Mumbai accounts for almost half the multi-drug resistant (MDR) TB patients in Maharashtra.
Since the implementation of the Revised National TB Control Program (RNTCP) in 2008, 40,422 suspected cases of MDR TB have been examined by the second quarter of 2013.
Of this, 8,129 have been diagnosed with MDR TB and 6,189 of them have been put on treatment.
Of the total cases diagnosed, 3,854 are from Mumbai. The number of MDR TB patients diagnosed in Maharashtra has shown a huge rise from 129 in 2008, 771 in 2011, 4,089 in 2012, 1,239 in the first quarter of 2012 and 1,531 in the second quarter of 2013.
In 2012, 51,081 net smear positive (NSP) TB patients were detected in Maharashtra, of which 8,054 were from Mumbai. Around 95% people infected with TB-- an infection spread via air through modes like coughing and sneezing-- belong to developing countries like India. Experts say HIV and MDR TB will make the problem more severe unless urgent action is taken.
Dr H.H Chavan, joint director (TB and Leprosy), pointed out that MDR TB cases were high in Mumbai due to the large number of people staying in slums and the city accounting for a high population density.
In such congested environments, coughing or sneezing led to the infection being transmitted.
Chavan said the diagnosis of MDR TB cases had increased.
“In slums, the first point of contact (for medical aid) is the private clinics,” said Chavan, adding that these practitioners, many of whom were not qualified to treat these patients, did not follow the standard protocol.
Dr Jaisingh Phadtare, head of department of pulmonology at the Grant Medical College, however, said there was no inordinate rise in MDR TB cases. “With the government providing drugs... data collection and reported cases have increased as you have to report it,” he added.
“We have improved the identifying capacity, so it is fast and easy to identify patients,” said Dr Satish Pawar, Director, Health Services, adding that some patients developed MDR TB due to resistance to some medicines which were common for TB and other diseases in case they discontinued these drugs midway.
Pawar noted that apart from crowded cities like Mumbai, MDR TB cases had also been observed in moffusil areas. He admitted that though tuberculosis was a notifiable disease, some private practitioners avoided reporting these cases to the government at times.
Officials admit that low awareness has led to case detection being a problem in Maharashtra. As against the 10 lakh TB suspects to be examined, the state has seen just around 7.62 lakh being examined in 2012 and the total number of TB patients initiated on treatment was 1.36 lakh as against the target of 2.46 lakh .
Total NSP cases initiated on treatment was just 51,081 in 2012 against the expected 91,040 target (80 cases per lakh population annually). The cure rate is over 83% and the death and default rates are below 5% according to the state health department’s figures.
