Lok Sabha Question No. 65 (STARRED), answered on 2015-07-24
Subject: Cases of TB and MDR-TB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SURESH KODIKUNNIL, PINAKI MISRA

**GOVERNMENT OF INDIA**

**MINISTRY OF HEALTH AND FAMILY WELFARE**

**DEPARTMENT OF HEALTH AND FAMILY WELFARE**

**LOK SABHA**

**STARRED QUESTION NO. 65**

**TO BE ANSWERED ON THE 24** **TH** **JULY, 2015**

**Cases of TB and MDR-TB**

***65. SHRI KODIKUNNIL SURESH:**

**SHRI PINAKI MISRA:**

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

(a) the number of cases of Tuberculosis (TB) and Multi-Drug Resistant TB (MDRTB) and attributable deaths reported in the country during each of the last three years and the current year, State/UT-wise;

(b) the steps taken/proposed to be taken by the Government for identification, detection and treatment of TB/MDR-TB cases along with the funds allocated and utilised therefor during the said period, State/UT-wise;

(c) whether the Government has set any target to control and eliminate tuberculosis, if so, the details thereof and the action plan drawn by the Government for the purpose, State/UT-wise;

(d) whether as per the findings of a latest study, use of Xpert molecular test as an initial diagnostic test for TB in public health facilities increased the rate of notification of TB and rifampicin resistant TB cases in the country; and

(e) if so, the details thereof along with the corrective measures being taken by the Government to include the same in country's TB control programme?

**ANSWER**

**THE MINISTER OF HEALTH AND FAMILY WELFARE**

**(SHRI JAGAT PRAKASH NADDA)**

(a) to (e)  A statement is laid on the Table of the House

**STATEMENT REFERRED TO IN REPLY TO LOK SABHA**

**STARRED QUESTION NO. 65 FOR 24** **TH** **JULY, 2015**

(a) to (c) Government of India, along with State Governments, has been implementing the Revised National Tuberculosis Control Programme in the country  which since 2005 is under the aegis of the National Health Mission. The goal of the programme is to attain universal access to free and quality assured diagnosis and treatment of tuberculosis.

Under the programme,   more than 13000 designated microscopy centres have been established for quality diagnosis of TB. Treatment for drug sensitive TB is provided through a network of DOT Centres where a dedicated box containing complete course of treatment is available for each patient. Most government hospitals, Community Health Centres (CHC), Primary Health Centres (PHC), sub centres function as DOT centres. In addition NGOs, Private Practitioners (PPs) involved under the RNTCP, community volunteers, Anganwadi workers, women self-help groups etc. also function as DOT providers/DOT Centres. Drugs are provided under direct observation and the patients are monitored to facilitate adherence to and completion of treatment.

Programmatic Management of Drug Resistant TB (PMDT) Services under RNTCP were initiated in India from year 2007 and the entire country was covered by 2013. Diagnosis of Drug Resistant TB is conducted through quality assured drug susceptibility testing at 62 Culture and Drug Susceptibility Testing (C & DST) laboratories, in addition to availability of rapid molecular tests like Line Probe Assay (LPA) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT).

The programme also addresses co-morbidities with TB. TB was made notifiable vide Government Order No Z28015/2/2012TB dated 7th May 2012.       A Case based web based online application ‘Nikshay’ has been implemented to improve surveillance and facilitate case notification. State/UT-wise number of cases of Tuberculosis (TB) and Multi-Drug Resistant TB (MDRTB) and attributable deaths reported in the country during each of the last three years and the current year is provided in Annexure 1 to 4. Details of funds allocated and utilized during the last three years and the current year, is provided in Annexure- 5.

Given the epidemiological pattern of TB in India, the Revised National TB Control Programme (RNTCP) targets Tuberculosis control and not elimination.

