Delhi is India's TB capital; Gujarat least affected state

Delhi is the tuberculosis (TB) capital of India, and Gujarat has the lowest disease prevalence, a health ministry funded National TB Prevalence survey conducted from 2019 to 2021 to know the actual disease burden of TB at a national level has concluded. The survey calls for prioritising the interventions in high prevalence states with focus on screening of elderly, malnourished and diabetics.

The survey results show that the prevalence of all forms of TB for all ages in India was 312 per lakh population for the year 2021. The highest prevalence for all forms of TB was 747 per lakh in Delhi and the lowest was 137 in Gujarat. The prevalence of TB infection among the population aged 15 years or more is 31.4%. Higher prevalence of Pulmonary TB (PTB) was observed in older age group, males, malnourished, smokers, alcoholics and known diabetics, the survey said.

According to the survey, 64% of symptomatic population did not seek health care services in India. The reasons varied from ignoring the symptoms (68%), not recognising the symptoms as TB (18%), self-treatment (12%) and unaffordability. Among the 36% of survey participants who sought care for their symptoms, there was equal preference for government and private facilities, the survey results revealed.

The survey called for implementing strategies to reduce the Prevalence to Notification (of the disease) gap. It also stressed the need to engage with the private sector for increased case notification. "We have to focus on health education in the general community for the symptom awareness and to improve the health seeking behaviour of the symptomatic. Further evaluation, to assess the impact of Covid-19 on TB estimates in the high and low burden states are ongoing," it said.

A total of 3,54,541 population was covered, of which 90.9% (3,22,480 out of 3,54,541) of the eligible population participated in the survey. Among 3,22,480 who participated, 100% had symptom screening results and 97.1% had chest X-ray results.

The survey protocol, design and standard operating procedures (SOPs) were developed in accordance with the global guidelines provided by the World Health Organisation. While technical assistance on the design of the survey, data management, monitoring its implementation was provided by WHO country office for India, the Department of Health Research and Indian Council of Medical Research (ICMR), New Delhi provided technical, administrative and financial support. ICMR- National Institute for Research in Tuberculosis (NIRT) was the primary agency which implemented the survey in collaboration with the other regional ICMR institutes and all the state TB cells of the country.