In India, screening for disease is usually associated with non-communicable rather than communicable diseases. However, since last month, India has embarked on a large-scale plan to screen all children for leprosy and tuberculosis. An estimated 25 crore children below the age of 18 will be screened for the two infectious diseases, and if a person is suspected to have either of the two, s/he will be sent to a higher centre for confirmation. The existing Rashtriya Bal Swasthya Karyakram (RBSK) infrastructure will be used for the screening.
Why it is necessary
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It usually affects the skin and peripheral nerves, but has a wide range of clinical manifestations. The disease is characterised by a long incubation period that is generally 5-7 years. It is a leading cause of permanent physical disability. Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disability due to leprosy.
Tuberculosis infection, caused by Mycobacterium tuberculosis, is one of the most common communicable diseases in India, its transmission fuelled by unhygienic, crowded living conditions. It is said that most Indians carry the bacterium and the infection flares up when their immunity levels are low, like when they are malnourished or suffering from conditions like AIDS in which the body’s immune system is compromised.
Both diseases are infectious and India has a substantial burden — its tuberculosis burden is the highest in the world. Children tend to be more prone to catching infectious diseases from their peers because of long hours in confined spaces and more bodily contact than in adults. Addressing the problem early would ensure that the infection cycle is broken.
In case of leprosy, it could mean prevention of disability. The programme would also give preventive medication to people who have come in contact with the confirmed cases.
For TB, India’s malnutrition burden is an additional risk factor. As per the National Family Health Survey (NFHS)-4 (2015-16), 35.7 per cent children below age five are underweight, 38.4 per cent are stunted (low height for age) and 21 per cent are wasted (low weight for height) in the country.
The burden in India
India eliminated leprosy in 2005 — WHO defines elimination as an incidence rate of less than one case per 10,000 population. All states except Chhattisgarh and the Union Territory of Dadra and Nagar Haveli have eliminated leprosy. However, 1.15 lakh to 1.2 lakh new leprosy cases are still detected every year, Health Ministry officials said.
TB kills an estimated 4,80,000 Indians every year — an average over 1,300 every day. India also has more than a million “missing” cases every year that are not notified. Most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector. The problem in the latter case is that many of these patients do not complete the full course of the antibiotic, thus exposing the bacterium to the medicine without fully killing it. This is trigger enough for the bacterium to evolve into a version of itself that is resistant to that particular drug.
The mission focus
Launched in 2013 under the National Health Mission, RBSK is focused on preventing disease and disability in children. “Child Health Screening and Early Intervention Services” basically refer to early detection and management of a set of 30 health conditions prevalent in children less than 18 years of age. These conditions are broadly defects at birth, diseases in children, deficiency conditions and developmental delays including disabilities, together described as 4Ds.
Until now, neither leprosy nor TB were a part of the programme. In 2017, India had set a target of elimination of leprosy by 2018, going by the Budget speech that year. The deadline has passed but leprosy remains a challenge in a country that launched the National Leprosy Eradication Programme way back in 1955.
For tuberculosis, the global Sustainable Development Goal target is to end the disease is 2030. However, there is a new urgency in India’s TB control efforts since last year, when Prime Minister Narendra Modi suo motu advanced the deadline for India to end TB to 2025. Speaking at the End TB summit in 2018, Modi had said: “A target has been set to end TB globally by 2030. I would like to announce that we have set aim to eradicate it from India five years ahead, by 2025.”