During the 12th five year plan, the focus is on Universal Access to free quality assured TB diagnosis and treatment with quality assured anti-TB drugs to all TB patients in the community. The salient features are as follows:

- Strengthening and improving the quality of basic DOTS services
- Further strengthening and aligning with health system under National Rural Health Mission (NRHM)
- Expanding efforts to engage all care providers
- Strengthening and provision of quality care to the vulnerable groups including slum dwellers, tribal population etc.
- Expanding diagnosis and treatment of drug resistant TB
- Improving communication, outreach  and social mobilization
- Utilizing Information Communication Technology (ICT) tools for strengthening TB   surveillance

(d)& (e)In a study undertaken to assess the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis and rifampicin-resistant cases of pulmonary TB in India, it was found that introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case notification rates of all bacteriologically confirmed TB and rifampicin resistant TB case notification.

Under RNTCP, appropriate technology is being used for early and improved detection of drug resistance, including the use of Line Probe Assay (LPA) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT).

**Annexure-1**

| **State/UT-wise  TB cases registered under RNTCP during last three years and the current year**   |                     |          |          |          |                      |
|---------------------------------------------------------------------------------------------------|---------------------|----------|----------|----------|----------------------|
| **S No**                                                                                          | **State/UTs**       | **2012** | **2013** | **2014** | **2015 (Jan-March)** |
| 1                                                                                                 | Andaman & Nicobar   | 844      | 738      | 762      | 167                  |
| 2                                                                                                 | Andhra Pradesh      | 108727   | 103707   | 88681    | 15108                |
| 3                                                                                                 | Arunachal Pradesh   | 2357     | 2500     | 2717     | 665                  |
| 4                                                                                                 | Assam               | 35788    | 35624    | 38365    | 8807                 |
| 5                                                                                                 | Bihar               | 73537    | 67020    | 68061    | 15781                |
| 6                                                                                                 | Chandigarh          | 2807     | 2890     | 2871     | 644                  |
| 7                                                                                                 | Chhattisgarh        | 27160    | 25889    | 28877    | 7659                 |
| 8                                                                                                 | Dadar& Nagar Haveli | 415      | 411      | 452      | 153                  |
| 9                                                                                                 | Daman & Diu         | 330      | 742      | 283      | 70                   |
| 10                                                                                                | Delhi               | 52006    | 50727    | 54076    | 13463                |
| 11                                                                                                | Goa                 | 1950     | 1778     | 1664     | 449                  |
| 12                                                                                                | Gujarat             | 72554    | 74086    | 77464    | 20129                |
| 13                                                                                                | Haryana             | 38036    | 38104    | 39534    | 9147                 |
| 14                                                                                                | Himachal Pradesh    | 13615    | 13691    | 14465    | 3426                 |
| 15                                                                                                | Jammu & Kashmir     | 12662    | 11038    | 10270    | 2326                 |
| 16                                                                                                | Jharkhand           | 36666    | 34941    | 35952    | 8246                 |
| 17                                                                                                | Karnataka           | 67572    | 61446    | 61385    | 14820                |
| 18                                                                                                | Kerala              | 25917    | 24204    | 23466    | 5913                 |
| 19                                                                                                | Lakshadweep         | 20       | 23       | 29       | 10                   |
| 20                                                                                                | Madhya Pradesh      | 89545    | 92420    | 100121   | 24036                |
| 21                                                                                                | Maharashtra         | 136045   | 137237   | 135615   | 33871                |
| 22                                                                                                | Manipur             | 2744     | 2329     | 2216     | 404                  |
| 23                                                                                                | Meghalaya           | 5114     | 5002     | 4958     | 1110                 |
| 24                                                                                                | Mizoram             | 2337     | 2005     | 2009     | 540                  |
| 25                                                                                                | Nagaland            | 3525     | 3339     | 3303     | 814                  |
| 26                                                                                                | Orissa              | 49191    | 45269    | 45837    | 11161                |
| 27                                                                                                | Pondicherry         | 1430     | 1458     | 1411     | 335                  |
| 28                                                                                                | Punjab              | 39569    | 37258    | 38192    | 9314                 |
| 29                                                                                                | Rajasthan           | 100966   | 94698    | 94974    | 20703                |
| 30                                                                                                | Sikkim              | 1832     | 1637     | 1638     | 249                  |
| 31                                                                                                | Tamil Nadu          | 79576    | 80407    | 84636    | 21128                |
| 32                                                                                                | Telangana           | -        | -        | 18655*   | 9813                 |
| 33                                                                                                | Tripura             | 2557     | 2540     | 2518     | 615                  |
| 34                                                                                                | Uttar Pradesh       | 271678   | 256733   | 255503   | 59155                |
| 35                                                                                                | Uttarakhand         | 15239    | 13700    | 14455    | 3400                 |
| 36                                                                                                | West Bengal         | 93274    | 90423    | 89869    | 21418                |
|                                                                                                   | TOTAL               | 1467585  | 1416014  | 1445284  | 345049               |

