The researchers used two standardized patient cases, one with a patient presenting with two to three weeks of pulmonary TB symptoms and a second with a patient with microbiologically confirmed pulmonary TB.
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A study has found that in 2014 there were 2.2 million TB patients treated in India’s private sector alone. In 2014, 9.6 million people (reported and unreported cases) fell ill with tuberculosis and 1.5 million died from the disease, a note on the study said.
The under-reporting of TB was because people opt for private health care, who fail to report to public health officials, the study said.
Dr. Nimalan Arinaminpathy, lead author of the research, from the School of Public Health at Imperial College London said, “TB is the top infectious disease killer worldwide, yet we have had little idea of the true scale of the problem in India – the worst affected country”.
In all probability, the higher TB burden in the private sector might still be an underestimation as drug-resistant TB cases were not taken into account.
All we can say is that there is an urgent need to not only make efforts to address the burden of TB treated by the private sector in India, but also to make improvents in surveillance of the private sector, as well as improve its cooperation with the public sector in India.
In 2014, 6.3 million TB cases were reported worldwide, with India accounting for over 25 pc of them – the highest for any country.
It said that although standardised tuberculosis treatment in India is delivered by the public sector through the Revised National TB Control Programme (RNTCP), early diagnosis and treatment are hampered by the presence of a “vast and unregulated” private health-care sector. Though the public sector in Odisha had 1.5-2.8 times the volume of TB medicines prescribed than the private sector, on a national level, there was almost twice as much TB treatment in the private sector as in the public sector in 2013 and 2014.
“Multi drug-resistant TB (MDR-TB) is a global worry, and the large number of cases of TB estimated in our study further fuels concerns about how we can control drug resistance”. But completing the course is key to effective treatment. Mumbai, for example, faces a worrying epidemic of drug-resistant TB and many would argue the private sector has a role in this, the researcher said. “There has been a lot of progress made, with a new reporting system and greater engaging with the private sector”, Dr Arinaminpathy told AFP. Dr Pai said they wanted to understand how pharmacies in the three cities treated patients with TB symptoms or diagnoses, and to determine whether these pharmacies were contributing to the inappropriate use of antibiotics. However, none of the pharmacies dispensed first-line anti-tuberculosis drugs. “Our study clearly showed that not a single pharmacy gave away first line anti-TB drugs (isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin) without prescriptions”.
In fact, the Government had mandated private doctors to notify them when they treat a TB patient at their clinics.
The study was funded by the Bill and Melinda Gates Foundation (BMGF), with other collaborators being IMS Health Inc; Central TB division (Government of India) and the India offices of the World Health Organization and BMGF. These findings show that there is a need to engage pharmacies in TB control and initiatives to prevent misuse of antibiotics.
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The researchers showed that pharmacies frequently dispensed antibiotics to simulated patients who presented with typical TB symptoms.
