Tuberculosis is the highest burden India has experienced for manyyears despite various efforts against it by the government and theWorld Health Organization. The situation is attributed to the factthat India is a developing country with a majority of its populationbeing low-income earners, therefore, not able to afford or live adecent life of nutritional feeding. In a span of 8 years, between2006 and 2014, the disease cost India an approximate of USD 340B(Sandhu, 2011). The diseaseis most dominant among the underprivileged families in India. Thisgroup takes up a bigger percentage due to India’s high populationas compared to other nations affected by the disease.
Mycobacterium tuberculosis, the bacterium responsible fortuberculosis, evolves inside a person who has an active Tuberculosiscontamination. The disease is caused by the weak immune system whichexposes the body to bacteria-causing diseases. The bacterium isspread through sneezing, coughing, and directly talking to aninfected person. However, the Indians face a higher risk ofcontracting the disease because of high pollution that is dischargedfrom the country’s industrial and slum areas that contaminate theair (Sandhu, 2011).
Due to the bacterium’s nature to infect weak immune systems, TB ismore prevalent among young infants, children and young adults inIndia. The three groups are the most vulnerable because their bodieshave relatively weaker immunity due to lack of exposure to varioushealth hazards. In 2014, India recorded an estimation of 4 millioncases of TB, a number that some epidemiologists forecast to rise dueto the high prevalence of AIDS. TB also weakens the immunity,therefore, exposing the body to the TB-causing bacterium. The ruralparts of India are more TB prevalent as compared to the urban centerswhere the wealthy reside (Sandhu, 2011). Also, most of the Indiansare recorded to be smokers. Smoking of tobacco has been associatedwith tuberculosis infection since the disease affects the lungs whichform the part where TB-contaminated air enters (Lee,Lin, Huang, Wei, Lai, & Lin, 2014).
According to WHO (2016), TB is among the top killing infectious andcurable illnesses in India. The country accounts for about 2 millionnew cases of tuberculosis every year (WHO, 2016). The high prevalenceexposes the state to approximately one death from tuberculosis everymonth. In 2014, there were about 17 million cases of TB treatment inprivate sector in India, a number that put the country to an enormousburden of managing mortality rate (WHO, 2016). Out of the cases, someof the patients die. Again, the figures indicate that there arerelatively higher hopes for quality treatment in private sector thanin public sector, which recorded a lower number of patients (WHO,2016). Therefore, the government of India is charged with the greaterresponsibility to revise and strengthen its commitment towards TBsurveillance.
Trajectoryof the Disease
The fight against TB in India can be categorized into three periods.First, the early period that occurred before the introduction ofchemotherapy and x-ray. Second, the post-independence period duringwhich some mechanisms and programs were introduced. Lastly, thecurrent period which is characterized by WHO interventions withcontrol programs in the fight against TB. For instance, the DirectlyObserved Treatment-Short course (DOTS) program is the fastest growingprogram globally in reaching out to TB patients (Madhav & Kiran,2004). However, attempts to control TB in India have been marred byincreased widespread of AIDS, poor health substructure in countrysideareas, lack of political will, and unfettered remote health care thathas resulted in the use of non-recommended first-line and second-linedrugs (Arinaminpathy, Batra,Khaparde, Vualnam, Maheshwari, Sharma, & Dewan, 2016).Also, the ingrained belief that TB is only prevalent to the poorcommunity in India has resulted in its spread because the rich employthe less privileged who end up infecting them without theirknowledge.
PrimaryPrevention of TB
Administration of BCG vaccine is the primary universal preventionstrategy against TB among infants and children. However, the vaccineis not administered to HIV/AIDS-infected babies. Administration ofBCG vaccine is mandatory in India, a location where children are athigher risk of contracting the disease due to pollution and asignificant number of infected people. Furthermore, the vaccine isadministered to young adults who had not received it during theirearly years. However, the vaccine is only effective in the preventionof Tuberculosis meningitis and disseminated TB and not Pulmonary TB.Additionally, educating the people about the threats underlyingbeneath unhealthy habits helps in primary prevention of TB (Madhav &Kiran, 2004).
