NAGALAND: Multi-pronged efforts needed to end Tuberculosis by 2025

Ketholeno Neihu
Kohima | March 1

Multi Drug Resistant (MDR) or Drug Resistant (DR) Tuberculosis (TB) is a recurring problem in Nagaland owing to multiple factors, indicating a need for collaborative efforts in both the private and public health sector.  

In the first two parts of this series, The Morung Express reported that DR/MDR patients in Nagaland were often found not adhering to the treatment process, thus leading to re-infections. However, it was found the lack of awareness and knowledge among the patients was not the only cause as there is lack of testing facilities, such as Line Probe Assay (LPA) or Culture and Drug Susceptibility Testing (DST), which has led to delays in detection of cases and subsequent treatment of patients. 

This last part of the series focuses on how state and non-state actors in the medical sector can proactively collaborate to efficiently tackle Tuberculosis and achieve the target to end TB in by 2025.

“We have stopped keeping records of TB cases reported in the hospital since government authorities stopped coming for collecting reports,” a medical officer (MO) of a private hospital in the state capital informed adding that registers they maintained in the past are lying unattended in file cupboards.

According the private hospital MO, Tuberculosis cases as well as DR/MDR cases are diagnosed in the hospital and treatment is also facilitated but, “we suggest and refer them to the District TB Centres for availing free drugs given its cost and duration required but we operate independently and vice-versa.”

In Nagaland, Nikshay which is a case based, web enabled TB programme management system, is used for maintaining reports and the TB status for both private and government setups. However, data available in the system reveal that not all districts have been using the portal to maintain records. 

For instance, in the year 2021, TB notification from private setups was 736 which were reported from only from Dimapur, Kohima, Mokokchung, Peren, Tuensang, and Wokha districts. There were no TB cases recorded from private setups in Kiphire, Mon, Longleng, Zunheboto and Phek districts. As per the Nikshay portal, the notification had achieved 98.1% of the target which was set at 750.

While most private hospitals in the state are also using Cartridge-based Nucleic Acid Amplification Test (CBNAAT) and Truenat for diagnosing suspected TB, there also appears to be a gap in the testing of suspected DR/MDR Tuberculosis cases.

When enquired whether sputum samples of suspected DR/MDR  TB cases are sent to District TB centres or other government hospital or outside the state for further confirmation, the MO at the private hospital said ‘nothing of that sort was usually practiced.’

Meanwhile, the medical officer at the Kohima District TB Centre, Dr Kezhasino Meru said that the DTCs are making efforts to collect information from private hospitals, undertake awareness programmes and organise activities such as mobile vans to reach maximum of the vulnerable population and reach the target to end TB in by 2025.

“We sit in our OPDs to educate and inform the patient, family members or caregivers on the need to complete the drug regimens and ensure that the patient does not relapse due to non-compliance to the treatment course,” Dr Kezhasino added. 

Another health worker opined that re-treatment, relapse or DR/MDR cases may be associated with lack of awareness, and suggested that patients seek help at DTCs for better intervention. For this to happen, the private and public sectors need to work collaboratively to ensure that referrals are followed up on and TB services are rendered in a robust manner.

Additionally, schemes also need to be implemented in a proper manner. For instance, the direct benefit transfer, a monthly incentive that is provided to TB patients for treatment support needs better streamlining. In this connection, a private hospital administrator viewed that since government authorities had not collected data and information from private hospitals, no efforts were made from their end to facilitate the services.