Of the 40,000 tuberculosis (TB) cases recorded in the city in 2013, more than 4,000 patients were relapse cases, according to civic health department data. The count of relapse cases has remained constant over the last few years — an indicator of the poor living conditions and of the hurdles in the treatment regime followed in public hospitals.
In 2013, over 10 per cent TB cases (4,467) were for re-treatment. In 2012, the figure stood at 4,460 of 30,828 cases, and in 2011 it was 4,329 of 29,212 cases. According to estimates, the actual count of relapse cases may be higher, as not all private hospitals are accounted for by the civic health department.
Dr Rajendra Nanavare, medical superintendent at the BMC-run Sewri TB hospital, said, “Sometimes, the bacteria lies dormant inside the patient’s body. The treatment regime gets over and the patient is cured. But whenever bacteria gets active, a relapse takes place.”
Nanavare added, “Quite often, patients don’t complete the treatment cycle and drop out in between. Chances of relapse in them are higher.”
The reasons for drop-out ranges from lack of finances to improper facilities in public hospitals. Sandeep Rai (22), a multi-drug resistant (MDR) TB patient in Sewri TB hospital, said, “The bedsheets and clothes are not changed daily. It’s better to be at home and take the medicines than stand the risk of contracting other infections at the hospital.”
Dr Zarir Udwadia, chest surgeon at P D Hinduja hospital, said, “In slums, the situation is worse. An entire family lives in 10 by 10 ft room and the hygiene conditions are poor. A cured patient already suffers from low immunity and he can easily contract TB again.”
According to the BMC, slums in Dharavi and Govandi contribute the most to the TB pool in the city. In November 2013, Dharavi had 2,993 and Govandi had 1,649 TB cases. The two GeneXpert machines there have helped in detecting more cases.
However, KEM hospital’s head of the chest department Dr Amita Athavale said, “The treatment may cure the patient of a particular strain of bacteria but due to low immunity, irrespective of living conditions, one may contract another strain.”
While the BMC is regularly involved in anti-TB campaigns, it is doing little to improve the living conditions of slum-dwellers, say residents. “With open drains and unclean toilets in our slum, people fall ill frequently. Even if a member in our family keeps coughing, we have to stay in the same room because there is no other place to go,” said Reshma Singh (25), resident of Mograpada slum. She lives with five more members in a small room.
Over the last three years, the count of Multi Drug Resistant (MDR) and Extensively Drug Resistant (XDR) TB cases has noticeably increased. From 181 new patients diagnosed with MDR TB and 288 already receiving treatment for it in 2011, the figure rose to 2,195 new patients diagnosed with MDR TB and 1,935 on treatment in 2012. In 2013, a whopping 2,903 patients were diagnosed with MDR TB and 2,604 were on treatment.
Dr Minnie Khetarpal, BMC’s TB control officer, said, “Though MDR cases are rising, patients receive second-line treatment. But in XDR cases, patients respond to very few drugs. Currently, Bedaquilin is considered a wonder drug, but is under clinical trials in India.” The drug, which has been used on five patients in Mumbai, is being imported from Belgium.
In 2013, the count of XDR TB rose to 90 cases from 32 in 2012. This year till now, 24 patients have been labelled as XDR by the BMC.
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