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Tuberculosis: An underreported killer
Many years ago, while visiting a village called Arogyavaram in Chitoor district of Andhra Pradesh which hosts a Christian Mission Hospital, I was shown a cottage where Kamla Nehru, the wife of Pt Jawaharlal Nehru had once stayed decades ago.

At that time, Arogyavaram, a place with a salubrious climate, was a TB sanatorium and Kamla Nehru, a patient hoping to recover her health there. In those days, (we are talking of the period around 1930s), tuberculosis had no cure and the only treatment prescribed was a longish stay in a TB sanatorium where it was hoped that a benevolent climate and good nutrition would aid recovery.

Sadly, that didn't happen for Kamla Nehru, although she kept moving from sanatorium to sanatorium, eventually dying at one in Lausanne in Switzerland in 1936. Exactly a decade later, streptomycin, the first drug to be effective against TB was discovered.

Tuberculosis has been there since antiquity and has always carried with it a lot of baggage and stigma. India has had its share of the disease burden with about 3 million people suffering from it at any given point of time and is the country's largest public health challenge. Although it was a challenge earlier also but in the 1990s and beyond with the spread of HIV & AIDS, and close association with TB in immune compromised people, it became a bigger challenge.

A bigger challenge though is that despite multiple advances in medicine since the discovery of streptomycin, the duration of treatment is still long (six months onwards) and many of the patients drop out of the treatment radar along the way. This incomplete treatment regime has given rise to strains of multi-drug resistant TB. India again has the dubious distinction of having the second largest number of drug resistant TB cases after China. The problem is not going away anytime soon.

According to a report published in the prestigious journal " Lancet", more than a million tuberculosis (TB) cases may be missing from official statistics in India, as many cases go unreported and the data only captures the numbers of people reporting to health care facilities in the organized sector.

But because of factors that are both economic as well as social, many patients seeking treatment for TB turn to unregulated private doctors who often do not report cases. It is also difficult to track as to how many of such people actually complete the course of treatment.

Again, one has to fall back on estimates and they seem to indicate that out of the 2.7 million individuals with tuberculosis (TB) in India in 2013, estimates show that only about 1.05 million or 39 per cent completed therapy through the government TB programme and survived for one year after treatment without experiencing a relapse, according to a report published in the Indian Express.

In today's infrastructure driven age, public health does not attract too many eyeballs. Yet TB, where India hosts the largest number of patients, has an under noticed and under reported problem.

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