TODAY -

Kerala's multi-layered approach to #endTB

Shobha Shukla *



As part of the #EndTB Dialogues series launched in lead up to the 50th Union World Conference on Lung Health last month, we got an opportunity for exclusive interview with Dr M Sunil Kumar, State Tuberculosis Officer, Ministry of Health and Family Welfare, Kerala, and Dr Shibu Balakrishnan, World Health Organization (WHO) consultant with the Revised National TB Control Programme (RNTCP) in Kerala.

Kerala’s multilayered sustained model of TB care and control is reflected in the reduced incidence rate of disease which was measured at 44 cases per 1,00,000 people, against the national average of 199 cases per 1,00,000 people. The annual decline rate of TB incidence in the state is 3%, which, again, is much higher than the national average.

Kerala is equipped to offer universal DST to all the diagnosed TB cases in the private and public sector. It has achieved 69% universal DST for rifampicin with CBNAAT. Additionally, 5 districts offer universal DST for isoniazid also through line probe assay. Prevalence of rifampicin resistance in TB infected people in Kerala is 1% and isoniazid resistance is also less than 2%.

People’s movement against TB

Kerala’s TB elimination activities have grown into a people’s movement against TB. At the grassroot level there are self-help groups called 'Kurmishri' who are involved in the TB control programme. The healthcare portal of the Kurmishri network meets once every quarter.

Health inspectors attend these group meetings in their jurisdiction where health related issues are discussed and symptomatic TB patients are directed to public health system. Also district panchayats or the local self-governments provide nutritional and housing support to TB patients and their families.

TB mapping and active case-finding

In 2018, Kerala launched a house to house survey to test every resident of the state for TB and to map vulnerable populations with a view to monitor them regularly. 87% of the Kerala’s population - which means 2,45,00000 people - was mapped by trained healthcare workers (including local/ village level health workers, social health activists, medical staff, etc ). Out of these only 352 new cases of TB were found.

In this active case-finding exercise all persons were scored on 13 health parameters. The survey found that 3.5% of Kerala’s population is vulnerable to TB and 50% of Kerala’s active TB cases come from the pool of people with latent TB infection (LTBI). These people with LTBI are now screened for TB once every 3 months by the field staff.

A new surveillance system has been in place at the district level since the last 2-3 years under the leadership of district TB officers. Under this system, pharmacists have to maintain the records of sale of TB drugs and this data is collected from the pharmacies in every district.

At the state level, monthly sales data of TB drugs is obtained from the drug controller’s office of Kerala. Names of private doctors giving TB treatments are tracked and forwarded to the respective districts to ensure that TB cases of the private sector are notified. This helps in identifying the missing cases that are getting treatment outside the existing public health system.

Private sector participation:

Private sector involvement has been there since 2004 with support of the Indian Medical Association (IMA). Statewide trainings for IMA doctors have been organised to train them in standards of TB care and treatment protocols. Patients diagnosed in the private sector are offered free treatment in the public sector.

Another initiative for better engagement with the private sector is the opening of STEPS (System for TB Elimination in Private Sector) centres in private hospitals. These centres, launched in 2018 by the then WHO Deputy Director Dr Soumya Swaminathan (now Chief Scientist at WHO), act as a link between the public and private sector. They provide a single window for TB case notification, linkage to treatment support, and they also ensure that all public health and social welfare schemes offered to RNTCP patients are available to patients in the private sector too. This has helped in ensuring good treatment adherence in the private sector at par with the public sector.

Some other state wide initiatives:

- School children are provided with handkerchiefs and trained in cough etiquette. There is also a legislation against spitting in public places.

- Token system in hospitals controls overcrowding of patients in OPDs, as overcrowding in hospitals abets TB transmission. A fast tracking mechanism for presumptive TB cases or those diagnosed with TB is in place so that they are fast tracked to the doctor to reduce the time gap between diagnosis and treatment initiation.

- All TB patients are given a financial incentive of 1000 INR every month for nutritional support.

Prevent TB to end TB

Kerala has taken many initiatives to prevent the spread of TB infection and to promote air borne infection control measures in public places. With its successful mapping of vulnerable populations and surveillance system, the state is all geared up for programmatic management of LTBI. Its proposal for a pilot in at least two districts (Idukki and Wayanad) to diagnose and treat LTBI has been approved by the government of India.

