PROBLEMS IN ESTIMATING THE BURDEN OF PULMONARY TUBERCULOSIS IN INDIA: A REVIEW pot

Original Article

PROBLEMS IN ESTIMATING THE BURDEN OF

PULMONARY TUBERCULOSIS IN INDIA: A REVIEW

M.S.Krishnamurthy*

(Received on 5.2.2001, Revised version received on 2.7.2001, Accepted on 9.7.2001)

Summary :It is generally agreed that there is need for developing an acceptable estimate of the tuberculosis problem in

India. Estimates obtained by the National Sample Survey have been found to be deficient for the purpose of enabling

rational allocation of resources and evaluating efficiency of anti-tuberculosis programmes. The WHO commissioned a

study on the subject and subsequently published a review of the global burden of tuberculosis, in which the Indian situation

was also considered. The Government of India also formulated a Committee in 2000 to address this problem. The author

reviews the estimates so far obtained.

Burden of pulmonary tuberculosis - the current corresponding to the population escalation taking

estimates place in the country.

For developing an appropriate strategy for

combating tuberculosis in the country, it is necessary

to obtain a precise estimate of the disease in the

community. The process of estimating it for as large

and diverse a country as India is not only difficult,

but is also expensive and time consuming.

It is common knowledge that the nation

wide sample survey carried out by the Indian Council

of Medical Research (ICMR) in 1955-58 (NSS),

followed by several similar surveys conducted at the

National Tuberculosis Institute, Bangalore (NTI),

New Delhi Tuberculosis Centre and the Tuberculosis

Research Centre, Chennai (TRC) had provided the

basis for estimating the prevalence of tuberculosis

in India. On an average, the same was taken to be

4.0 and 16.0 per thousand for bacteriological (C+)

and radiologically active tuberculosis cases (X+)

respectively. Although the tuberculosis situation and

the prevalence rates were considered to be static in

time, as per the findings of several of the studies

carried out in India, the absolute number of cases in

the country had to be constantly revised upwards,

The case for revision of estimates

The global resurgence of tuberculosis,

especially in the context of Human Immuno￾deficiency Virus, has created an unprecedented

awareness for tuberculosis in recent times. Several

international bodies have, as a result, involved

themselves in tuberculosis control with an intensity

never evidenced before. The question, however,

which has been disturbing the intervention-strategists

is how to evaluate changes in tuberculosis situation,

following the implementation of the control measures

requiring investment in money and manpower.

Evidently, some kind of change in the tuberculosis

situation could result and this would require

measurement. It is, however, open to question how

precise the estimate for the disease should actually

be to make it amenable to measurement. On the one

hand, we are made aware by Chakraborty, in a recent

communication1

, and even in an earlier paper2

, that

he had found the available data in India unsuitable

for efficacy and efficiency evaluation exercises. On

the other hand, an editorial in the Indian Journal of

Tuberculosis (IJT)suggests that ideals (in estimating)

* Health Scientist, Bangalore

Correspondence: Mr M S Krishnamurthy, 2315, 21st Cross, Banasanhai II Stage, Banglore 560 0070

The Indian Journal of Tuberculosis