Secondary prevention of TB aims at reducing its spread or infectionto a wider population due to its precarious nature. The firstsecondary prevention for TB is screening, such as Tuberculin SkinTest (TST) and Interferon-Gamma Release Assays (IGRAs). In TST,vulnerable people, especially the children, are evaluated for TBinfection. IGRA is used in place of TST in the screening processwhere patients have had either BCG vaccination or undetermined returnfor TST. Early diagnosis is also a second way of secondary preventionin which a detection for TB is done at the appropriate time before itspreads. The diagnosis is either done after observation of TBsymptoms or depending on the history of patients’ exposure to thedisease (Madhav & Kiran, 2004).
For the people living with TB, programs and groups have been formedthat enlighten the affected groups on how to live well and to avoidhealth hazards that could further weaken the immune system (WHO,2016). Also, vocational rehabilitation programs are essential ingiving hopes to people living with TB. In India today, these groupsand programs are common, especially those facilitated by WHO.
This is a type of treatment that is mostly used in medicalexperiments and aims at reducing bias in a treatment process. Such atest has two groups one that receives the treatment, and the controlgroup that does not receive the treatment. There is a widespreadprevalence of HIV/AIDS, and the majority of the people live in slumsand semi-permanent residential areas. Due to the possible congestionin the streets, there is pollution resulting from poor means of wastemanagement. Due to the widespread aspect of AIDS, people sufferingfrom the disease have a weaker immune system. The challenges faced ineradicating TB is also due to the use of anti-tuberculosis drugs fromover-the-counter vendors who have minimal knowledge about thedisease. Also, recent studies show that smoking is a risk factor forTB, where India has a significant number of smokers (Mahishale,Patil, Lolly, Wti, & Khan,2017).
According to a previous study conducted to establish the relationshipbetween Diabetes Mellitus and TB relapse, the study concluded thatDM, which is common among middle and low-income countries weakensimmunity for the patients consequently, exposing the patients to TBrelapse (Lee et al., 2014). Also, TB relapse patients were relativelyhard to cure than other types of TB. The study recommended that itwas necessary for DM patients to undergo screening to examine if theywere battling with TB without their knowledge (Lee et al., 2014).
Implicationfor Nursing and Health Services
Despite the efforts made by the World Health Organization to create a“TB Free” world, the government of India has a significantresponsibility in enhancing policies that seek to control pollution,smoking and primary prevention strategies for Tuberculosis (Mahishaleet al., 2017). Reaching out to the rural community and enlighteningthem on the causes and effects attached to TB would help to controlthe disease. India’s political administration needs to interveneand offer free TB screening exercises to its citizens.
Arinaminpathy, N., Batra, D.,Khaparde, S., Vualnam, T., Maheshwari, N., Sharma, L., … Dewan, P.(2016). Thenumber of privately treated tuberculosis cases in India:an estimation from drug sales data. Retrieved from www.thelancet.com
Lee, P., Lin, H., Huang, A. S.,Wei, S., Lai, M., & Lin, H. (2014). Diabetesand Risk of Tuberculosis Relapse: Nationwide Nested Case-ControlStudy. Retrievedfrom http://journals.plos.org
Madhav, M., & Kiran, N. (2004, January-March). A COMPARATIVESTUDY OF DOTS AND NON-DOTS INTERVENTIONS IN TUBERCULOSIS CURE [IndianJournal of Community-Medicine]. XXIX, No.1. Retrievedfrom http://medind.nic.in
Mahishale, V., Patil, B., Lolly,M., Wti, A., & Khan, S. (2017). Prevalenceof Smoking and Its Impact on Treatment Outcomes in Newly DiagnosedPulmonary Tuberculosis Patients: A Hospital-Based Prospective Study.Retrieved from https://www.ncbi.nlm.nih.gov
Sandhu, G. K. (2011). Tuberculosis:Current situation, challenges, and overview of its control programsin India. Retrieved fromwww.ncbi.nim.nih.gov
World Health Organization.(2016). TBburden estimates and country-reported TB data.Retrieved from www.who.int