The primary diagnostic test is interferon gamma release assay (IGRA) and primary treatment regimen is 3HP (once weekly dose of isoniazid–rifapentine for 12 weeks). It will be rolled out as soon as the national policy on LTBI management is announced.

NCDs are a major threat to TB control

A major hurdle which Kerala faces in its TB control efforts is the rising incidence of non-communicable diseases (NCDs). Around 44% of its TB patients suffer from diseases like diabetes, hypertension, etc. So now the thrust is on linking all TB patients with the NCDs control programme. Kerala started screening for diabetes in TB patients from 2003 onwards and TB diabetes bidirectional screening has been there since last 2-3 years.

Kerala has a robust general health system that is supported by political and administrative commitment. This, coupled with its high literacy rate and good health seeking behaviour of the people, is likely to make Kerala the first TB free state in the country and become a beacon of hope for other states.


* Shobha Shukla, CNS (Citizen News Service) wrote this article for e-pao.net
The writer is the Managing Editor of CNS (Citizen News Service) and Coordinator, APCAT Media (Asia Pacific regional media network to end TB & tobacco, and prevent NCDs). Follow her on Twitter @shobha1shukla or visit www.citizen-news.org)
This article was posted on November 18, 2019 .


* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Photos from 2012-2019 : Inner Line Permit
  • Miss Kut at Imphal #5: Gallery
  • Demand for Inner Line Permit (ILP) : Articles
  • Brahmacharimayum Mahendra : Silpbhusan
  • My worries in filing stories about Assembly
  • Silver jubilee of Tingkao Ragwang Chapriak
  • My DSLR Journey :: Travelogue
  • Career in CAPF
  • Killing 2 birds, 1 stone : No CAB, Yes ILPS
  • A phone call that overwhelm our CM
  • NTC opposes Pan Naga Hoho post solution
  • Inauguration: Sangai Fest #1: Gallery
  • Gaiguilung, Changbombi : eMing
  • Induction of NCC Microlite Aircraft : Gallery
  • Inner Line Permit (ILP) Demand : Timeline
  • Is disruption possible in Manipur politics?
  • Sex education: The unspeakable undeniable
  • CAB: Protest at Delhi University
  • KASHISH 2020 : Queer Film Festival
  • The rape circle is complete
  • WC refutes NNC pledging support to FA
  • Communities @ Shirui Lily Fest #1 : Gallery
  • Winter Relief @Tokpaching : Gallery
  • My way only :: Poem
  • Remembering Dr BR Ambedkar #1
  • Winter Relief Service at Arong Khunou
  • Karnataka-Manipur Cultural Festival
  • Workshop on MOOCs at NEHU
  • Beauty essential while traveling in winter
  • Reinstate workers fired in FCI
  • Significance of windows
  • Thanga Ningol to mapam #3 : Gallery
  • Xmas shopping @CCpur [Dec 6] : Gallery
  • Irawat and 1939 Women's War
  • Naga Peace Process :: News Timeline
  • Cannot end AIDS without combating AMR
  • Power of Pranayama #2
  • Jobs @ Birla Emporiums, Khurai
  • Memo to BOSEM, Manipur
  • Appreciation to Kuki Iron Lady
  • Questions over 'instant justice'
  • Optimist perspectives
  • NE bandh call on Dec 10 against CAB
  • Football: Manipur vs Mandalay #2: Gallery
  • Flower festival at Mao : Gallery
  • #iWill :: Poem
  • H Nageshwar : Expedition to Antarctica
  • Relevance of Nehru today #2
  • Climate Change & Agricultural hurdles
  • The Rat on the Run :: Poem
  • Info from Delhi; Reading ILPS idea
  • Confusing the constitution
  • Finding on Yek of Meitei & Hao #1
  • Miss Kut at Imphal #4: Gallery
  • A Girl with Golden Hair :: Poem
