The number of tuberculosis cases in India may be up two to three times higher than current estimates, a new study has said while underlining the need for strengthening the surveillance of the disease.
Noting that India's private sector is treating an enormous number of tuberculosis patients, the study said that there is a "re-doubled" need to address this burden, strengthen surveillance and its burden estimates revised.
"If 40-60 per cent of private-sector tuberculosis diagnoses are correct and if private-sector tuberculosis treatment lasts on average 2-6 months, this implies that 1.19-5.34 million tuberculosis cases were treated in the private sector in 2014 alone.
"The midpoint of these ranges yields an estimate of 2.2 million cases, two to three times higher than currently assumed," the study said.
The study was done by a research team comprising researchers from the Imperial College of London, the Indian government's Revised National TB Control Programme, WHO and other organizations and was published in the Lancet Journal of Infectious Diseases today.
Terming tuberculosis as a major global public health challenge, the study said that in 2014, 6.3 million cases of tuberculosis worldwide were reported to WHO, with India accounting for over a quarter of these cases, the highest of 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.
"Poor diagnostic practices in this sector prolong tuberculosis transmission by delaying diagnosis, whereas a general lack of counselling and support of treatment adherence hampers successful, relapse-free cure. Moreover, most cases treated in the private sector are never notified to public health authorities," the study said.
According to this study's findings, there are roughly 2.2 million people being managed for TB in the private sector while 1.4 million being managed in the public health system.
To try and reach an estimate of the number of cases of TB
in India's private healthcare system, the researchers calculated nationwide sales of TB drugs across the private sector. They then used this figure to calculate the number of cases.
This suggested there were 2.2 million TB cases in the private sector in 2014 - two to three times higher than current estimates.
"India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised.
"Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision," the study said.
The study said that its findings have implications for the tuberculosis strategy in India and the "vast disorganised" private health-care sector poses major challenges to tuberculosis control.
"Our work points to the urgent need for further strengthening of tuberculosis surveillance in the private sector. Our findings highlight uncertainty around the true burden of tuberculosis in India. Methods for estimating this burden should be complemented by independent approaches generating primary data," the study said.
