health and wellness centres, and engagement of the private sector as well. The government also said that the Ni-kshay Mitra where people provide additional nutritional support to TB patients has also resulted in the adoption of over 11 lakh TB patients. This support is in addition to government’s R500 nutritional support.
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What is India’s TB elimination target?
India has set a target of 2025 for eliminating TB in the country. The national strategic plan 2017-2025 sets the target of no more than 44 new TB cases per lakh population by 2025. The 2023 report pegs this number at 199 cases per lakh. Achieving this target is a big task as the plan had envisaged an incidence of only 77 cases per lakh population by 2023.
The programme also aims to reduce the mortality to 3 deaths per lakh population by 2025. Even with the WHO accepting the lowered estimates for India, this stands at 23 per lakh population.
|Pre-pandemic (TB Report 2020)||Previous TB Report 2022||Present TB Report 2023|
|Estimated TB cases||26.4 lakh||29.6 lakh||28.2 lakh|
|Percentage of global burden||26%||28%||27%|
|Mortality||4.36 lakh||4.94 lakh||3.31 lakh|
|Percentage of global deaths||36%||36%||26%|
|Drug-Resistant TB||1.16 lakh||1.19 lakh||1.10 lakh|
|Percentage of global drug-resistant TB||27%||26%||27%|
(Data via WHO Global TB Reports)