The sociodemographic factors and misconceptions have affected timely detection of TB, including the noncompliance towards treatment, which increases the risk of drug resistance. Due to lockdowns during the Covid-19 pandemic, case reporting of TB has reduced significantly. An integrated program which involves NGOs and the community is the need of the hour.
Tuberculosis (TB) is the second most leading cause of death by infectious diseases, first being the COVID-19. The pandemic succeeded in shifting the focus from TB. With most of the healthcare services being utilized for COVID-19 diagnosis and treatment, the consequent decline in TB reporting was inevitable. In our effort to draw the world’s attention back on TB, it is imperative we understand its status in the society.
TB is caused by the bacterium Mycobacterium tuberculosis and it mainly affects the lungs. The infection can also occur in other sites like pleura, meninges of brain, spine and kidneys. The main mode of transmission is through air. When the person having active TB coughs or sneezes, it leads to release of aerosols which can cause infection in a healthy person.
The prevalence of TB is influenced by sociodemographic factors. As of October 2021, India accounts for highest number of cases followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Human Immunodeficiency Virus (HIV) accounts for a large fraction of TB cases as people with HIV are 16-27 times more likely to get infected with active TB as compared to HIV negative people. [1] This is primarily due to decreased capacity of immune system and other risk factors like lower socioeconomic conditions, cigarette smoking and non-adherence to the treatment.
Studies from Ethiopia and other African countries indicate an overall high awareness of TB, but there are some gaps in the understanding of cause and mode of transmission of the disease. Several communities account evil forces, misdeeds committed in previous lives and other religious beliefs as the cause. As a result, they visit traditional healers who prescribe herbal medicines and perform unfounded rituals, most often accompanied by instances of physical and sexual abuse inflicted on the participants. [2] Smoking and alcohol abuse were also seen as few of the causes from a study in Indonesia. [3] Same study also reports misconceptions like TB spreads from sharing utensils, clothes or by carrying children. Such beliefs aggravate the pre-existing stigma around TB patients. The people are reluctant to report their symptoms to community healthcare workers from the fear of being marginalized from the society. This delay in seeking help is extremely detrimental for proper treatment of the disease. Moreover, many people see the importance of visiting a healthcare facility only when the symptoms become intolerable and by this time the disease may have spread to others around them.
Even when the line of treatment has been laid out, the social attitudes towards it are often uncooperative. The regimen for TB treatment requires patients to come to the health centre every few weeks for tests and procuring the medications. This proves to extremely stressful for those who work as daily wage laborers. For others belonging to lower socioeconomic backgrounds, travelling to the health facility every now and then, is a luxury they can’t afford. [4} This non-compliance to the treatment protocol increases the risk of developing drug resistant TB, which may be Multi Drug Resistant (MDR-TB) or even Extensively Drug Resistant TB (XDR TB), where resistance is seen in Rifampicin, Isoniazid, the first line drugs, the fluoroquinolone, and in at least 3 of the injectable second line drugs (e.g. kanamycin). [5]
The COVID-19 pandemic has further cast a gloom over this. Numerous people were filled with dread of their diagnosis coming out to be COVID, they deliberately ignored their symptoms of TB. This attitude has been reflected in World Health Organization’s (WHO) 2021 Global TB report. In the high burden TB countries like India and Indonesia, the sharp decline in recorded cases can be ascertained to the reluctance to visit hospitals during a lockdown. [6]
Looking at this, the Indian government is launching a special door-to-door TB campaign on 24th March, 2022, which is observed as the world TB day. This aims to return to the 2019 levels of case detection. [7]
To combat TB, an approach which involves collaboration of government bodies, NGOs and the communities is required. The local volunteer groups are the ones having the most intimate knowledge about the traditions, beliefs, education level of a certain community. They can engage influential personalities and through them emphasize the need for timely diagnosis and treatment. Several NGOs play a vital role in supporting marginalized groups like refugees, sex workers, prisoners etc. who are at high risk of exposure. Through their assistance, educational programs and campaigns would be having a wider reach.
What about the people of the community? It goes without saying, ‘your health is in your hands’. In nearly every society, youth are often the most aware and so, are the key for changing social mindset towards TB. Encouraging them to work as health volunteers will enhance communication and help in overcoming barriers.
References - 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821649/ 2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508321/ 3. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3448-4 - Abs1 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961875/ 5. https://tbfacts.org/drug-resistant-tb/ 6. https://www.who.int/publications/i/item/9789240037021 7. https://theprint.in/health/covid-left- big-gap-in-tb-reporting-modi-govt-looks-to-fill-it-with-special-door-to-door-drive/863397/