October 20, 2009 11:34:17 pm
Mumbai may have a higher percentage of Multi Drug Resistant Tuberculosis (MDR-TB) than accepted national estimates,a study published recently in an international journal reveals.
The study on 724 patients in the Revised National Tuberculosis Control Programmes (RNTCP) DOTS centre of four wards in the city (run by Brihanmumbai Municipal Corporation) for three years reveals a high proportion of MDR-TB strains in both newly diagnosed,previously untreated cases and treatment-failure cases.
Of the 724 patients,493 were newly diagnosed and may have acquired the infection from MDR-TB patients and 231 were those with a failed first line treatment.
According to the study,MDR-TB prevalence is as high as 24 per cent (118 out of 493) in newly diagnosed and previously untreated cases whereas national estimates suggest 2.6 to 3 per cent. One MDR-TB patient (resistant to at least two anti-TB drugs) can infect 10 to 15 persons a year. Further,MDR-TB was seen to be as high as 41 per cent (95 out of 231 patients) of the total treatment failure cases whereas national figures estimated ranges from 14 to 17 per cent. Amongst the new cases,resistance to three to four drug combinations was greater (amplified drug resistance).
The first-of-its-kind study in Mumbai published in Biomed Central,an open access Public Health journal,was conducted between April 2004 and January 2007 at four wards,F/North,G/N,H/E,and K/E. Of the 724 patients,the majority belonged to the 15-35 age group.
Since the study was part of a larger epidemiological project on transmission of MDR-TB in an endemic setting,four centrally located wards characterised by a high sputum-positive case load,with moderately suboptimal cure rates ranging between 78¿81% were selected. Cumulatively,the four wards comprised 38 DOTS Centres covering a population of approximately 3 million. Each field worker covered an average of nine DOTS Centres thrice a week, said Dr Yatin Dholakia,honorary secretary and technical advisor to the Maharashtra State Anti-TB Association and one of the authors of the study.
Even though the study conducted by Foundation for Medical Research was indicative of Mumbais scenario,authors themselves say it cannot be extrapolated to the national scenario. The study findings cannot be extrapolated to the entire nation as Mumbai has its unique problems. High number of infected,huge population density,acute and rapid transmission,high number of defaulters,crowded areas and other factors play a major role in increase in number of MDR-TB cases in Mumbai, said Dr Nerges Mistry,director,Foundation for Medical Research.
The four wards selected for the study were characterised by a high sputum-positive case load with moderately suboptimal cure rates ranging between 78- 81 per cent.
Drug susceptibility testing was done on the patients at the foundation for research centre and a proportion of samples were sent to the Swedish Institute for Infectious Diseases Control,a WHO supranational laboratory in Stockholm, said Dr Mistry.
Currently,TB patients in Mumbai are given Directly Observed Treatment Short course (DOTS) therapy,also called the first line treatment; however there are many who are resistant to the first line drugs (MDR-TB). At present there is no laboratory in the city to determine MDR-TB cases. Only recently,Hinduja Hospital was accredited to carry out tests for MDR-TB to roll out DOTS Plus therapy (second line treatment).
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