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SHOCKING! TB kills 1,183 Indians daily

June 16, 2018 09:06 IST

'There is little doubt that India's tobacco epidemic is contributing to its TB epidemic,' says Neil W Schluger.

Shontish Hansda, 35, suffering from tuberculosis, lies outside his hut in the village of Mirjapur, some 120 kilometres west of Kolkata. Photograph: Desmond Boylan/Reuters

Shontish Hansda, 35, suffering from tuberculosis, lies outside his hut in Mirjapur village, some 120 kilometres west of Kolkata. Photograph: Desmond Boylan/Reuters

India's government is aiming to eradicate tuberculosis from India by 2025, five years ahead of the global TB elimination target of 2030.

Jotindra Singh, 65, suffering from Tuberculosis (TB) waits for his free treatment outside a medical centre in Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

Jotindra Singh, 65, waits for free treatment outside a medical centre in Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

It is a worthy goal that will bring significant health and economic benefits: TB killed 432,000 Indians in 2016 -- more than 1,183 every day, with most deaths occurring among economically productive adults.

 

A health technician analyses blood samples for tuberculosis testing in a high-tech tuberculosis lab. Photograph: Mariana Bazo/Reuters.

A health technician analyses blood samples for tuberculosis testing in a high-tech tuberculosis lab. Photograph: Mariana Bazo/Reuters

To make the goal achievable, India must look beyond improving diagnosis and treatment and attack the many factors that are driving tuberculosis.

A win-win strategy for the government will be taking strong action to reduce tobacco use.

A Government of India TB poster. Photograph: Courtesy: https://tbcindia.gov.in

A Government of India TB poster. Photograph: Courtesy: https://tbcindia.gov.in

The first World Health Organization monograph on the links between TB and tobacco was published in 2007. The evidence base has only increased since then.

Studies consistently find that smoking increases the risk of developing active TB, is linked with more severe presentations and longer duration of TB, makes treatment for TB less effective -- increasing the risk of death -- and is associated with a higher rate of relapse.

Research confirms these risks also increase among non-smokers exposed to secondhand tobacco smoke, mainly children.

Young boys smoke a bidi. Photograph: Amit Dave/Reuters

Young boys smoke a bidi. Photograph: Amit Dave/Reuters

There is little doubt that India's tobacco epidemic is contributing to its TB epidemic.

Over 103 million adults (15+ years old) and 625,000 children (10 to 14) use tobacco each day.

Our most recent Tobacco Atlas notes that 7.9 per cent of TB-related deaths in India are specifically related to tobacco use -- but it is a factor in many more of the 2.79 million cases of TB in India in 2016 alone.

Tara Devi, who suffers from tuberculosis, waits outside a medical centre in Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

Tara Devi, who suffers from tuberculosis, waits outside a medical centre in Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

From a physiological perspective, tobacco smoke (for smokers and those exposed to SHS) is a risk factor for TB as it damages vital immune cells in the lungs.

This harm is similar to other forms of air pollution that cause disease, such as dust from mining.

An x-ray showing a pair of lungs infected with TB. Photograph: Luke MacGregor/Reuters

An X-ray showing a pair of lungs infected with TB. Photograph: Luke MacGregor/Reuters

In addition, there is a behavioral reason for the heavy toll of TB among smokers: a key barrier to timely diagnosis and treatment is the assumption that a persistent cough is related to smoking, rather than an indicator of TB.

Five-month-old Rotiya Ashur, who suffers from tuberculosis, rests inside the tuberculosis ward of a hospital on the outskirts of Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

Five-month-old Rotiya Ashur, ill with tuberculosis, rests inside the tuberculosis ward of a hospital near Siliguri, West Bengal. Photograph: Rupak De Chowdhuri/Reuters

The Government of India, recognising this risk, was the first in the world to launch a mass media campaign designed to alert the population to the links between TB and tobacco.

'TB Cough' shows tobacco consumption and exposure to SHS increases the risk of TB and of dying from the disease.

It encourages smokers to visit their doctor to confirm whether a persistent cough is a sign of TB, and to quit tobacco use.

The striking central message of the campaign: 'Every bidi, cigarette brings you and those around you closer to TB'.

Our research indicates that this campaign will have made a difference.

Sputum samples. Photograph: Beawiharta/Reuters

Sputum samples. Photograph: Beawiharta/Reuters

During rigorous pretesting with a target audience, 'TB Cough' made respondents 'feel sympathetic to those with TB', 'made them feel concerned about symptoms of TB', 'made them more likely to visit a doctor if they had TB symptoms', 'increased their confidence to take TB medications if they got sick' and 'made respondents feel more concerned' about smoking around others.

An Indian doctor examines a sex worker suffering from tuberculosis at a health clinic for prostitutes in Kolkata. Photograph: Jayanta Shaw/Reuters

A doctor examines a sex worker afflicted by tuberculosis at a health clinic for prostitutes in Kolkata. Photograph: Jayanta Shaw/Reuters

Other campaigns that warn of the health harms of tobacco -- like 'Clinical' -- will also help reduce smoking in India.

While most smokers quit without help, this campaign was the first to promote the national quit-line as a source of advice for smokers who need support.

Neil W Schluger is Senior Advisor for Science, Vital Strategies.
Vital Strategies, according to its Web site, partners 'with governments to rapidly design and implement public health initiatives that bridge the gap between public health needs and solutions, especially in low- and middle- income countries.'

Neil W Schluger
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