Tuberculosis in India

Last updated
tuberculosis patient Depiction of a tuberculosis patient.png
tuberculosis patient

Tuberculosis in India is a major health problem, causing about 220,000 deaths every year. In 2020, the Indian government made statements to eliminate tuberculosis from the country by 2025 through its National TB Elimination Program. Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.

Contents

India bears a disproportionately large burden of the world's tuberculosis rates, with World Health Organization (WHO) statistics for 2011 giving an estimated incidence figure of 2.2 million cases for India out of a global incidence of 9.6 million cases. [1]

Tuberculosis is one of India's biggest health issues, but what makes this problem even worse is the recent discovery of Totally Drug-Resistant Tuberculosis, TDR-TB. This issue of drug resistance began with MDR-TB, moved to XDR-TB and, as of 2021, has grown to embrace the most dangerous form, TDR-TB. [2] [3]

The cost of this death and disease to the Indian economy between 2006 and 2014 was approximately US$1 billion. [4]

Epidemiology

Children have special needs both in preventing and treating tuberculosis. Tuberculosis checkup for child India 2009.jpg
Children have special needs both in preventing and treating tuberculosis.

Tuberculosis is one of India's major public health problems. According to World Health Organization (WHO) estimates, India has the world's largest tuberculosis epidemic. [5] In 2020, India accounted for 26% of the incident TB cases across the globe. India has incidence rate of 192 cases per 100,000 of population. India accounted for 38% of global TB deaths among HIV-negative people and for 34% of the combined total number of TB deaths in HIV-negative and HIV-positive people. Further in 2020, India accounted for 24% of global gap between estimated TB incidence and the number of people newly diagnosed with TB and reported. [6] Many research studies have investigated the effects and consequences of TDR-TB, especially in India, where social and economic development is still in progress. A report by Zarir Udwadia, originating from studies at the Hinduja Hospital in Mumbai, discusses the drug-resistant effects and results. [7] An experiment was conducted in January 2012 on four patients to test how resistant and unique the “new category” of TDR-TB is. These patients were given all the first-line drugs and second-line drugs that usually are prescribed to treat tuberculosis, and were resistant to all. As a response, the government of India appeared to stay in denial, while the WHO decided that although patterns of drug-resistance were evident, there was insufficient evidence to create a new category of TDR-TB from these results. [8]

Compared to India, Canada has about 1,600 new cases of TB every year. [9] Citing studies of TB-drug sales, the government of India now suggests the total has gone from being 2.2 million to 2.6 million people nationwide. [10] On March 24, 2019, TB Day, the Ministry of Health & Family Welfare of India notified that 2.15 million new tuberculosis patients were discovered only in 2018. [11]

In India, tuberculosis is responsible for the death of every third AIDS patient. Moreover, India accounts for about a quarter of the global tuberculosis burden. [11] The ministry reiterated their commitment to eliminating tuberculosis in the country by 2025. [11] As part of its efforts to eliminate tuberculosis, the Union Government changed the name of Revised National Tuberculosis Control Program (RNTCP) to National Tuberculosis Elimination Program (NTEP) on December 30, 2019. [12]

Cause and symptoms

The bacterium that causes TB is called mycobacterium tuberculosis. A person can unknowingly acquire this bacteria and have it lie dormant within them, a condition known as inactive tuberculosis. Active tuberculosis begins when the bacteria starts developing, and the signs and symptoms begin to be visible. Although the TB bacteria can infect any organ (e.g., kidney, lymph nodes, bones, joints) in the body, the disease commonly occurs in the lungs. [9] Around 80% of all TB cases are related to pulmonary or lung.

Common symptoms include: coughing (that lasts longer than 3 weeks with green, yellow, or bloody sputum), weight loss, fatigue, fever, night sweats, chills, chest pain, shortness of breath, and loss of appetite.

Additional causes

Scanning electron micrograph of Mycobacterium tuberculosis Mycobacterium tuberculosis.jpg
Scanning electron micrograph of Mycobacterium tuberculosis

Susceptibility to tuberculosis is heightened by a weak immune system. That is why babies, children, and senior adults have a higher risk of developing TB. [9] The bacterium spreads in the air sacs and passes into the lungs. Coughing, sneezing, and even talking to someone can release the mycobacterium into the air, and a person's chances of becoming infected are higher in countries where TB is common and where there is a big proportion of homeless people. [9] India, having the most TB cases of any country, [13] clearly falls into this category.

