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TB TAKES A TOLL ON WOMEN, CHILDREN 3L Kids Are Orphaned, 1L Ailing Women Lose Homes Every Year
Fear of becoming homeless and social isolation once diagnosed with TB makes over 75% of women dismiss their constant coughing as seasonal. Thousands of children, on the other hand, drop out of school on account of parental illness, while over 20% of them take up jobs in order to supplement income, especially if the father has TB, thereby encouraging child labour. Several studies conducted between 1997-2006 by Dr Rajeswari Ramachandran from Tuberculosis Research Centre, Chennai, confirmed that TB had tremendous impact on patients’ households in terms of income, health, education and nutrition, particularly if the patient was a wage earner. Over 35% patients admitted to not being able to afford to buy adequate food, clothing and books for children due to loss of income. “TB’s greatest impact is on productive adults. Adults aged 15-59 years are the most economically productive individuals. They are also parents on whom the survival and development of children depend. Thus, TB has the potential to impede the development of both individuals and society,” Dr Ramachandran said. She added, “The fear and stigma associated with TB have a greater impact on women than on men. The man leaves his wife if she develops TB and remarries. On the other hand, nobody marries a single girl suffering from TB.” Health minister A Ramadoss too is worried about the stigma women face after being affected by TB. “One in 1,000 women loses her home because she has TB. India’s revised national TB control programme is therefore giving special emphasis on building awareness and removing stigma,” he told TOI. TB in women has been found to greatly affect child survival which fell from 64% to 35% among rural females and from 74% to 33% in urban females affected by the disease.
DEADLY DISEASE
To
date, 6.7 million patients in India have received DOTS treatment,
averting more than 1.22 million deaths (Times of India) DRUG-RESISTANT TB STRAINS ATTACKING CHILDREN IN INDIA, REVEALS STUDY MARCH 24, 2008: It’s difficult to believe that a patient would take anti-tuberculosis (TB) drugs for four consecutive years, but Vakola child Suvarna did exactly that before the real picture emerged. “Suvarna had multi-drug-resistant (MDR) TB, with her left leg and spine getting so affected that her growth was stunted,’’ said Dr Vikas Agashe, an orthopedic surgeon who operated on the 10-yearold’s leg a few months ago.
Suvarna’s father Selva, a tailor’s assistant and a worried man, said, “She has had four operations and the drugs prescribed recently cost Rs 4,500 a month.’’ Dr Agashe knows many patients like Suvarna as he has researched the rising incidence of bone TB in Mumbai for the past three years. Pulmonary (chest) TB is still the most common form, but the incidence of TB of other organs is growing rapidly as well. We are, in fact, sitting on a volcano,’’ he said on the study of patients with bone TB, funded by Bombay Orthopaedic Society and Hinduja Hospital. The surgeon cited the example of an 18-month-old boy with MDRTB. The child was the youngest in his study with this difficult-to-treat TB variant. A labourer couple had visited his clinic in Kurla two years ago when their 18-month-old child seemed paralysed on one leg. “The child was on regular TB drugs, but we realised that he had MDR-TB when we conducted tests,’’ said Dr Agashe. The family did not return for six months, during which both the child’s legs became paralysed. “We operated on him (the child) and got a chest specialist to put him on a course for MDRTB. He has been doing well since then,’’ the surgeon said. In a year when TB sprang back into the news, thanks mainly to US health officials quarantining a young lawyer with suspected extensively resistant TB (XDR), the news for India is grim as well. The World Health Organisation last week declared India as the hotbed for MDR-TB, and blamed the country as well as China for their failure to control the emergence of fresh cases. Worse, the number of XDR-TB cases also seems to be rising every day. Dr Agashe’s study on 150 bone TB patients from various city hospitals reveals an equally worrisome facet of the disease: it’s never been as aggressive in children as it is now. “More than 50% of the patients were under 10 years of age. Fourteen of them had MDR-TB, of whom two children had XDR-TB, who never returned for follow-up.” None of the 150 patients or their family members had previous exposure to TB. So how did they get the disease? “It appears that a resistant TB strain was present in the vicinity that affected the children,’’ explained Dr Agashe. Diagnosis is often difficult in the case of bone (osteoarticular) TB as patients are rarely advised to go for culture tests. “Their lungs may or may not show the infection, so it is important to read the signs, which could be pain and swelling in the joints,’’ the surgeon said. The doctor plans to set up an osteoarticular TB registry in Mumbai. “The aim is to register all new and old cases of bone, joint and spine TB between May 1 and June 30.’’ It will help the medical fraternity fight the disease. Chest physician Dr Ashok Mahasur from Hinduja Hospital said, “There’s no doubt that the incidence of MDR-TB is on the rise, but the problem of extensively resistant TB (XDR-TB) is aggravating too. There are patients who are resistant to newer drugs and injections, making it difficult for us to help them at all.’’ He believes the reason for this unhealthy trend is largely due to delayed treatment or breaks in the process. INCIDENCE OF THE DISEASE IN INDIA
1,932,852: Estimated incidence (all new
cases in 2006) MDR-TB accounts for 3-5% of all cases XDR-TB accounts
for 9% of all MDR-TB cases It is a disease caused by germs that spread from person to person through air. TB usually affects the lungs, but can also affect the brain, kidneys or the spine
SYMPTOMS
TB can usually be treated with a course of four standard or first-line, anti-TB drugs. If these are misused or mismanaged, multi-drug-resistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects If these drugs too are misused or mismanaged, extensively drug-resistant TB (XDR-TB) can develop As XDR-TB is resistant to firstand second-line drugs, treatment options are seriously limited and so are the chances of cure (Times of India)
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