*Data since July 2014

| **Annexure 2**                                                                                                 |           |           |           |                      |
|----------------------------------------------------------------------------------------------------------------|-----------|-----------|-----------|----------------------|
| **State/UT-wise  Drug Resistant-TB cases registered under RNTCP during last three years and the current year** |           |           |           |                      |
| **State/UTs**                                                                                                  | **2012**  | **2013**  | **2014**  | **2015 (Jan-March)** |
| Andaman & Nicobar                                                                                              | 8         | 21        | 39        | 11                   |
| Andhra Pradesh                                                                                                 | 1228      | 1625      | 803       | 106                  |
| Arunachal Pradesh                                                                                              | 122       | 172       | 206       | 33                   |
| Assam                                                                                                          | 179       | 388       | 360       | 97                   |
| Bihar                                                                                                          | 118       | 527       | 970       | 283                  |
| Chandigarh                                                                                                     | 62        | 43        | 45        | 6                    |
| Chhattisgarh                                                                                                   | 34        | 125       | 141       | 40                   |
| Delhi                                                                                                          | 1653      | 1278      | 1572      | 298                  |
| Goa                                                                                                            | 33        | 42        | 36        | 12                   |
| Gujarat                                                                                                        | 1710      | 1660      | 1971      | 388                  |
| Haryana                                                                                                        | 126       | 505       | 561       | 142                  |
| Himachal Pradesh                                                                                               | 96        | 248       | 236       | 43                   |
| Jammu & Kashmir                                                                                                | 73        | 130       | 97        | 14                   |
| Jharkhand                                                                                                      | 136       | 257       | 225       | 47                   |
| Karnataka                                                                                                      | 90        | 717       | 733       | 199                  |
| Kerala                                                                                                         | 299       | 220       | 198       | 52                   |
| Madhya Pradesh                                                                                                 | 347       | 814       | 1116      | 253                  |
| Maharashtra                                                                                                    | 3357      | 4687      | 5072      | 1325                 |
| Manipur                                                                                                        | 26        | 56        | 38        | 8                    |
| Meghalaya                                                                                                      | 108       | 134       | 204       | 25                   |
| Mizoram                                                                                                        | 49        | 29        | 47        | 9                    |
| Nagaland                                                                                                       | 40        | 76        | 75        | 10                   |
| Orissa                                                                                                         | 142       | 203       | 244       | 81                   |
| Puducherry                                                                                                     | 26        | 18        | 28        | 5                    |
| Punjab                                                                                                         | 288       | 465       | 437       | 97                   |
| Rajasthan                                                                                                      | 2040      | 1805      | 1663      | 340                  |
| Sikkim                                                                                                         | 99        | 226       | 242       | 45                   |
| Tamil Nadu                                                                                                     | 679       | 1287      | 1136      | 291                  |
| Telangana                                                                                                      | -         | -         | 686       | 134                  |
| Tripura                                                                                                        | 17        | 10        | 14        | 5                    |
| Uttar Pradesh                                                                                                  | 110       | 1859      | 2798      | 931                  |
| Uttarakhand                                                                                                    | 87        | 177       | 281       | 57                   |
| West Bengal                                                                                                    | 735       | 1289      | 1799      | 337                  |
| **Grand Total**                                                                                                | **14117** | **21093** | **24073** | **5724**             |

Data of Lakshadweep is reported along with Kerala, whereas Data of Daman, Diu and Dadra & Nagar Haweli is reported along with Gujarat.

