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Five risk factors — malnutrition, diabetes, human immunodeficiency virus (HIV), alcohol consumption, and smoking — account for 44 per cent of the total estimated cases of tuberculosis in the country, showed the latest India TB report 2023 by the Union Ministry of Health and Family Welfare.
On World TB Day, which falls on March 24 every year, the report showed that ‘achieving the target of eliminating TB by 2025 requires a significant progress in addressing health-related risk factors and socioeconomic determinants’.
Malnutrition is an established risk factor for the progression of TB infection to active TB (six to 10 times). Dr Soumya Swaminathan, former chief scientist at the World Health Organisation, told The Indian Express that the central government’s Poshan Abhiyaan can help in the National TB Elimination Programme (NTEP) to address the underlying cause in nutrition in the community as a whole. “The Centre’s Poshan Abhiyaan can help the NTEP, with both being interdependent,” said Dr Swaminathan, chairperson of MS Swaminathan Research Foundation in Chennai.
The National TB Prevalence Survey 2019-21 had also found a higher prevalence of pulmonary TB among the older age group, men, malnourished persons, smokers, alcoholics, and known diabetics. Dr Swaminathan said the survey talks about the factors for TB and the existing gaps that need to be eliminated.
“Targeted interventions based on data and science, behavioural changes, and communication are needed to address the risk factors for TB,” Dr Swaminathan said. The survey has shown 64 per cent of the symptomatic patients had not sought treatment for TB as they were unaware of their health condition. “The findings are very important, and underlines the need for a massive awareness drive, besides scaling up molecular tests to diagnose TB. Citing common reasons for the development of TB, the survey showed not seeking care or ignoring symptoms stands at 68%, not recognising TB symptoms (18%), self-treatment (12%), and not being able to afford healthcare (2%).
According to India’s estimates of TB cases attributable to selected comorbidities in 2021 — as per the WHO’s Global TB Report 2022 — include malnourishment (7.38 lakh), harmful level of alcohol consumption (2.58 lakh), smoking (1.10 lakh), diabetes (1.05 lakh), and HIV (93,000). Alcohol use disorder is an important risk factor for TB.
The India TB Report 2023 showed that around 74 per cent of notified TB patients were screened last year for alcohol consumption, and the same was reported in 7.2 per cent of them.
