Times of India
24 March 2011
By Pratibha Masand & Malathy Iyer

Medication Abuse, Congested Spaces Threaten To Reverse Progress Against Tuberculosis, MDR Cases In City At 17%
World TB Day

Tuberculosis is no doubt a killer considering that it claims two persons every three minutes in the country. But widespread abuse of medications and congested environs have given rise to drug–resistant TB. While there are no fresh studies to pinpoint the exact incidence of drugresistant TB in the city, doctors believe it accounts for between 10–17% of total TB cases. A study done four years back in a city hospital put the MDR–TB incidence at 9% of all cases.

The seriousness of the issue was underlined by WHO officials in Europe last week when scientists noted that the progress made in TB so far could be wiped out in the next few years due to the emergence of drug–resistant TB. This could be especially true for India, more so Mumbai, where infected people live in congested homes. "No patient perceives an immediate threat due to TB. Hence they choose to ignore the symptoms for as long as possible and end up spreading the disease in the community," said chest specialist Dr Ashok Mahasur from Hinduja Hospital.

The city registered 29,528 cases of TB last year, according to BMC statistics. The medical community is not sure how many of these are caused by the MDR strain, but is nevertheless worried. "I would say 8% to 12% of my new patients suffer from MDR–TB," said chest specialist Dr Alpa Dalal from BMC’s TB specialty hospital in Sewri. However, a sentinel survey from Nagpur said 10% and 17% of all TB patients had MDR–TB. BMC doctors said the city has an incidence of 10%.

Said a BMC health official, "In 2010, Mumbai registered 29,528 TB cases, only 1% less than last year. Of these 21,000 were new cases, while the rest were for re–treatment as the first line of treatment did not work." Many possibly have MDR–TB but due to poor availability of testing facilities and expensive medication, exact numbers are unavailable. The Centre last year identified labs in the country for free MDR–TB testing, but they are few.

The BMC provides testing and medicines at only three zones. "From public hospitals, 84 samples were sent for MDR–TB testing in Hinduja . We pay the hospital Rs 2,000 for each sample. Of these 60 tested positive,” said the BMC official.

What is worrying doctors is the resistance. "We get one or two patients every week with extreme drug resistance or XDR–TB. We have to find a way to quickly diagnose and treat them," said Dr Dalal.