**Annexure 3**

| Deaths reported under RNTCP- Drug Sensitive TB (last 3 years and current year  #  )   |       |       |       |                  |
|---------------------------------------------------------------------------------------|-------|-------|-------|------------------|
| State                                                                                 | 2011  | 2012  | 2013  | 2014 (Jan-March) |
| Andaman & Nicobar                                                                     | 43    | 34    | 18    | 12               |
| Andhra Pradesh                                                                        | 5371  | 5439  | 5169  | 783              |
| Arunachal Pradesh                                                                     | 79    | 65    | 67    | 19               |
| Assam                                                                                 | 1586  | 1648  | 1678  | 418              |
| Bihar                                                                                 | 1972  | 2125  | 2139  | 482              |
| Chandigarh                                                                            | 56    | 82    | 65    | 10               |
| Chhatisgarh                                                                           | 988   | 1085  | 782   | 344              |
| D & N Haveli                                                                          | 21    | 12    | 15    | 4                |
| Daman & Diu                                                                           | 59    | 7     | 8     | 4                |
| Delhi                                                                                 | 1503  | 1241  | 1316  | 348              |
| Goa                                                                                   | 168   | 75    | 76    | 16               |
| Gujarat                                                                               | 3950  | 3808  | 4094  | 1089             |
| Haryana                                                                               | 1400  | 1649  | 1628  | 410              |
| Himachal Pradesh                                                                      | 630   | 521   | 518   | 149              |
| Jammu & Kashmir                                                                       | 468   | 337   | 303   | 74               |
| Jharkhand                                                                             | 1431  | 1341  | 1332  | 397              |
| Karnataka                                                                             | 4676  | 4542  | 4356  | 1026             |
| Kerala                                                                                | 1002  | 1205  | 1158  | 259              |
| Lakshadweep                                                                           | 3     | 1     | 1     | 0                |
| Madhya Pradesh                                                                        | 4079  | 2966  | 3174  | 830              |
| Maharashtra                                                                           | 6735  | 7687  | 7716  | 1948             |
| Manipur                                                                               | 167   | 72    | 73    | 27               |
| Meghalaya                                                                             | 177   | 213   | 202   | 46               |
| Mizoram                                                                               | 76    | 79    | 77    | 24               |
| Nagaland                                                                              | 135   | 91    | 201   | 27               |
| Orissa                                                                                | 2424  | 2405  | 2332  | 592              |
| Puducherry                                                                            | 72    | 78    | 66    | 21               |
| Punjab                                                                                | 1875  | 1925  | 1678  | 429              |
| Rajasthan                                                                             | 4134  | 3592  | 3599  | 852              |
| Sikkim                                                                                | 164   | 82    | 47    | 10               |
| Tamil Nadu                                                                            | 3794  | 3865  | 4005  | 1099             |
| Telangana                                                                             | NA*   | NA*   | NA*   | 568              |
| Tripura                                                                               | 292   | 150   | 106   | 31               |
| Uttar Pradesh                                                                         | 8221  | 7866  | 7946  | 1988             |
| Uttarakhand                                                                           | 823   | 552   | 500   | 138              |
| West Bengal                                                                           | 4691  | 5047  | 5184  | 1136             |
| Total                                                                                 | 63265 | 61887 | 61629 | 15610            |

#treatment outcomes of patients on first line treatment under RNTCP are reported 1 year after  patient registration