  • NEP for Skill India
  • The great cosmic discovery - III
  • Interference by TA & Hills official
  • A one line statement from Amit Shah
  • Insertion of a clause to Peoples' Bill
  • RK Meghen at Imphal [28 Nov] #2: Gallery
  • Midnight drama, hush-hush swearing-in
  • Plight of peasants in the hills #2
  • Jobs @ Kanglei Khoni, Langthabal
  • Drones can be an innovative career
  • Winners @ South Asian Games
  • Winners @ Asian Athletic C'ship
  • Waiting for CBI probe
  • When the savior turns perpetrator
  • Tapta: Jayenta Loukrakpam :: A Profile
  • Destination North East @ Vanarasi : Gallery
  • Winter Book Sales at Manipur University
  • The Vow :: Poem
  • Written assurance is still not tenable
  • Protest against rape of woman vet
  • From 2012 to 2019 no change
  • The 'Trust' factor
  • NSCN (IM) clarifies on 'calendar' issue
  • Centre assures flights betn IMF & Mandalay
  • Sanathong Water Fall, Chandel : Gallery
  • Facts about Naga insurgency #2
  • CC Meet 2019 : Match Fixture
  • Commemoration Kuki Rebellion 1917-1919
  • Moirangthem Sushilkr : Honorary Doctorate
  • Power of Pranayama #1
  • Khumang: 'Science for Society' Report
  • A fresh look at ST demand
  • Wakching Thana Lakpada #1 :: eRang
  • Football: Manipur Vs Mandalay : Gallery
  • December Calendar for Year 2019 : Tools
  • Why not carve out a future in Chakhao ?
  • Relevance of Nehru today #1
  • The great cosmic discovery - II
  • The Killing Fields 2013-19 : News Timeline
  • Diversion - the age old shrewd game
  • Lamhui amashung Keishal : Funga
  • Eyek Tamba :: Learn Manipuri script
  • Kut : State level @Imphal #4: Gallery
  • Sangai Festival: Extended till 2nd Dec
  • 133 months left to make U=U (on HIV)
  • Galaxy Roy & my Sainik memories
  • Need to silence the loud mouth
  • CAB issue raise in Zero Hour
  • RK Meghen at Imphal [28 Nov] #1: Gallery
  • Plight of peasants in the hills #1
  • Nawa Loude :: Poem
  • Awarded, outdated currencies & MCS/MPS
  • Social Unrest in N-E Regions
  • Winter care for beautiful hair
  • No harm but a clause needed: The absurdity
  • A blow to survival
  • Leirum- used in Luhongba : Gallery
  • Ningol Chakkouba Shopping #2 : Gallery
  • Road safety in Manipur: need to plug gap
  • AAI steps up effort for gender equality
  • Preparing children before diagnostic test
  • Licypriya Kangujam embarks on 5 Nations
  • One Word of Truth :: Poem
  • Riders in the assurance of Amit Shah
  • GK Pillai's way out and today's Manipur
  • Mera Houchongba @Kangla #5: Gallery
  • Facts on Naga insurgency & its impact #1
  • Binodkumar: public urinal with plastic waste
  • Joining Indian Navy as sailors
  • National Constitution Day observed
  • Condemn incident of molestation in CCpur
  • After a date with Amit Shah
  • Sustaining Evening daily- challenging task
  • Culturals @ Shirui Fest #3: Gallery
  • Banana Festival @ Noney #2 : Gallery
  • Air pollution rise what do common man do
  • Conversation with Prof Rajendra Kshetri
  • 'It is a unique experience to play polo here'
  • The great cosmic discovery - I
  • Make Delhi trip meaningful !
  • Confusing stand; confusing act
  • Manipur Polo International: Opening: Gallery
  • Kut : State level @Imphal #3: Gallery
  • Kalum Kai: House of worship of Zeliangrong
  • Christian virtues
  • Blame it on Farmers for Pollution
  • Title: Square one ? :: Poem
  • Bucket of cold water after a hot shower
  • Radio-tagged Amur falcon flies to Africa
  • Myanmar Air KBZ flight to Imphal: Gallery
