Leprosy-iastoppers
Editorial Notes

[Editorial Notes] Leprosy & TB: India’s disease burden

India recently has embarked on a large-scale plan to screen all children for leprosy and tuberculosis under Rashtriya Bal Swasthya Karyakram (RBSK). An estimated 25 crore children below the age of 18 will be screened for the leprosy and tuberculosis.
By IASToppers
September 07, 2019

Contents

  • Introduction
  • Why screening of Leprosy and TB are necessary?
  • Status of Leprosy and TB in India
  • Focus of the Rashtriya Bal Swasthya Karyakram (RBSK)

Leprosy & TB: India’s disease burden

For IASToppers’ Editorial Simplified Archive, click here

Introduction

  • India recently has embarked on a large-scale plan to screen all children for leprosy and tuberculosis under Rashtriya Bal Swasthya Karyakram (RBSK).
  • An estimated 25 crore children below the age of 18 will be screened for the leprosy and tuberculosis.

leprosy-iastoppers

Why screening of Leprosy and TB are necessary?

Leprosy

  • Leprosy is a leading cause of permanent physical disability.
  • Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disability due to leprosy.
  • In case of leprosy, the programme under RBSK would give preventive medication to people who have come in contact with the leprosy cases.

Tuberculosis (TB)

  • Tuberculosis infection is one of the most common communicable diseases in India, its transmission fueled by unhygienic, crowded living conditions.
  • Most Indians carry the TB bacterium and the infection starts when their immunity levels are low, from malnourished or suffering from conditions like AIDS.
  • India tuberculosis burden is the highest in the world.
  • Children tend to be more prone to catching infectious diseases from their peers because of long hours in confined spaces and more bodily contact than in adults.
  • Addressing the problem early would ensure that the infection cycle is broken.

Status of Leprosy and TB in India

Leprosy in India

  • India eliminated leprosy in 2005. As per WHO, elimination mean incidence rate of less than one case per 10,000 populations.
  • All states except Chhattisgarh and the Union Territory of Dadra and Nagar Haveli have eliminated leprosy. However, more than 1 lakh new leprosy cases are still detected every year in India.
  • In 2017, India had set a target of elimination of leprosy by 2018. However, leprosy still remains a challenge in a country that launched the National Leprosy Eradication Programme in 1955.

TB in India

  • TB kills an estimated 4,80,000 Indians every year, an average over 1,300 every day.
  • India also has more than a million TB cases every year that are not notified. Most remain either undiagnosed or inadequately diagnosed.
  • Many of the TB patients do not complete the full course of the antibiotic, thus exposing the bacterium to the medicine without fully killing it.
  • This results in the bacterium to evolve into a version of itself that is resistant to that particular drug.
  • For tuberculosis, the global Sustainable Development Goal target is to end the disease is 2030. However, in 2018, Prime Minister of India advanced the deadline for India to end TB by 2025.

Focus of Rashtriya Bal Swasthya Karyakram (RBSK)

  • Launched in 2013 under the National Health Mission, Rashtriya Bal Swasthya Karyakram (RBSK) is focused on preventing disease and disability in children.
  • “Child Health Screening and Early Intervention Services” refer to early detection and management of a set of 30 health conditions prevalent in children less than 18 years of age.
  • These conditions are broadly defects at birth, diseases in children, deficiency conditions and developmental delays including disabilities, together described as 4Ds.
  • Until now, neither leprosy nor TB were a part of the RBSK.

Key Facts

  • As per the National Family Health Survey (NFHS)-4 (2015-16), 35.7 per cent children below age five are underweight, 38.4 per cent are stunted (low height for age) and 21 per cent are wasted (low weight for height) in the country.

 

IT’s Input

About Leprosy

leprosy image iastoppers

 

  • Leprosy is also known as Hansen’s disease.
  • It is known to occur at all ages ranging from early infancy to very old age.
  • It is curable and early treatment averts most disabilities.

Causes

  • It is a chronic infectious disease caused by Mycobacterium leprae, a rod-shaped bacillus that is an obligate intracellular (only grows inside of certain human and animal cells) bacterium.

Transmission

  • The infection is spread from person to person by nasal secretions or droplets.
  • Leprosy is rarely transmitted from chimpanzees, mangabey monkeys, and nine-banded armadillos to humans.

Effects

  • The disease develops slowly (from six months to 40 years) and results in skin lesions and deformities.
  • It most often affects the cooler places on the body (for example, eyes, nose, earlobes, hands, feet, and testicles).
  • The disease is similar to tuberculosis, because it produces inflammatory nodules (granulomas) in the skin and nerves over time.

Types of Leprosy

  • Indeterminate
  • Tuberculoid
  • Borderline tuberculoid
  • Mid-borderline
  • Borderline lepromatous
  • Lepromatous
  • Paucibacillary
  • Multibacillary

Leprosy in India

  • In 2014, India had the largest number of latest leprosy cases globally.
  • From 2005 till 2014, the National Leprosy Eradication Programme (NLEP)recorded a rate of 1.25 to 1.35 lakh new cases each year.
  • With medical advances, it’s currently a very curable disease.
  • Although, a serious hurdle is that the social stigma related to leprosy as well as lots of persons affected by leprosy still be outcast from society.
  • The Law Commission has prepared a model draft legislation, titled “Eliminating Discrimination Against Persons affected by leprosy (EDPAL) Bill, 2015”.
  • This draft law contains principles of equal protection that must be provided to all persons affected by leprosy or members of their family.

About Tuberculosis (TB)

  • Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
  • TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
  • Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries.
  • Tobacco use greatly increases the risk of TB disease and death. 7.9% of TB cases worldwide are attributable to smoking.
  • Ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals.

Difference between XDR-TB and Multi-drug-resistant tuberculosis (MDR-TB)

  • People with TB who do not respond to at least isoniazid and rifampicin, which are first-line TB drugs are said to have MDR-TB.
  • People who are resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin, or capreomycin) are said to have XDR-TB.

TB in India

  • India has 27,000 MDR-TB patients, the highest in the world, and nearly 2000 XDR-TB patients.
  • The success rate of treatment for XDR-TB in India is merely 23 per cent while for MDR-TB is 46 per cent.
  • India has 24% of MDR-TB cases in the world.

TB Globally

  • As per the World Health Organisation’s Global Tuberculosis Report 2018, 4.5 lakh people across the world have MDR-TB while 37,500 people have XDR-TB.
  • By the end of 2017, XDR-TB had been reported from 127 countries, including India.
  • Antimicrobial resistance (AMR) is a growing threat to global health security. TB is responsible for about one-third of all AMR deaths.
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