* reported along with undivided Andhra Pradesh

**Annexure 4**

| **Number of Deaths in drug resistant TB reported under RNTCP (State-wise)**   |          |          |          |           |
|-------------------------------------------------------------------------------|----------|----------|----------|-----------|
| **State**                                                                     | **2009** | **2010** | **2011** | **2012*** |
| Andaman & Nicobar                                                             | -        | -        | 0        | 2         |
| Andhra Pradesh                                                                | 15       | 17       | 47       | 114       |
| Arunachal Pradesh                                                             | -        | -        | 0        | 9         |
| Assam                                                                         | -        | -        | 0        | 12        |
| Bihar                                                                         | -        | -        |          | 19        |
| Chandigarh                                                                    | -        | -        | 0        | 7         |
| Chhattisgarh                                                                  | -        | -        | 0        | 4         |
| Delhi                                                                         | 37       | 58       | 110      | 224       |
| Goa                                                                           | -        | -        | 1        | 5         |
| Gujarat                                                                       | 64       | 168      | 190      | 328       |
| Haryana                                                                       | 10       | 16       | 20       | 25        |
| Himachal Pradesh                                                              | -        | -        | 13       | 12        |
| Jammu & Kashmir                                                               | -        | -        | 0        | 10        |
| Jharkhand                                                                     | -        | 0        | 7        | 17        |
| Karnataka                                                                     | -        | -        | 15       | 13        |
| Kerala                                                                        | 22       | 18       | 17       | 36        |
| Madhya Pradesh                                                                | -        | -        | 8        | 61        |
| Maharashtra                                                                   | 20       | 49       | 102      | 556       |
| Manipur                                                                       | -        | -        | 0        | 4         |
| Meghalaya                                                                     | -        | -        | 0        | 10        |
| Mizoram                                                                       | -        | -        | 0        | 3         |
| Nagaland                                                                      | -        | -        | 0        | 2         |
| Orissa                                                                        | 1        | 3        | 8        | 17        |
| Puducherry                                                                    | -        | -        | 2        | 3         |
| Punjab                                                                        | -        | -        | 0        | 30        |
| Rajasthan                                                                     | 17       | 46       | 69       | 357       |
| Sikkim                                                                        | -        | -        | 1        | 3         |
| Tamil Nadu                                                                    | 23       | 38       | 38       | 89        |
| Telangana                                                                     | 24       | 28       | 60       | 74        |
| Tripura                                                                       | -        | -        | 1        | 1         |
| Uttar Pradesh                                                                 | -        | -        | 14       | 14        |
| Uttarakhand                                                                   | -        | -        | 4        | 13        |
| West Bengal                                                                   | 5        | 42       | 38       | 88        |
| **Grand Total****                                                             | **238**  | **483**  | **765**  | **2162**  |

*Data till 30 th Sept 2012 (as treatment outcomes of drug resistant TB patients registered under RNTCP are reported 33-36 months after initiation of treatment),

**Deaths reported have increased over the years because the programme been scaled-up to cover the entire country under programmatic management of drug resistant TB and accordingly, has been able to detect and report more and more cases of drug-resistant TB cases.

Data of Lakshadweep is reported along with Kerala, whereas Data of Daman, Diu and Dadra & Nagar Haweli is reported along with Gujarat.

**Annexure : 5**

**Funds Allocated and utilized under RNTCP, State wise( last 3 financial years and current FY)**

(Rs. in lakhs)