Socioeconomic Dimensions of TB

Local decreases in the incidence of tuberculosis in India correlate with improvements in social and economic determinants of health more than with access to quality treatment. [14] In India, pollution is widespread throughout the country. Pollution causes many effects in the air that people breathe, and since TB can be passed from person to person through the air, the chances of catching TB remain high in many parts of India. [15]

Lack of infrastructure

Another major cause for the growth of TB in India has to do with its standing as a developing country. A study of Delhi slums has correlated higher scores on the Human Development Index and high proportions of one-room dwellings tend to correlate with TB at higher rates. [16] Poorly built environments, including hazards in the workplace, poor ventilation, and overcrowded homes have also been found to increase exposure to TB [14]

Lack of access to treatment

Another major reason for the high incidence of TB in India is because the majority of those infected are not able to afford the treatment drugs prescribed. “At present, only the 1.5 million patients already under the Indian government's care get free treatments for regular TB. That leaves patients who seek treatment in India's growing private sector to buy drugs for themselves, and most struggle to do that, government officials say.” [10] Although the latest phase of the state-run tuberculosis eradication program, the Revised National Tuberculosis Control Program (RNTCP), has focused on increasing access to TB care for poor people, [13] the majority of poor people still cannot access TB care financially. [17] “It is estimated that just 16% of patients with drug-resistant TB are receiving appropriate treatment”. [18] To combat this huge problem, India has begun a new program to try to provide free drugs to all those infected in the country. [10]

While RNTCP has created schemes to offer free or subsidized, high quality TB care, less than 1% of private practitioners have become fully involved. [17] This is exacerbated by a lack of education and background information which practitioners and professionals hold for prescribing drugs, or those private therapy sessions. A study conducted in Mumbai by Udwadia, Amale, Ajbani, and Rodrigues, showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR-TB. [19] Because the majority of TB cases are treated by private providers, and because the majority of poor people access informal (private) providers, the RNTCP's goals for universal access to TB care may have difficulty being met. [17]

Poor health

Poverty and a lack of financial resources are also associated with malnutrition, poor housing conditions, substance misuse, and HIV/AIDS incidence. These factors often contribute to a weakened immune system and are accordingly correlated with a higher susceptibility to TB. [14] They also tend to have a greater impact on people from high incidence countries such as India. [20] Indeed, addressing these factors may have a stronger correlation with decreased TB incidence than removing the financial burdens associated with care. [14] Yet, the RNTCP's treatment protocols do not address these social determinants of health. [14]

Treatment

Although tuberculosis is on the rise in India, treatment for it is also on the rise. To prevent spreading TB, it is important to get help quickly and to follow the treatment from your doctor through to completion. This can stop transmission of the bacteria and the appearance of antibiotic-resistant strains. Bacterial infections like tuberculosis require antibiotics for treatment and prevention; thus, commonly, you will see that patients diagnosed with tuberculosis have certain pills and antibiotics carried around with them. The antibiotics most commonly used include isoniazid, rifampin, pyrazinamide, and ethambutol.The treatment under the National TB Elimination Program (NTEP) in India consists of a 2 (HRZE)/4(HRE) anti-TB regime wherein INH, Rifampicin, Pyrazinamide, and ethambutol are given for an initial two months(intensive phase) followed by four months of INH, Rifampicin and Ethambutol. This treatment is a daily Fixed-dose combination-based treatment regime. It is crucial for a patient to take the medication that their doctor prescribes and to continue taking it for the full course of the treatment (which may last for months or even years). This will help to ward off types of TB bacteria that are antibiotic-resistant, which take longer and are more difficult to treat. [9] In India, the majority of infections are of a type that is resistant to regular antibiotic treatment (MDR-TB, XDR-TB, TDR-TB); therefore, rather than one or two medications, a combination of different medications will be prescribed over a course of between 18 and 24 months, depending on how deep the infection is. Since the 1960s two drugs, isoniazid and rifampicin, have been the standard TB treatment. [18] In addition to antibiotics, a vaccine is available to limit the spread of bacteria after TB infection. This vaccine is generally used in countries or communities where the risk of TB infection is greater than 1% each year, [9] which includes parts of India. [18] In the past, treatment modalities in the public sector in India did have some drawbacks. [21] However, recently there has been a significant improvement in TB healthcare services in the public sector. The National TB Elimination Program (NTEP) in India has broadened its spectrum, in addition to providing free diagnostic and treatment services for drug sensitive as well as drug resistant forms of tuberculosis. The program is currently also targeting the TB Preventive therapy in vulnerable population with TB infection, who are at an increased risk of progressing to active TB disease.

