Dr. Sharda Jain
Chairperson
Women wing, IMA

TB is number one killer of women in general and of women in the reproductive age group in particular for almost two decades. Women are most vulnerable to TB infection as they only are health care providers in the family for the ailing in-laws, husband and children afflicted with TB.  Prompt medical care to women infected with TB is not available in rural area and urban slums as seeking medical help and diagnosis is delayed usually. With delay in diagnosis there is delay in starting treatment as well . Unwillingness to spend on continued treatment for the entire 6 month period of the course is yet another major barrier to their cure. It is not unusual to find that when women get infected, they are sent back to their parental home for treatment or deserted in many cases. Beside neglect by family members, she neglects herself as well.

In present DOT treatment, the diagnosis and treatment of TB, pose another problem for women as they need to leave home, travel to  a health centre, escorted by a male member incurring expenditure on travel and medicines.  These clinics are not opened at convenient timing i.e. early morning or late evening  when bread winner can spare some time for women . Thus women fail to obtain quality care in the absence of a support system at home to care for the children, and financial capacity to meet the high cost of medicines. Not being in a position to make decisions on financial resources of the family, they postpone or deny themselves urgent health care.

 Social isolation of patients of tuberculosis occurs on the belief that tuberculosis is hereditary or   infectious. Non-pulmonary TB, can cause INFERTILITY which is usually difficult to diagnose and even when diagnosed, remains untreated. Women suffering from infertility are invariably deserted or ostracized by family.

Till now it was felt overpopulation, poverty and tuberculosis go hand in hand.  But TB has crossed all barriers of rich and poor, north and south. It affects everybody. Younger lots of upper class family are especially vulnerable to this disease due to low resistance. You name a celebrity significant number of them have had this disease.  One good point of this disease is that, “it is easy to diagnose and easy to treat provided one follows doctor’s instructions”.

The National TB Control Programme was initiated in 1962. We are still far far away from national goal of putting stop to new TB infection.  It is estimated 25 to 38% of all women and men are infected by tuberculosis at one or other stage of their life. The ratio of persons afflicted with non-infectious (pulmonary and extra pulmonary) tuberculosis to those suffering from infectious tuberculosis of the lungs is estimated to be 1.5:1 . According to one estimate, the prevalence of active pulmonary tuberculosis is 9/1000 and infectious tuberculosis is 6/1000. This  figure seems grossly inadequate.

Studies of National TB Institute (NTI) Bangalore, reveals that 95% of infectious TB patients were conscious of their symptoms  in cities and, infact, 50%  sought medical  help themselves . But public awareness  of this disease in slums and rural areas is still non existent .

BCG trials conducted in Chingelpet (Tamil Nadu) by TB Research Center , Madras showed that BCG vaccination  given at birth did not protect children against pulmonary TB.  However the experience of large number of pediatricians showed that BCG did protect them against severe forms of TB ( milliary TB and TB  meningitis), which take heavy toll of  life . The results of the above  landmark studies contributed to shifts in TB care strategies globally. This is indeed a major contribution made by Indian public health experts. This is the very reason the BCG vaccination is still given at birth.

Despite the identification of  TB as the major public enemy No.1 and the biggest killer of women in the reproductive age group, infection is on the increase (Indian Medical Association). The reasons for this are several.

• Inadequate budget outlay for TB.
• Patchy involvement of the private sector in TB care
• Inadequate diagnostic and therapeutic facilities for 85% of population belonging to weaker section of society.
• Lack of awareness in the patients and inadequate education  by the  health personnel  regarding danger of drug default and emergence of drug resistance.
• Non availability of Anti-TB drugs for weaker section of society who do not come to government run clinic or Hospital.
• Spiraling costs of anti-TB drugs and medical costs.
• No training of private doctors on therapeutic guidelines under the revised National TB Control Programme.

Major shifts   are required in the approach to tackle rampant  TB in Indian population  in more intensive. No accountability along with budget constraints causes weakening of the public health system.

It is estimated that government sector can not reach out to 85% of countries population and they are dependent on private doctors.

IMA  wishes  TB free  India and wishes to upscale government’s  effort 5-6 times by involving private sector in a big way in all states. 

IMA launched Major TB project of public-private partnership on 24th   March i.e.  “on world TB day ” to realize its dream to check TB in this country. It is requested that
every doctor  and health professional should spend extra   30  minutes with patient and family – to  emphasize guideline adhere to treatment, failing which the disease  becomes untreatable  and drug resistant.

For Tuberculosis :  IMA appeal to people
                        TB is a  leading killer of the day.
                        It is a global emergency of today.
                        Spreading like wild fire, record  says.
                        India shoulders 1/3 global load, now a  days.
                       
                        Monster kills more than 1000 lives every day.
                        How pathetic, need not to say.
                        Poor, malnourished and HIV infected
                        are its favorite preys.
                       
                        But wicked hands not leave any one who comes in its way.
                        If cough clogs the airway for  more than 21 days.
                        Inspite of treatment, it stays & you strive for clear airways.
                        Then rush for sputum exam & X-rays .

                        If it comes out to be TB
                        Jump on to the treatment, don’t delay.
                        Forget about coins, you need not to pay
                        Now DOTS come with bright rays.

                        It is a service to patient in direct way,
                        It ensures cure & reduces the spread rate.
                        Prompt diagnosis & uninterrupted therapy.
                        Change the marks of weakness from morbid  & gloomy lace.