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T.B or not T.B

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By Suraj Radhakrishnan

Bangalore, Oct 25: Karnataka has the lowest patient retreatment success figures in India after Assam, Meghalaya and Maharashtra. Sixty-two percent of patients are relapsing and the figure is growing.

According to WHO definitions, TB retreatment is when patients need TB treatment again after they have ended their first course of drug treatment. People who need retreatment may be classified according to whether they relapsed, failed or defaulted on their original treatment.

Transactions of the Royal Society of Tropical Medicine and Hygiene published a study in March 2016 involved 400 interviews and 208 hours of observation, and 2,000 observed patient interactions in 10 clinics in India.

In any retreatment situation it is possible that the person has got drug resistant to TB. This is particularly likely to be the case if the person has never responded to and (or) has failed their initial drug treatment. In this case they need testing for drug resistance and they may need specific TB treatment of drug resistant TB.

According to the study, the rate of treatment discontinuation is very high. Sixty-five per cent of the patients discontinue treatment due to several reasons, mainly unavailability of medicine and costs of private hospitalization.

“A large percentage of the patients who relapse die in the state. Most relapses are because of high medicine prices and lack of equipment. Patient care must improve as T.B. Is rampant in our country” says Dr. Shoba.

”This can be attributed to bad patient care and lack of medicines here. Take the average PHC in Bangalore, half the time we do not have any kits. How can we diagnose anything?” Says Dr.Shoba, PHC doctor, Nayandhalli.

Out of the 17793 thousand patients recorded in 2015 only 9340 thousand patients chose public sector health care.

“This has led to the number of patients stopping health care mid-way. Treatment of T.B ranges from 2-9 months depending on the severity of the case. Most rural patients and poor/slum patients from urban sector cannot afford this lengthy spell of medicines, hospital fees and transport.” She added.

One of the highlights of this study was that none of the 175 practitioners exclusively practiced their system of training. While allopathic medicines, including antibiotics, were prescribed for acute conditions, the physicians generally prescribed their system of medicine for chronic conditions.

The patients were treated with broad-spectrum antibiotics and other symptomatic drugs during the first few visits. Different antibiotics were prescribed during each visit. This process of experimentation using antibiotics usually lasted 10-14 days.

“I shuttled between the hospital and my home for over 3 weeks before they suspected T.B. I was coughing heavily. The doctor asked me to take medicine for 6 months. I had treatment for 1 month only because treatment already cost me six thousand rupees.” Said Umapathy, 46, auto driver.

“The overall treatment cost me nearly one Lakh rupees. I wouldv’e continued the treatment if I had access to the tablets or if they were available nearby. I had to go very far away and they cost me a lot. I didn’t know discontinuation will prove so costly.” He added.

“Though fever is common and not very specific to TB, and more than two weeks of cough is one of the main symptoms of TB, no physician ever asked for lab investigation on the first visit. Instead the focus is in managing symptoms using non-specific therapy.” Says Dr. Karunakaran, Pulmonologist, Apollo Velachery, Chennai.

These reasons cause the high number in patient relapses in a country that is responsible for over 25 percent of the global T.B. Cases.

“There needs to be implementation of the WHO TDR program, which provides funds for T.B. Medication across the nation. The focus should be on curing the patients rather than misdiagnosing.” added Dr. Karunakarn.N.

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