70-80% of TB patients first visit the private sector, where the diagnostic and treatment services of TB are suboptimal and need to be improved. [22] [23] Directly observed therapy (DOT) has been helpful to increase adherence and reduce resistance. In recent years, as smartphone usage and accessibility to low-cost internet services have gained traction in India, perceptions of alternative services such as SMS reminders, voice calls and video DOT (vDOT) have been explored and shown to be acceptable to a variety of patient population thus saving time and money. [24]

History

India's response to TB has changed with time and with the increasing sophistication of technology. [25] Responses to TB have evolved, from pre-independence through post-independence to the current WHO-assisted period. [25] The first national study of tuberculosis was carried out by Arthur Lankester in 1914. [26] [27]

Following Independence, the Indian government established various regional and national TB reduction programmes. [25] The Indian government's Revised National TB Control Programme (RNTCP) started in India during 1997. The program used the WHO-recommended Directly Observed Treatment Short Course (DOTS) strategy to develop ideas and data on TB treatment. This group's initial objective was to achieve and maintain a TB treatment success rate of at least 85% in India among new patients. [28] [ unreliable source? ]“In 2010 the RNTCP made a major policy decision that it would change focus and adopt the concept of Universal Access to quality diagnosis and TB treatment for all TB patients”. [29] By doing so, they offered a helping hand to all people diagnosed with TB, by providing better quality services and improvement in therapy for these patients.

The contemporary response to TB includes India's participation and leadership in global TB reduction and elimination programs. [25] Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated “within the confines of government-sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis”. [18] Given this conclusion by Udawadai, et al., it is considered certain, as of 2012, that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever. [10]

Society and culture

Organizations

The Tuberculosis Association of India is a voluntary organization that was set up in February 1939. It is affiliated to the government of India and is working with the TB Delhi center. [30]

Laboratories

The Revised National Tuberculosis Control Program (RNTCP) has established a network of laboratories where TB tests can be done for purposes of diagnosis and to determine whether a person has drug-resistant TB. The laboratory system comprises the National Reference Laboratories (NRLs), state level Intermediate Reference Laboratories (IRLs), Culture & Drug Susceptibility Testing (C & DST) laboratories and Designated Microscopy Centres (DMCs). Some private laboratories are also accredited as Culture & Drug Susceptibility Testing laboratories for tuberculosis (i.e. Microcare Laboratory & tuberculosis Research Centre, Surat)

Stigma

Disempowerment and stigma are often experienced by TB patients as they are disproportionately impoverished or socially marginalized. [31] The DOTS treatment regimen of the RNTCP is thought to deepen this sentiment, [32] as its close monitoring of patients can lead to stigma. To counteract disempowerment, some countries have engaged patients in the process of implementing the DOTS and in creating other treatment regimens that give more attention to their nonclinical needs. This knowledge can complement the clinical care provided by the DOTS. [33] Pro-poor strategies, including wage compensation for time lost to treatment, working with civil society organizations to link low income patients to social services, nutritional support, and offering local NGOs and committees a platform for engagement with the work done by private providers may reduce the burden of TB [34] and lead to greater patient autonomy.

Economics

Some legal advocates have argued that public interest litigation in India must be part of the TB response strategy to ensure that available resources actually fund the necessary health response. [35] India has a large burden of the world's TB, with an estimated economic cost of US$100 million lost annually due to this disease. [36]

Special populations

How Scheduled Tribes and other Adivasi are coping with TB highlights a lack of research and understanding of the health of this demographic. [37] [38] There is a belief that this community is more vulnerable and has less access to treatment, but details are lacking on how TB affects tribal communities. [37] [38]

Related Research Articles

<span class="mw-page-title-main">Tuberculosis</span> Infectious disease

Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis. Around 10% of latent infections progress to active disease that, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss. Infection of other organs can cause a wide range of symptoms.

