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Cyclists rally across city to spread awareness about TB

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Awareness is critical to India’s tough battle against tuberculosis

PATNA: TB causes two deaths every three minutes in India. In Bihar, as many as 58,814 new TB cases surfaced in 2014 . However, what is more worrisome is the fact that 1,010 cases are of multi-drug resistant ( MDR ) TB and 25 cases are of extensive-drug resistant TB, known as XDR. In Bihar , 21 deaths occur in one lakh population.MDR TB develops when the first line of treatment fails. That may happen if the patient does not complete the six-month dosage of drugs for any reason. When TB becomes resistant to two most powerful anti-TB drugs — isoniazid and rifampicin- MDR TB develops. XDR TB is resistant to almost all common TB drugs.“There is a possibility that about 12% old TB cases may convert into MDR cases. Even 3% new cases can be of MDR type,” said state programme officer for TB, Dr S N Sahai.MDR TB treatment is costlier than normal TB. While normal TB treatment may cost a few thousands, MDR TB treatment costs about Rs 2 lakh and the treatment stretches for about two years. XDR TB drugs are rarely available in government sector. In private sector too, the drug is normally in short supply. The mortality rate of XDR TB is nearly 100%.Dr Sahai says 40% people in Bihar harbour TB bacteria. “We expect fresh TB cases to go up to two lakh every year till 2035,” he said. What compounds the woes is the fact that despite TB being a notifiable disease, private practitioners are not reporting it to the authorities concerned. As many as 67% patients visit private doctors. “There is a fixed protocol to treat TB. In government set-up, frontline health workers do the necessary follow-up, but in private sector that is not done. This further leads to MDR and XDR TB,” Dr Sahai said.Apart from pulmonary TB, extra pulmonary TB cases, including abdominal TB, bone TB, brain TB and liver TB, are also on the rise. “Abdominal TB is especially on the rise as infants in villages are fed with unboiled milk due to several myths,” said PMCH TB and chest physician Dr Ashok Shankar Singh .People with HIV are especially prone to contracting TB infection. “More than 50% HIV positive people are at the risk of developing TB. In fact, recent studies suggest uncontrolled diabetes can also lead to TB,” Dr Diwakar Tejaswi said.According to a study by Rajendra Memorial Research Institute of Medical Science doctors, the combination of three infections – kala-azar, HIV and TB — can be deadly. Since Bihar accounts for 80% kala-azar cases, the triad of infections can be deadly for Bihar. “Poverty, overcrowding and malnutrition make them (people) vulnerable to TB. The nexus of the three major diseases together make diagnosis difficult and pose a genuine therapeutic challenge. The cost of such elaborate diagnostic procedures and treatment was very high and beyond the reach of most people in developing countries such as India,” the paper reads.