India accounted for 27 per cent of the 10 million people who developed tuberculosis in 2017, the highest among the top 30 high TB burden countries in the world, according to a latest report by the World Health Organization.
The 2018 edition of the Global Tuberculosis Report, released here Tuesday, provides a comprehensive and up-to-date assessment of the TB epidemic and progress in the response at global, regional and country levels.
The report said that globally, the best estimate is that 10 million people developed TB disease in 2017. Of these, 5.8 million are men, 3.2 million women and one million children.
There were cases in all countries and age groups, but overall 90 per cent were adults, and nine per cent were people living with HIV.
Of the global total, two-thirds were in eight countries alone - India 27 per cent; China nine per cent; Indonesia eight per cent; the Philippines six per cent; Pakistan five per cent; Nigeria four per cent; Bangladesh four per cent and South Africa three per cent.
The report said that these eight nations and 22 other countries in the WHO's list of 30 high TB burden countries accounted for 87 per cent of the world's cases. Only six per cent of the global cases were in the WHO European Region - three per cent and WHO Region of the Americas - three per cent.
"TB is the 10th leading cause of death worldwide, and since 2011 it has been the leading cause of death from a single infectious agent, ranking above HIV/AIDS," the report said adding that it claims over 4,000 lives a day.
Actions and investments to end the epidemic fall far short and as the high-level UN General Assembly kick starts here next month, heads of State will meet at the first-ever United Nations General Assembly High-level Meeting on TB on September 26 to commit to accelerate the TB response.
According to an estimated epidemiological burden of TB in 2017, for the 30 high TB burden countries, WHO regions and globally, India's total TB burden incidence was 2.74 million, the highest.
The report noted that estimates of TB incidence and mortality for India are interim, pending results from the national TB prevalence survey planned for 2019/2020.
It further said that drug-resistant TB continues to be a public health crisis. The best estimate is that worldwide in 2017, 558,000 people developed TB that was resistant to rifampicin (RR-TB), the most effective first-line drug, and of these, 82 per cent had multidrug-resistant TB (MDR-TB).
Three countries accounted for almost half of the world's cases of MDR/RR-TB: India 24 per cent; China 13 per cent and Russia 10 per cent.
Worldwide in 2017, 6.4 million new cases of TB were officially notified to the national authorities and then reported to the WHO.
This number has been increasing since 2013, following four years (2009–2012) in which 5.7–5.8 million new cases were reported annually, mainly due to increased reporting of detected cases by the private sector in India (plus 44 per cent between 2013 and 2017), following the introduction of a national policy of mandatory notification in 2012 and the rollout (also since 2012) of a nationwide web-based and case-based reporting system (called 'Nikshay') that facilitates reporting of detected cases by care providers in the public and private sectors.
Ten countries accounted for 80 per cent of the 3.6 million global gap, the top three being India 26 per cent, Indonesia 11 and Nigeria nine per cent.
The report said that urgent action is required to improve the coverage and quality of diagnosis, treatment and care for people with drug-resistant TB. Globally, 1,60,684 cases of MDR/RR-TB were detected and notified in 2017 (a small increase from 1,53,119 in 2016). Of these, a total of 1,39,114 people, 87 per cent, were enrolled on treatment with a second-line regimen.
India accounted for 32 per cent of global TB deaths among HIV-negative people, and for 27 per cent of the combined total TB deaths in HIV-negative and HIV-positive people.
The report noted that in India, multiple sources of evidence from surveys and surveillance have shown large underreporting of detected TB cases, especially in the private sector.
The report stated that among the six WHO regions, the highest treatment success rates in 2016 were in the WHO Eastern Mediterranean Region 92 per cent and the WHO Western Pacific Region 91 per cent.
The lowest rates (at 75 per cent) were in the WHO South-East Asia Region (due to high proportions of unevaluated cases, especially in India), the WHO Region of the Americas (due to high levels of loss to follow-up and missing data) and the WHO European Region (due to high rates of treatment failure and death, influenced by the high frequency of MDR/RR-TB).
It noted that as highlighted in the 2017 Global tuberculosis report, in India there has been a particularly striking increase in the TB-specific budget and domestic funding for this budget since 2016. Between 2016 and 2018, domestic funding for the national budget for TB in India more than quadrupled, from USD 110 million in 2016 to USD 458 million in 2018.
India is an example of a country that took major steps in 2017–2018 to expand TB-specific cash transfers and linkages to broader nutrition schemes.
The report said that for the past year, the Revised National TB Control Programme (RNTCP) and National AIDS Control Organization (NACO) in India have been capturing data to evaluate TB case-finding activities among people attending antiretroviral therapy centres.
It noted that several anti-TB drugs are being tested across the world, including a Phase II/III trial for prevention of TB recurrence in adults is being implemented in India.