<span class="mw-page-title-main">Thioridazine</span> Typical antipsychotic medication

Thioridazine is a first generation antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis. The branded product was withdrawn worldwide in 2005 because it caused severe cardiac arrhythmias. However, generic versions are still available in the US.

<i>Mycobacterium tuberculosis</i> Species of pathogenic bacteria that causes tuberculosis

Mycobacterium tuberculosis, also known as Koch's bacillus, is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. This coating makes the cells impervious to Gram staining, and as a result, M. tuberculosis can appear weakly Gram-positive. Acid-fast stains such as Ziehl–Neelsen, or fluorescent stains such as auramine are used instead to identify M. tuberculosis with a microscope. The physiology of M. tuberculosis is highly aerobic and requires high levels of oxygen. Primarily a pathogen of the mammalian respiratory system, it infects the lungs. The most frequently used diagnostic methods for tuberculosis are the tuberculin skin test, acid-fast stain, culture, and polymerase chain reaction.

Directly observed treatment, short-course is the name given to the tuberculosis (TB) control strategy recommended by the World Health Organization. According to WHO, "The most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The best curative method for TB is known as DOTS." DOTS has five main components:

<span class="mw-page-title-main">Management of tuberculosis</span> Disease treatment

Management of tuberculosis refers to techniques and procedures utilized for treating tuberculosis (TB), or simply a treatment plan for TB.

Multiple drug resistance (MDR), multidrug resistance or multiresistance is antimicrobial resistance shown by a species of microorganism to at least one antimicrobial drug in three or more antimicrobial categories. Antimicrobial categories are classifications of antimicrobial agents based on their mode of action and specific to target organisms. The MDR types most threatening to public health are MDR bacteria that resist multiple antibiotics; other types include MDR viruses, parasites.

Latent tuberculosis (LTB), also called latent tuberculosis infection (LTBI) is when a person is infected with Mycobacterium tuberculosis, but does not have active tuberculosis (TB). Active tuberculosis can be contagious while latent tuberculosis is not, and it is therefore not possible to get TB from someone with latent tuberculosis. The main risk is that approximately 10% of these people will go on to develop active tuberculosis. This is particularly true, and there is added risk, in particular situations such as medication that suppresses the immune system or advancing age.

TB Alliance is a not-for-profit product development partnership (PDP) dedicated to the discovery and development of new, faster-acting and affordable tuberculosis (TB) medicines. Since its inception in 2000, TB Alliance has worked to grow the field of available treatments for TB and now manages the largest pipeline of new TB drugs in history. It was founded in Cape Town, South Africa, and has since expanded. It is headquartered in New York City and has a regional office in Pretoria.

<span class="mw-page-title-main">Extensively drug-resistant tuberculosis</span> Tuberculosis that is resistant to the most effective drugs

Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resistant TB (MDR-TB).

<span class="mw-page-title-main">Multidrug-resistant tuberculosis</span> Medical condition

Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medications (drugs): isoniazid and rifampicin. Some forms of TB are also resistant to second-line medications, and are called extensively drug-resistant TB (XDR-TB).

The National Tuberculosis Elimination Programme (NTEP), earlier known as the Revised National Tuberculosis Control Programme (RNTCP), is the Public Health initiative of the Government of India that organizes its anti-Tuberculosis efforts. It functions as a flagship component of the National Health Mission (NHM) and provides technical and managerial leadership to anti-tuberculosis activities in the country. As per the National Strategic Plan 2017–25, the program has a vision of achieving a "TB free India",with a strategies under the broad themes of "Prevent, Detect,Treat and Build pillars for universal coverage and social protection". The program provides, various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.

<span class="mw-page-title-main">Bedaquiline</span> Medication used to treat tuberculosis

Bedaquiline, sold under the brand name Sirturo, is a medication used for the treatment of active tuberculosis. Specifically, it is used to treat multi-drug-resistant tuberculosis along with other medications for tuberculosis. It is taken by mouth.

