TB patients losing hope,a major cause of concern for doctors

Like Sujata,there are many in the city who drop out midway from the Directly Observed Tuberculosis Short course (DOTS) therapy. Mumbai in recent years has achieved its target of coverage and defaulter rate has been significantly reduced with the introduction of DOTS therapy in the RNTCP programme in the city. However,despite intense efforts,the Mumbai District Tuberculosis Society is unable to reverse the defaulters for anti tuberculosis therapy.

According to the figures released by the BMC on World Tuberculosis Day earlier this week,defaulter rates have dropped but only marginally. In the year 2004,percentage of patients who dropped out from the anti tuberculosis therapy was 6.02 per cent with 411 patients out of 28,887 smear positive cases. In the following year it was 6.67 percent and for 2006 and 2007 it was 5.16 percent (444 out of 25,465 patients) and 4.57 percent (411 out of 28,887 patients) respectively. The figures were collected from over 730 DOTS centers including some private hospitals.

“Due to intolerance to drugs,adverse reactions to wrong dosage given by private doctors and substance abuse,among other factors people drop out of the programme,” said Dr Amita Athavale,head of chest medicine department,King Edward Memorial Hospital. “Before starting the DOTS therapy,addresses of patients are checked by medical social workers at the hospital however tracing defaulters still remains a major problem,” added Dr Athavale.

“Defaulters compound resistance that ultimately leads to Multi Drug Resistant TB (MDR-TB) and Extremely Drug Resistant TB (XDR-TB). They develop a resistance strain due to erratic treatment,” said Dr Zarir Udwadia,chest physician,Hinduja Hospital,adding,“Of the 200 patients on anti TB therapy at Hinduja Hospital more than half of them refused to go to a public hospital for reasons of being alienated. The concept of being supervised prevented them from going to government hospitals. At private hospitals,educating the patient helps in patient adherence.”

“Peru has one of the best TB programmes. As part of that a paid health volunteer goes to the patient’s house to give him the dosage. In Bangladesh a community- based approach has been adopted. However,in India due to the population this is not possible,” said Dr Udwadia.