• UGI USER
  • Aug 04, 2024
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39% OF TB CASES IN T.N. SURVEY WERE ASYMPTOMATIC

Syllabus:

GS 2:

  • Government Policies and Interventions for Development in various sectors
  • Issues Relating to Development and Management of Social Sector/Services relating to Health

Why in the News?

The Tamil Nadu TB survey revealed that 39% of detected TB cases were asymptomatic, highlighting the importance of using chest X-rays in addition to symptom screening for comprehensive TB detection. This finding underscores the need for policy changes to improve early detection and curb TB transmission effectively.

Source:IE

Survey Findings

  • Survey Duration: The cross-sectional TB survey was conducted from February 2021 to July 2022, targeting individuals aged over 15 across Tamil Nadu.
  • Participants: Of the 130,932 participants, 130,914 underwent symptom screening, and 125,870 had both symptom screening and chest X-ray examinations.
  • Detection Methods: TB was confirmed using Xpert, smear microscopy, and liquid culture, identifying 244 microbiologically confirmed TB cases from the participants.
  • Symptom Statistics: Only 54.5% of the 244 TB cases reported having symptoms, while 92.6% showed chest X-ray abnormalities.
  • Molecular Tests: The CBNAAT test accurately detected 91.8% of TB cases, whereas smear microscopy detected only 50.40% of the cases.
  • Asymptomatic Cases: Significantly, 39% of TB cases detected were asymptomatic, underscoring the importance of chest X-rays for identifying subclinical TB.
What is Tuberculosis?

About

  • Definition: Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis, affecting various organs such as lungs, pleura, lymph nodes, intestines, spine, and brain.
  • Commonly Affected Areas: The most frequent sites of TB infection are the lungs, pleura (lining around the lungs), and lymph nodes.
  • Systemic Impact: TB can also impact the intestines, spine, and brain, showcasing its ability to affect multiple body systems.
  • Global Presence: TB is present worldwide, with higher prevalence in low- and middle-income countries.
  • Leading Infectious Killer: TB remains the world’s top infectious killer, despite being preventable and curable.
  • High-Risk Countries: About half of all TB cases are found in Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines, and South Africa.

Recommendations

  • Chest X-Rays: The Tamil Nadu TB programme should prioritize chest X-rays for early detection and cutting the transmission chain, given the high rate of asymptomatic cases.
  • Molecular Tests: Scale up the use of molecular tests like CBNAAT to enhance TB detection rates, addressing the current over-reliance on smear microscopy.
  • Policy Changes: Integrate chest X-rays in routine screening for all suspected TB cases, not just those with symptoms, for comprehensive detection.
  • High-Risk Groups: Expand active case finding to include chest X-rays for high-risk and vulnerable groups to improve TB detection rates significantly.
  • Increased Yield: Combining chest X-rays with molecular diagnostics will likely increase TB detection yield, particularly in asymptomatic cases.
  • Transmission Control: Early detection of subclinical TB through chest X-rays will significantly help in cutting the TB transmission chain in the community.

National Context

  • Active Case Finding: In 2022, active case finding screened 22.1 crore individuals, diagnosing only 2.5%, highlighting the need for better TB screening tools.
  • TB Incidence: With a TB incidence rate of 199 per 100,000, improved screening methods are essential for increasing TB detection rates across the population.
  • National TB Survey: The National TB Prevalence Survey (2019-2021) revealed that 42.6% of bacteriologically positive TB cases were asymptomatic.
  • Meta-Analysis Findings: A Lancet paper indicated that 27.7% of TB cases in high-burden countries were asymptomatic, contributing significantly to the TB burden.
  • Transmission Without Symptoms: Even in the absence of symptoms like cough, individuals can still transmit TB, emphasizing the need for comprehensive screening.
  • Screening Tools: The findings underscore the necessity of incorporating chest X-rays as a standard screening tool for TB, alongside molecular diagnostics.

Global Insights 

  • TB Prevalence: A 2021 paper in the American Journal of Respiratory and Critical Care Medicine highlighted that subclinical TB can drive significant transmission.
  • Droplet Transmission: TB can be transmitted through activities like talking, singing, and breathing, even without coughing, necessitating vigilance in asymptomatic cases.
  • Slow Decline in TB Incidence: Global TB incidence is dropping slower than TB deaths, suggesting that current measures are less effective in stopping transmission.
  • Subclinical TB Impact: Asymptomatic TB cases play a crucial role in ongoing transmission, highlighting the need for improved detection methods worldwide.
  • Transmission Dynamics: The paper emphasized that people with subclinical TB could have high bacillary loads, driving transmission without exhibiting typical symptoms.
  • Effective Measures: Enhanced TB screening strategies, including the use of chest X-rays and molecular tests, are critical for more effective TB control globally.

Challenges in Meeting Targets 

  • Ambitious Goals: Despite ambitious goals to eliminate tuberculosis (TB) by 2025, India has struggled to meet these targets.
  • Shortfall in 2023: The recorded TB cases and deaths in 2023 fell short of the country’s set targets.
  • Risk Factors: Various risk factors contribute to TB incidence and treatment outcomes, including undernourishment, HIV, diabetes, alcohol use, and smoking.
  • Undernourishment: In 2022, nearly 7.44 lakh TB patients were undernourished. The government provides Rs 500 monthly to nearly one crore beneficiaries to improve nutrition.
  • Ni-kshayMitra Programme: The programme encourages the donation of food baskets to support TB patients.
  • HIV Impact: People with HIV have a 20-times higher risk of developing TB. In 2022, 94,000 TB patients in India had HIV.

Way Forward/ Action Steps

  • Policy Implementation: Tamil Nadu and other high-burden regions should implement chest X-ray screening for all suspected TB cases, not just symptomatic individuals.
  • Public Awareness: Increase public awareness about the significance of chest X-rays and molecular tests in detecting TB, especially subclinical cases.
  • Healthcare Training: Train healthcare workers on the importance of using chest X-rays and molecular diagnostics for comprehensive TB screening and detection.
  • Funding and Resources: Allocate resources to scale up the use of advanced TB detection methods, ensuring widespread availability and accessibility for effective control.
  • Collaborative Efforts: Foster collaboration between state health departments, national TB programmes, and international health organizations to enhance TB detection and control.
  • Comprehensive Screening: Advocate for a combined approach using symptom screening, chest X-rays, and molecular diagnostics to effectively identify and manage TB cases.

Conclusion

The Tamil Nadu TB survey’s findings emphasize the critical role of chest X-rays in identifying asymptomatic TB cases. Implementing this screening method alongside molecular tests can significantly enhance early detection, reduce transmission, and contribute to achieving TB elimination goals, necessitating urgent policy revisions and resource allocation.

Source:Indian Express

Mains Practice Question:

Discuss the significance of the Tamil Nadu TB survey findings in the context of TB detection and control. How can the incorporation of chest X-rays in routine screening improve TB management? Evaluate the policy implications and suggest measures to enhance TB detection and prevention in India.

Associated Article:

https://universalinstitutions.com/tuberculosis-tb/