India: State's failure to track migrants with tuberculosis raises concern

"No system to track the migrant population with TB is a serious concern, especially in the highly-urbanized state like Maharashtra. All efforts to eradicate TB would turn futile if a mechanism to this effect is not put in place," said Yatin Dholakia, honorary secretary and technical advisor of the Maharashtra State Anti-Tuberculosis Association.

"Our survey in Mumbai and Pune concluded that migration is a major cause of infection here. But that doesn't mean other places are safe since people come here for temporary jobs and move on to other cities," Dholakia added.

A UN-HABITAT report has stated overcrowding and poor ventilation in slums as conducive to the spread of the disease worldwide with HIV-related tuberculosis becoming an increasingly urban phenomenon.

"Urban slum dwellers are at a higher risk since these areas have higher population density and unhygienic living conditions. Research indicates that the annual risk of TB infection was 69% higher in urban than rural areas," stated the Global Health Strategies report on TB in India.

Other factors such as the prevalence of diabetes and transmissibility of disease are higher in urban areas which contribute to the greater prevalence of TB here. It is estimated that nearly 1 in 3 persons in India is infected with bacteria that can cause active TB.

However, despite repeated concerns raised by experts and activists, the state government is still unprepared to tackle the situation. While senior state health officials were unwilling to speak, Sanjiv Kamble, joint state director (TB), admitted that the state lacked a system to track migrants carrying TB.

But efforts are now being taken, he said, adding that in a recent state-level meeting, they had directed city and district officials to keep a record of migrant patients.

A senior state bureaucrat conceded that the government's health department was apathetic towards setting up tracking system for urban migrants. "TB control programme continues to remain largely on paper. It is all about keeping records and seeking funds," he said.

Another problem in TB treatment is the social dogma attached to the disease. "Poor patients don't want to be recognized as TB patients since it would mean isolation and no jobs for them. Quite often, they do not even complete the prescribed first-line course of medicines and by the time they are referred to government hospitals, they are already drug resistant," NGOs said.

Chapal Mehra, former senior director with Global Health Strategies and currently an independent consultant, said awareness and availability of services are vital for TB treatment in urban slums. "Also, there is a need for grassroots community movement in cities facing widespread migration," he added. More efforts should go into reaching vulnerable groups in the slums, he said.

The government-sponsored Revised National TB Control Programme, which was supposed to cover a large part of the population through its DOTS programme, has not reached a majority of the population in urban slums.

Source: The Times of India