<span class="mw-page-title-main">Tuberculosis in China</span>

Tuberculosis is a serious public health problem in China. China has the world's third largest cases of tuberculosis, but progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. The spread of severe acute respiratory syndrome (SARS) in 2003, brought to light substantial weaknesses in the country's public health system. After the government realized the impact that the SARS outbreak had on the country, they increased leadership in their health department. After the SARS epidemic was brought under control, the government increased its commitment and leadership to tackle public health problems and, among other efforts, increased public health funding, revised laws that concerned the control of infectious diseases, implemented the world's largest internet-based disease reporting system to improve transparency, reach and speed, and started a program to rebuild local public health facilities and national infrastructure.

Totally drug-resistant tuberculosis (TDR-TB) is a generic term for tuberculosis strains that are resistant to a wider range of drugs than strains classified as extensively drug-resistant tuberculosis. Extensively drug resistant tuberculosis is tuberculosis that is resistant to isoniazid and rifampicin, any fluoroquinolone, and any of the three second line injectable TB drugs. TDR-TB has been identified in three countries; India, Iran, and Italy. The term was first presented in 2006, in which it showed that TB was resistant to many second line drugs and possibly all the medicines used to treat the disease. Lack of testing made it unclear which drugs the TDR-TB were resistant to.

<span class="mw-page-title-main">Karel Styblo</span>

Karel Styblo was a Czech-Dutch physician. Internationally recognized for his work with tuberculosis (TB), he was a medical advisor to the Royal Netherlands Tuberculosis Association, and was named director of the International Union Against Tuberculosis and Lung Disease (IUATLD) in 1979. He is known as the "father of modern TB epidemiology" and the "father of modern TB control".

Operation ASHA(OpASHA) is a non-profit organization (NGO) founded in 2006 to bring tuberculosis (TB) treatment at economically feasible rates to disadvantaged communities. The organization's primary work is to detect and cure TB, as well as to prevent and treat multidrug-resistant tuberculosis (MDR-TB) in India and Cambodia. Operation ASHA specializes in last-mile connectivity, bridging the gap between government medicine distribution centers and the communities of patients to deliver treatment at the doorsteps of the under-served. In addition to detecting and curing TB, OpASHA's community health workers also educate the community about TB and its symptoms thereby helping to reduce the stigma there is regarding the disease. In addition to TB, Operation ASHA's model and technology has been used in many other diseases such as diabetes, hemophilia and mental health.

<span class="mw-page-title-main">National Tuberculosis Institute</span> Indian Government institute

The National Tuberculosis Institute (NTIB) is a Government of India institute, under the Directorate General of Health Services, Ministry of Health and Family Welfare, dedicated to advanced research on Tuberculosis. The Institute is located along Bellary Road, in Bengaluru, Karnataka state, India.

Zarir Udwadia is an Indian pulmonologist and researcher. His work on drug resistant tuberculosis has led to improvements in India's National Tuberculosis Control Programme. Udwadia was the only Indian invited by the WHO to be part of the TB ‘Guidelines Group’, which formulated the 4th edition of the TB Guidelines, published in 2010. He was also the only doctor to be named among India's best strategists.

Elimination of tuberculosis is the effort to reduce the number of tuberculosis (TB) cases to less than one per 1 million population, contrasted with the effort to completely eradicate infection in humans worldwide. The goal of tuberculosis elimination is hampered by the lack of rapid testing, short and effective treatment courses, and completely effective vaccine. The WHO as well as the Stop TB Partnership aim for the full elimination of TB by 2050—requiring a 1000-fold reduction in tuberculosis incidence. As of 2017, tuberculosis has not been eliminated from any country.

