Yadav, et al.  reported the annual risk of tuberculosis
infection (ARTI) of 1.2-1.6% and infection prevalence of 6.3-8.2% in
tribal children <10 years in Madhya Pradesh. These metrics are similar to
those in other tribal populations and in general populations throughout
India . They conclude stating: "there is need to strengthen and further
intensify TB control measures in the area," implying that current measures
are failing. Other recent papers also have illustrated the failure of TB
control in spite of long-standing efforts of the Ministry of Health [2,3].
National TB Control Programme (NTCP), started in 1962, was evaluated in
1990-92 and found to have failed [4,5]. The Revised NTCP (RNTCP) was
launched in 1992-93 [4,5]. Control status requires reduction of cumulative
infection prevalence to <1 in children by 14 years of age and ARTI of ~
0.07% [3-5]. However, ARTI remains >1% over decades; infection prevalence
in orders of magnitude higher than desired [1-4]. Nationally, there is no
decline in incidence or prevalence of TB in adults .
Why has TB not come under control? Treatment of the
infectious form of TB has not been validated sufficient for control [2-4].
Treatment can be given only to persons captured in the diagnostic net, but
it does not capture all infectious cases, allowing many to seek private
healthcare, wherein non-standard treatment is rampant, and follow up poor,
contributing to development of drug resistance. The sensitivity of TB
diagnosis is inadequate without micro-biological diagnostic support. Even
those captured in RNTCP become non-infectious only after they have shed
the bacilli for several weeks. Thus chains of infection continue unabated
and ARTI remains high in all studies [1-4].
RNTCP must be revamped, deficiencies covered,
interfaced effectively with healthcare (public and private sectors), and
supported adequately with laboratory facilities [2-4]. Infection incidence
must be regularly monitored in all districts by systematic surveys of ARTI
[2-4]. Pediatric TB infection and disease must be given high priority for
detection and treatment [2-4]. Such strengthening and intensification of
RNTCP will be essential to control TB and convincingly document it.
1. Yadav R, Rao VG, Bhat J, Gopi PG, Wares DF. Annual
risk of tuberculosis infection among tribal children of Jhabua, Madhya
Pradesh. Indian Pediatr. 2011;48:43-5.
2. Vashishtha VM, John TJ. Prevalence of
Mycobacterium tuberculosis infection in children in western Uttar
Pradesh. Indian Pediatr. 2010;47:97-100.
3. John TJ, Vashishtha VM, John SM, Sudarshanam TD.
Tuberculosis control must be scientifically defined and soundly designed.
Indian J Med Res. 2010;132:4-8.
4. John TJ. Tuberculosis control, without protection
from BCG. Indian Pediatr. 2000;37:9-18.
5. http://www.tbcindia.org/perfor.asp. Accessed on 29 January, 2011.