New Delhi: The Covid-19 lockdown may lead to 1,86,000 new tuberculosis (TB) cases and 88,000 additional deaths due to the disease in India, according to a new study.
The findings, published in the Indian Journal of Tuberculosis, reveal that there had been a 59 per cent under-detection of TB cases during the eight-week lockdown, between March and May, compared to the same duration before that.
The research was conducted by Dr Anurag Bhargava, Department of Medicine, Yenepoya University, Mangalore, and Dr Hemant Deepak Shewade, Centre for Operational Research at The Union, an international non-profit working on TB.
The nationwide lockdown, to curb the spread of Covid-19, had caused disruption in TB services and delay in diagnosis of this bacterial illness. This, the authors have noted, may lead to additional deaths if patients do not get treatment on time.
Lockdown’s impact on poverty
India has the highest number of TB cases and deaths resulting from it, says the study. It is more than a quarter of the world’s 10 million estimated cases and 449,700 of the world’s estimated 1.3 million TB-related deaths.
TB kills around 4.8 lakh Indians every year, or about 1,400 people daily, according to estimates from the National Strategic Plan for TB Elimination (2017-25).
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The official figure for TB deaths, according to a health ministry report, was 79,000 in 2018. This is the latest available figure.
The 68-day nationwide lockdown (from 25 March to 31 May) had led to worsening of poverty, under nutrition among the poor and under-detection of active TB cases, notes the study.
There would be a 25 per cent reduction in annual income because of the lockdown that could push 354 million Indians into poverty and double the country’s poverty levels, according to estimates quoted in the study.
Lockdown also had a short-term effect on per capita calorie and protein consumption among the poor and a long-term delay in recovery of the economy as well as increased unemployment.
The authors have noted how previous socio-economic crises in Cuba and Zimbabwe had led to increased TB incidences.
The pandemic and subsequent lockdowns may have serious implications on progression of TB and its transmission in India, where the disease is still strongly associated with poverty, the authors have said.
Under nutrition and tuberculosis
The nutritional status of a population is a strong determinant of TB incidences in a country. In India, under nutrition in adults alone account for 32-44 per cent of TB cases.
The authors have also estimated how economic slowdown will lead to decrease of one unit in Body Mass Index (BMI) among populations most-affected by poverty.
This means losing two to three kilos and that can lead to a 14 per cent increase in TB cases. The situation is further worsened by a reduced dietary protein intake among the poor.
The authors have recommended an urgent need for restoring TB services, active case finding in high-risk populations and systematic identification, referral as well as clinical management of severe TB among notified patients.
They also said the government should consider taking steps to counter nutritional impact of this current crisis by social protection measures such as cash transfers, restoring livelihoods, providing employment through schemes like the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS).
“The PDS should start making pulses available at subsidised prices to enable intake in quantities sufficient to meet the daily requirement of 40g per day per adult,” said the paper.
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