References

  1. ↑ TB Statistics for India. (2012). TB Facts. Retrieved April 3, 2013, from http://www.tbfacts.org/tb-statistics-india.html
  2. ↑ Udwadia, Zarir; Vendoti, Deepesh (2013-06-01). "Totally drug-resistant tuberculosis (TDR-TB) in India: every dark cloud has a silver lining". J Epidemiol Community Health. 67 (6): 471–472. doi:10.1136/jech-2012-201640. ISSN   0143-005X. PMID   23155059. S2CID   42481569.
  3. ↑ Loewenberg, Samuel (2012-01-21). "India reports cases of totally drug-resistant tuberculosis". The Lancet. 379 (9812): 205. doi:10.1016/S0140-6736(12)60085-3. ISSN   0140-6736. PMID   22272391. S2CID   39443765.
  4. ↑ World Health Organization (2009). "Epidemiology". Global tuberculosis control: epidemiology, strategy, financing. pp. 6–33. ISBN   978-92-4-156380-2 . Retrieved 14 June 2020.
  5. ↑ WHO. Global tuberculosis control. WHO report. WHO/HTM/TB/2006.362. Geneva: World Health Organization, 2006.
  6. ↑ Global Tuberculosis Report 2021. Geneva: World Health Organization. 2021. ISBN   978-92-4-003702-1 . Retrieved 3 November 2021.
  7. ↑ Udwadia, Zarir; Vendoti, Deepesh (2013). "Totally drug-resistant tuberculosis (TDR-TB) in India: Every dark cloud has a silver lining". Journal of Epidemiology and Community Health. 67 (6): 471–472. doi:10.1136/jech-2012-201640. PMID   23155059. S2CID   42481569.
  8. ↑ Kanabus, Annabel. "Totally drug resistant TB - resistance to all known drugs". TBFACTS.ORG Information about Tuberculosis. Global Health Education, England. Retrieved 5 September 2021.
  9. 1 2 3 4 5 6 Tuberculosis - Causes, Symptoms, Treatment, Diagnosis. (2013). C-Health. Retrieved April 3, 2103, from [usurped]
  10. 1 2 3 4 Anand, Geeta; McKay, Betsy (26 December 2012). "Awakening to Crisis, India Plans New Push Against TB". Wall Street Journal.
  11. 1 2 3 "India records 2.15m new TB patients in 2018". The Nation. 2019-03-26. Retrieved 2019-03-27.
  12. ↑ AuthorTelanganaToday. "TB eradication mission renamed". Telangana Today. Retrieved 2020-01-02.
  13. 1 2 Sachdeva, Kuldeep Singh et al. “New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access - "reaching the un-reached".” The Indian journal of medical research vol. 135,5 (2012): 690-4.
  14. 1 2 3 4 5 Hargreaves, James R.; Boccia, Delia; Evans, Carlton A.; Adato, Michelle; Petticrew, Mark; Porter, John D. H. (April 2011). "The Social Determinants of Tuberculosis: From Evidence to Action". American Journal of Public Health. 101 (4): 654–662. doi:10.2105/AJPH.2010.199505. PMC   3052350 . PMID   21330583.
  15. ↑ Sumeda (2022-05-22). "Explained: What Lancet report says about India's pollution problem". The Hindu. ISSN   0971-751X . Retrieved 2024-04-04.
  16. ↑ Chandra, Shivani; Sharma, Nandini; Joshi, Kulanand; Aggarwal, Nishi; Kannan, Anjur Tupil (17 January 2014). "Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, India". Health Research Policy and Systems. 12 (1): 3. doi: 10.1186/1478-4505-12-3 . PMC   3898563 . PMID   24438431.
  17. 1 2 3 Verma, Ramesh; Khanna, Pardeep; Mehta, Bharti (2013). "Revised National Tuberculosis Control Program in India: The Need to Strengthen". International Journal of Preventive Medicine. 4 (1): 1–5. PMC   3570899 . PMID   23413398.
  18. 1 2 3 4 Rowland, Katherine (2012). "Totally drug-resistant TB emerges in India". Nature. doi:10.1038/nature.2012.9797. S2CID   84692169.
  19. ↑ Udwadia, Z. F; Amale, R. A; Ajbani, K. K; Rodrigues, C (2011). "Totally Drug-Resistant Tuberculosis in India". Clinical Infectious Diseases. 54 (4): 579–581. doi: 10.1093/cid/cir889 . PMID   22190562.
  20. ↑ Dye, Christopher; Bourdin Trunz, Bernadette; Lönnroth, Knut; Roglic, Gojka; Williams, Brian G.; Gagneux, Sebastien (21 June 2011). "Nutrition, Diabetes and Tuberculosis in the Epidemiological Transition". PLOS ONE. 6 (6): e21161. Bibcode:2011PLoSO...621161D. doi: 10.1371/journal.pone.0021161 . PMC   3119681 . PMID   21712992.
