Lok Sabha Question No. 3310 (UNSTARRED), answered on 2019-07-12
Subject: Tuberculosis in India
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Subhash Ramrao Bhamre, Heena Vijaykumar Gavit, Kuldeep Rai Sharma, Supriya Sadanand Sule, Amol Ramsing Kolhe, Sunil Dattatray Tatkare

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 3310 TH

TO BE ANSWERED ON 12 JULY, 2019

## TUBERCULOSIS IN INDI A

## 3310. DR. SUBHASH RAMRAO BHAMRE:

DR. HEENA GAVIT:

SHRI KULDEEP RAI SHARMA:

SHRIMATI SUPRIYA SULE:

DR. AMOL RAMSING KOLHE:

SHRI SUNIL DATTATRAY TATKARE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  whether  the  Government  has undertaken  assessment  to  ascertain  the main contributors to tuberculosis in India;
- (b) if so, the details thereof and if not the reasons therefor;
- (c)  whether  the  Government  has undertaken  study  to  prove  the effectiveness of tobacco cessation counseling to TB patients and if so, the details thereof;
- (d) wheth er the Government is considering to establish tobacco cessation centres in each district to regulate and monitor tobacco usage among citizens, and if so, the details thereof and if not, the reasons therefor; and
- (e) the other steps taken/being taken by th e Government to control tuberculosis in the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

- (a) &(b) Yes , the Ministry of Health & Family Welfare (MOHFW) has made assessments to ascertain the main contributors to the spread of Tuberculosis in India.

Tuberculosis is an airborne infection, transmitted by inhalation of infected drople which are discharged in air when an untreated TB patient coughs or sneezes.

The reasons for Tuberculosis in India are attributed to various social determinants wh perpetuate the spread of TB infection. These social determinant factors like poverty (Mu M. et al (1), under - nutrition (Padmapriyadarsini C et al (2)), poorly ventilated livin g including air pollution  (Behera  D  et  al.(3)),  alcohol  consumption  (Suhadev  M  et  al  (4));  tobacco  sm (Kolappan C et al (5)), etc. increase the likelihood of conversion of TB infection to TB d

(c) Yes; The evidence emerges from several studi es conducted to look at the association of TB and tobacco use in India and globally and almost 38% of TB deaths are associated with th of tobacco. Prevalence of TB is three times higher among ever - s kers as compared to that of never - smokers.

The  Government  has  undertaken  two  studies  to  prove  the  effectiveness  of  tobacco  cessa counselling to TB patients.

A pilot project was implemented in Vadodara, Gujarat in 2010, which offered as 'B Advice' to TB patients registered for the Directly Observe d Treatment Short course (DOTS) and among those who were using tobacco in any form. At the end of the treatment, 67.3% pati who were offered 'Brief Advice' were able to quit tobacco use.

A similar study was conducted in Jaipur, Rajasthan. Around 75% T B patients had quit tobacco use after getting counselled by the DOTS provider.

(d) Government  of  India  launched  the  National  Tobacco  Control  Programme  (NTCP)  in 2007- 08, with the aim to create awareness about the harmful effects of tobacco consump red uce the production and supply of tobacco products; ensure effective implementation o provisions under 'The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) A ct, 2003' (COTPA); help the people quit tobacco use, and facilitate implementation of strategies for preve control  of  tobacco  advocated  by  WHO  Framework  Convention  of  Tobacco  Control  . Accordingly, there is a provision of setting - up of Tobacco Ces sation Centre (TCC) at the district level under National Tobacco Control Programme (NTCP) of the Ministry for strengthening cessation facilities including pharmacological treatment facilities along with promotio tobacco cessation facilities in t he community.

(e)          The  Ministry  has  developed  the  National  Strategic Plan (NSP) for Tuberculosis (20172025) with the goal of ending TB by 2025.

The key focus areas are:

-  Early  diagnosis  of  all  the  TB  patients,  prompt  treatment  with  quality  assured  drugs  and treatment regimens along with suitable patient support systems to promote adherence.
- Engaging with the patients seeking care in the private sector.
- Prevention strategies including active case finding and contact tracing in high risk / vulnerable population
- Airborne infection control.
- Multi-sectoral response for addressing social determinants.

## References

- 1) M Muniyandi & Rajeswari Ramachandran (2008) Socioeconomic inequalities of tuberculosis  in  India,  Expert  Opinion  on  Pharmacotherapy,  9:10,  1623-1628, DOI: 10.1517/14656566.9.10.1623
- 2) Padmapriyadarsini  C,  Shobana  M,  Lakshmi  M,  Beena  T,  Swaminathan  S. Undernutrition  &  tuberculosis  in  India:  Situation  analysis  &  the  way  forward. Indian Journal of Medical Research. [Review Article]. 2016 July 1, 2016;144(1):11-20
- 3) Behera D et al. Domestic Cooking Fuel Exposure and Tuberculosis in Indian Women. Ind J Chest Allied Dis. 2010 Vol 52. Pg 139-43
- 4) Suhadev  M,  Thomas  BE,  M  RS,  P  M,  V  C,  Charles  N,  R  D,  M  A,  Mathew  TA, Wares  F.  Alcohol  Use  Disorders  (AUD)  among  Tuberculosis  Patients:  A  Study from Chennai, south India. PLoS One.2011;6:1-6
- 5) Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax.2002;57:964-966