Campaign brings out undetected TB cases

The State’s ‘catch-up’ campaign to detect tuberculosis cases that may have gone undiagnosed during the COVID-19 pandemic between June and August, screened over six lakh people, tested 29,166 and diagnosed 802 people with tuberculosis (TB) between October and December 2020.

The dip in tuberculosis cases detected between June and August 2020, when compared to figures in 2019, prompted the Health Department to initiate a ‘catch-up’ campaign as part of the Akshaya Keralam project.

“There was a 40%-50% dip in active TB cases between June and August,” said M. Sunilkumar, State TB Officer. While 2,049 cases were detected in August 2019, the figure fell to 1,213 in August 2020.

He identifies two reasons for the fall of around 1,500 cases in three months – people were afraid to visit health centres with the coronavirus doing the rounds and lab technicians were afraid to handle sputum for sputum microscopy. People were even reluctant to cough keeping the COVID-19 stigma in mind, he added.

An analysis of the situation in August made the Health Department change tack. In 2018, a list of people vulnerable to TB was prepared in each panchayat. This vulnerability mapping exercise, which identified 7.75 lakh people, proved useful between October and December 2020, when ASHA workers reached out to them over phone to identify and test people with symptoms.

Vulnerable segments

Vulnerable populations include the elderly, people with chronic conditions who might be immunocompromised, smokers, and alcoholics.

A hub-and-spoke model was set in motion for testing with samples being collected from homes, taken to PHCs, and then a diagnostic centre. Medicines were delivered at homes. People who showed symptoms like weight loss, cough, and fever but tested negative for COVID-19 were tested for TB. “We tried molecular diagnostics, which is automated, over sputum microscopy. This improved case finding,” Dr. Sunilkumar said.

Private hospitals

Mirroring the situation across the State, in Ernakulam, private hospitals diagnosed 25% more cases in 2020 when compared to 2019, said P.S. Rakesh, WHO consultant for TB elimination for Kerala and Lakshadweep. “There was a dip in diagnosis in the public sector since some hospitals were converted into COVID-19 treatment facilities. Patients may have depended on the private sector for other ailments. As part of the STEPS (System for TB Elimination in the private sector) programme, some patients were even directed to private hospitals from government ones handling COVID-19,” he said

Across the State, till the first week of December 2020, 174 TB patients were infected with COVID-19 and 26 among them died.

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