When MDR-TB comes knocking ....
- Hueiyen Lanpao Editorial :: June 21 2012 -

MP Dr T Meinya lighting the ceremonial lamp to inaugurate an advocacy workshop on 'Care and Control of TB in Manipur' at Hotel Classic, Imphal :: Pix - Hueiyen Lanpao

For an economically backward state like Manipur where access to health care delivery system is still a distant dream for many, the report that average rate of people infected by Multi-Drug Resistance TB (MDR-TB) in the state has surpassed more than double the all India rate is a matter of serious concern.

From among 73 cases tested for MDR-TB in Manipur, 28 cases have been confirmed positive, which is about 38 percent, as against the all India infection rate of 12 to 18 percent.

As a matter of fact, anti-tuberculosis (TB) drug resistance is becoming a major public health problem that threatens progress made in TB care and control worldwide today.

MDR-TB develops during treatment of fully sensitive TB when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill the bacteria.

This can happen for a number of reasons like the patients may feel better within a month of undergoing the treatment and halt their antibiotic course, drug supplies may run out or become scarce, or patients may forget to take their medication from time to time.

The seriousness of MDR-TB is such that it can be spread from person to person as readily as drug-sensitive TB and in the same manner. Even if MDR-TB can be cured with long treatments of second-line drugs, these are more expensive than first-line drugs and have more adverse effects.

In many cases, patients from poor families could not afford the treatment. Consequently, mortality rate from MDR-TB is very high.

Essentially, drug resistance arises in areas with weak TB control programmes, and Manipur fits the bill perfectly. It is sad to note that in spite of the seriousness of the issue, the state-owned Jawaharlal Nehru Institute of Medical Sciences (JNIMS) is the only place in Manipur where treatment facility for MDR-TB is 'supposed' to be available.

However, the building of the block where this treatment is 'supposed' to be provided is still under construction. So, there is no such place as such where treatment of MDR-TB is currently available in Manipur.

Moreover, although tests for MDR-TB cases are currently being carried out at the Intermediate Reference Laboratory located within the R & D Wing of the Medical Directorate at Lamphelpat, the test reports are to be dispatched to a National Reference Laboratory for confirmation.

It may be the only Intermediate Reference Laboratory functioning in the entire North East region since March 19 last year, but it is yet to get the required accreditation for declaring the results of positive cases and start treatment of the patients right away without waiting for green signal from the National Reference Laboratory.

What has happened to the plan for upgrading the existing Intermediate Reference Laboratory to a National Reference Laboratory, for which even a Central team had come down for inspection last year?

All these dilly-dallying have only shown lack of political commitment on the part of the government in taking up the issue.

So, it was not at all surprising for the honourable Health Minister to harp on the need for a separate Health and TB Policy, when MDR-TB is already knocking at the door.