  • Alert Rally @ Sagolband : Gallery
  • 50th International Film Festival
  • World Antibiotics Awareness Week (WAAW)
  • CAB : Indians are not foreigners
  • Dissolution of TSA Imphal Branch
  • Anti-corruption crusade at time of CAB
  • Gandhari (Dance Drama) #2 : Gallery
  • Epilogue to Nambul Nostalgia :: Poem
  • Hostile education system in Northeast
  • Stigma and mental illness
  • Paulallungmuan: 12 yr-old at Class X exam
  • 3 from Manipur named Unsung Heroes
  • Raids at Imphal, Aizawl, Gurgaon
  • Make sure that Sangai fest is successful
  • Laonii Festival, Poumai #2 : Gallery
  • Khamba Thoibi Museum #2 : Gallery
  • Enigma of Unique Histories
  • When God's people humble
  • The great cosmic discovery - V
  • TB prevention is no longer a choice..
  • Stakeholders to be consulted: Final pact
  • The unresolved crisis
  • IM leaders camping along India-Myanmar
  • Trekking to Dzukou Valley #3 : Gallery
  • Licypriya- SDG Ambassador Award: Gallery
  • Featured Front Page Photo 2019 #5: Gallery
  • Whither Pangals ?
  • Licypriya Kangujam: SDG Ambassador
  • Blood Donation Camp at Benguluru
  • The Sun on the Western Horizon :: Poem
  • Rejoinder to NDPP [20 November]
  • Regarding resignation of NPF Youth Wing
  • Rider to be exempted from CAB: ILP
  • Truth, sincerity & commitment ...
  • CAB : Total Shutdown - Nov 19 : Gallery
  • CAB : Sit In Protest - Nov 19 : Gallery
  • Dr Sanajaoba (Dr KS Singh): Reminiscence
  • Career option in technical writing
  • What Mindset does Govt of Manipur have ?
  • 12 Members resigned from NPF
  • Where is the special clause in CAB?
  • Please understand CAB; future is at stake
  • CAB protest - Nov 18 : Gallery
  • Children's Day @CM Bungalow : Gallery
  • Why CAB is being opposed in North East
  • Meeteis' paradox
  • A Vision :: Poem
  • NE development: Lean on regional planning
  • Sand War- deadly war against mother Earth
  • From 'ahead of final pact' to CAB
  • Can Meitei, Naga & Kuki jointly resist CAB?
  • Mera Houchongba @Kangla #4: Gallery
  • Ningol Chakouba Fish Fair #2: Gallery
  • History - from Obscurity to Visibility ?
  • Manipur State Journalist Awards, 2019
  • Was it a Hindu Day in Assam book season
  • Kerala's multi-layered approach to #endTB
  • Being vegetarian can fight climate change
  • Let the rivers flow uninterrupted
  • Cry of a Dying River : 100 Poems
  • MANITEX & the poor fate of weavers
  • Anecdote, Fable & Refugee Blues : Poem
  • What is pollution doing to your skin
  • Dispensation in Nagaland is rudderless
  • Resistance to CAB may fail
  • Culturals @ Shirui Fest #2: Gallery
  • Gender, Power in South Asia :: Book Rvw
  • Stop Burning of Hay- uplift Rural Economy
  • Disoriented mind :: Poem
  • What is all about a flag ?
  • Cannabis plant : Myths and facts
  • Need to be on guard against rumours
  • Smart city or smart earning...
  • Ningol Chakouba @ Pune : Gallery
  • Rani Hingchabi :: Funga Wari
  • Miss Kut @Imphal #3 : Gallery
  • Salt brines : Source of Meitei Thum
  • Children from Noney #1: Gallery
  • Ema Keithel (Khwairamband) #2: Gallery
  • Argentina hosts Manipur Cup (Polo)
  • Cry of a Dying River - 100 :: Poem
  • Thanga Ningol to mapam #2 : Gallery
  • Lungpuiga Remei : Natyabhusan
  • World Tourism Day @Noney #5 : Gallery
  • Ningol Chakkouba @ Korea : Gallery
  • Ningol Chakkouba @ Mysore #2 : Gallery
  • Ningol Chakouba & Kut at Korea
  • Ningol Chakkouba by Journalists : Gallery
  • Ningol to her mapam lamdam : Gallery
  • Tolloi, Ukhrul :: 360 Panorama View
  • SPONSORED ADS