| **Sl. No.**   | **Name of States**   | **2012-13**         |                    | **2013-14**         |                    | **2014-15**         |                    | **2015-16**         |
|---------------|----------------------|---------------------|--------------------|---------------------|--------------------|---------------------|--------------------|---------------------|
|               |                      | **Funds Allocated** | **Funds utilized** | **Funds Allocated** | **Funds utilized** | **Funds Allocated** | **Funds utilized** | **Funds Allocated** |
| 1             | Andhra Pradesh       | 2733.31             | 1883.80            | 2733.31             | 1620.70            | 1594.07             | 1092.37            | 1817.88             |
| 2             | Andaman & Nicobar    | 51.89               | 40.38              | 76.62               | 57.34              | 76.62               | 77.91              | 87.36               |
| 3             | Arunachal Pradesh    | 396.52              | 362.33             | 434.38              | 441.23             | 434.38              | 367.95             | 495.37              |
| 4             | Assam                | 1088.95             | 876.50             | 1192.94             | 1140.93            | 1192.94             | 845.25             | 1360.43             |
| 5             | Bihar                | 2486.62             | 1511.81            | 2486.62             | 1605.98            | 2486.62             | 1769.56            | 2835.74             |
| 6             | Chandigarh           | 86.83               | 72.12              | 128.22              | 123.52             | 128.22              | 100.65             | 146.14              |
| 7             | Chhattisgarh         | 1050.90             | 1069.14            | 1050.90             | 1059.49            | 1050.90             | 208.23             | 1198.45             |
| 8             | D & N Haveli         | 40.74               | 32.49              | 60.16               | 47.39              | 60.16               | 49.39              | 68.60               |
| 9             | Daman & Diu          | 25.88               | 17.98              | 38.21               | 19.58              | 38.21               | 20.85              | 43.55               |
| 10            | Delhi                | 947.40              | 1084.46            | 1398.97             | 947.88             | 1398.97             | 844.75             | 1595.39             |
| 11            | Goa                  | 68.59               | 70.59              | 101.29              | 107.48             | 101.29              | 60.37              | 116.51              |
| 12            | Gujarat              | 1318.95             | 1902.32            | 1947.62             | 2262.15            | 1947.62             | 2901.59            | 2221.07             |
| 13            | Haryana              | 883.25              | 599.70             | 883.25              | 643.73             | 883.25              | 839.73             | 1007.26             |
| 14            | Himachal Pradesh     | 346.28              | 399.57             | 511.33              | 405.03             | 511.33              | 299.02             | 584.12              |
| 15            | Jammu & Kashmir      | 557.35              | 452.09             | 823.00              | 556.11             | 823                 | 404.48             | 938.55              |
| 16            | Jharkhand            | 1270.98             | 817.83             | 1270.98             | 784.94             | 1270.98             | 1152.75            | 1449.43             |
| 17            | Karnataka            | 1548.05             | 1738.52            | 2285.92             | 2028.04            | 2285.92             | 1543.06            | 2606.86             |
| 18            | Kerala               | 735.50              | 745.65             | 1086.07             | 811.18             | 1086.07             | 821.56             | 1238.55             |
| 19            | Lakshadweep          | 22.19               | 18.45              | 32.76               | 15.19              | 32.76               | 8.02               | 37.35               |
| 20            | Madhya Pradesh       | 1472.48             | 1407.95            | 2373.24             | 1738.69            | 2373.24             | 2793.36            | 2706.44             |
| 21            | Maharashtra          | 3744.12             | 4080.51            | 5528.72             | 5193.83            | 5528.72             | 5050.80            | 6304.95             |
| 22            | Manipur              | 330.91              | 251.31             | 362.51              | 311.96             | 362.51              | 283.73             | 413.41              |
| 23            | Meghalaya            | 243.62              | 207.24             | 266.88              | 288.11             | 266.88              | 205.45             | 304.35              |
| 24            | Mizoram              | 278.63              | 291.65             | 305.24              | 358.58             | 305.24              | 332.86             | 348.10              |
| 25            | Nagaland             | 305.30              | 286.12             | 334.45              | 290.43             | 334.45              | 237.32             | 381.41              |
| 26            | Orissa               | 1458.95             | 1015.63            | 1458.95             | 1161.32            | 1458.95             | 1387.03            | 1663.79             |
| 27            | Puducherry           | 106.48              | 106.57             | 157.24              | 146.23             | 157.24              | 157.48             | 179.61              |
| 28            | Punjab               | 627.47              | 742.37             | 926.55              | 882.49             | 926.55              | 968.42             | 1056.64             |
| 29            | Rajasthan            | 1216.44             | 1076.22            | 1796.85             | 1441.93            | 1796.85             | 1475.22            | 2049.13             |
| 30            | Sikkim               | 162.01              | 117.82             | 177.48              | 194.73             | 177.48              | 104.97             | 202.40              |
| 31            | Tamilnadu            | 1425.65             | 1427.87            | 2105.17             | 1902.53            | 2105.17             | 2349.56            | 2400.74             |
| 32            | Tripura              | 194.07              | 111.24             | 212.60              | 137.5              | 212.60              | 139.78             | 242.53              |
| 33            | Uttar Pradesh        | 4411.44             | 4320.65            | 5674.56             | 5209.21            | 5674.56             | 8558.02            | 6471.30             |
| 34            | Uttrakhand           | 501.40              | 433.53             | 501.40              | 414.18             | 501.4               | 564.46             | 571.80              |
| 35            | West Bengal          | 1707.64             | 2105.81            | 2521.57             | 2698.00            | 2521.57             | 1952.50            | 2875.60             |
| 36            | Telangana            | NA*                 | NA*                | NA*                 | NA*                | 1139.24             | 158.84             | 1299.19             |
| **Total**     |                      | **33846.79**        | **31678.22**       | **43245.96**        | **37047.61**       | **43245.96**        | **40127.29**       | **49320.00**        |

****Not applicable***

***Note: Statement of Expenditure (SOE) from 10 States/UTs have not yet been received for 4*** ***th*** ***qtr. 2014.***