  21. ↑ Mishra, Gyanshankar; Ghorpade, S. V; Mulani, J (2014). "XDR-TB: An outcome of programmatic management of TB in India". Indian Journal of Medical Ethics . 11 (1): 47–52. doi: 10.20529/IJME.2014.013 . PMID   24509111. S2CID   20830937.
  22. ↑ Mishra, Gyanshankar (2012). "Public-private mix in tuberculosis". The Lancet Infectious Diseases. 12 (12): 908–909. doi:10.1016/S1473-3099(12)70257-8. PMID   23174376 . Retrieved 4 September 2021.
  23. ↑ Mishra, Gyanshankar; Mulani, Jasmin (2013). "Tuberculosis Prescription Practices In Private And Public Sector In India". National Journal of Integrated Research in Medicine. 4 (2): 71–78. doi:10.6084/m9.figshare.13271513 . Retrieved 4 September 2021.
  24. ↑ Kumar, Anil A.; Costa, Ayesha De; Das, Arundathi; Srinivasa, G. A.; D'Souza, George; Rodrigues, Rashmi (2019-04-03). "Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative?". JMIR mHealth and uHealth. 7 (4): e11687. doi: 10.2196/11687 . PMC   6468344 . PMID   30942696.
  25. 1 2 3 4 Sandhu, GK (April 2011). "Tuberculosis: current situation, challenges and overview of its control programs in India". Journal of Global Infectious Diseases. 3 (2): 143–50. doi: 10.4103/0974-777X.81691 . PMC   3125027 . PMID   21731301.
  26. ↑ "TB a national emergency: Health Minister Harsh Vardhan". The Economic Times. 6 September 2014.
  27. ↑ Venkhat, Bharat Jayram (2021). At the Limits of Cure. Durham: Duke University Press. ISBN   9781478091776 . Retrieved 5 January 2023.
  28. ↑ http://www.scidev.net/tb/facts%5B%5D%5B%5D
  29. ↑ Coghaln, Andy (12 January 2012). "Totally drug-resistant TB at large in India". New Scientist.
  30. ↑ "Welcome to the Tuberculosis Association of India".
  31. ↑ Daftary, Amrita; Frick, Mike; Venkatesan, Nandita; Pai, Madhukar (31 October 2017). "Fighting TB stigma: we need to apply lessons learnt from HIV activism". BMJ Global Health. 2 (4): e000515. doi:10.1136/bmjgh-2017-000515. PMC   5717927 . PMID   29225954.
  32. ↑ Achmat, Z (December 2006). "Science and social justice: the lessons of HIV/AIDS activism in the struggle to eradicate tuberculosis". The International Journal of Tuberculosis and Lung Disease. 10 (12): 1312–7. PMID   17167946.
  33. ↑ "Street Science: Characterizing Local Knowledge". Street Science. 2005. pp. 47–78. doi:10.7551/mitpress/6494.003.0004. ISBN   978-0-262-27080-9.
  34. ↑ Kamineni, Vishnu VARDHAN; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Singh Sachdeva, Kuldeep; Singh Chauhan, Lakbir (2012). "Addressing poverty through disease control programmes: examples from Tuberculosis control in India". International Journal for Equity in Health. 11 (1): 17. doi: 10.1186/1475-9276-11-17 . PMC   3324374 . PMID   22449205.
  35. ↑ McBroom, K (June 2016). "Litigation as TB Rights Advocacy: A New Delhi Case Study". Health and Human Rights. 18 (1): 69–84. PMC   5070681 . PMID   27781000.
  36. ↑ Udwadia, Zarir F (2012). "MDR, XDR, TDR tuberculosis: Ominous progression". Thorax. 67 (4): 286–288. doi: 10.1136/thoraxjnl-2012-201663 . PMID   22427352.
  37. 1 2 Rao, VG; Muniyandi, M; Bhat, J; Yadav, R; Sharma, R (January 2018). "Research on tuberculosis in tribal areas in India: A systematic review". The Indian Journal of Tuberculosis. 65 (1): 8–14. doi:10.1016/j.ijtb.2017.06.001. PMID   29332655.
  38. 1 2 Thomas, BE; Adinarayanan, S; Manogaran, C; Swaminathan, S (May 2015). "Pulmonary tuberculosis among tribals in India: A systematic review & meta-analysis". The Indian Journal of Medical Research. 141 (5): 614–23. doi: 10.4103/0971-5916.159545 (inactive 1 November 2024). PMC   4510760 . PMID   26139779.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)

Further consideration

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.