EDITORIAL 1: How a novel initiative helped Tamil Nadu bring down TB deaths in the state
Context
Tamil Nadu has witnessed a dip in the number of tuberculosis (TB) deaths in the state after the rollout of the Tamil Nadu Kasanoi Erappila Thittam (TN-KET), or TB death free initiative, in 2022.
The data
- Due to the initiative, three districts — Dharmapuri, Karur, and Villupuram — witnessed a reduction in the number of TB deaths between 2022 and 2023.
- Scientists at the National Institute of Epidemiology told that within the six months of the TN-KET program, Tamil Nadu saw a dip in the number of early TB deaths by 20% across the state.
- Two-thirds of the districts in the state documented a 20% to 30% reduction in total deaths in 2024, according to scientists.
The reasons
- Experts say, the program has been successful for two reasons.
- One, it uses a quick, easy-to-use tool, which helps a doctor determine whether a patient is severely ill and needs to be hospitalised soon after being diagnosed with TB. The tool does not require any laboratory-based investigations.
- Two, the initiative follows a differentiated care model which offers a patient-centred approach instead of a one-size-fits-all treatment.
How does the tool work?
- Tamil Nadu health workers use a paper-based triage tool which prioritises patient care based on the severity of the illness.
- To determine the severity, health workers record five key parameters for all TB patients in the state.
- Height and weight of the patient is used to calculate body mass index (BMI) which can flag undernutrition.
- Swelling of the leg is determined by pressing it for 15 seconds;
- Respiratory rate per minute is recorded in a sitting position;
- Oxygen saturation is taken using a pulse oximeter; and
- It is determined whether TB patients can stand without support.
- If a patient has a BMI of less than 14 kg/sq m, or suffers from respiratory issues, or performs poorly on any of the other metrics, they are tagged as “severely ill”.
- Such a patient is immediately referred for comprehensive assessment and inpatient treatment.
The benefits
- The paper-based triage tool is simpler than other tools where health workers have to record 16 parameters of a patient, and send them for laboratory-based investigation.
- This makes the process of diagnosis at least a week long. Using the TN-KET program’s triage tool, a diagnosis can be made within a day.
- The Tamil Nadu government has also launched a portal called Severe TB Web Application, where once the recorded parameters are entered, one can assess the probability of a patient dying.
What is a differentiated TB care model?
- The TN-KET is one of India’s first initiatives to implement the differentiated care guidelines issued by the National Tuberculosis Elimination Programme (NTEP) in 2021.
- By following a patient-centred model, it provides treatment based on a patient’s medical history and medical parameters such as age, weight, and specific disease conditions.
- It also considers the severity of the disease in all patients diagnosed with TB, and provides comprehensive care to the worst affected.
TB burden in India
- Currently, India bears the highest burden of TB across the world.
- With an estimated 28 lakh cases, the country accounted for 26% of the global TB burden in 2023, according to the Global TB report, which was released last year.
- With 3.15 lakh deaths due to TB in 2023, India accounted for 29% of the global burden, the report revealed.
Conclusion
The success of the TN-KET program has demonstrated that a differentiated care model combined with the use of a simple triage tool could save the lives of TB patients. This initiative can now be emulated by other states, helping reduce the number of TB deaths across the country.