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ZHADIMA — Nagaland recorded a total of 4,284 active Tuberculosis (TB) cases in 2023, achieving an 86% notification rate, with 4,300 cases notified out of the allotted target of 5,000. This translates to a notification rate of about 204 cases per lakh population.
This data was presented by Dr. Vezokholu Theyo, State TB Officer, National Tuberculosis Elimination Programme (NTEP) during the state-level programme to commemorate World TB Day, under the Directorate of Health and Family Welfare, on Sunday.
Addressing the programme at 10th NAP (IR) camp, Zhadima, Dr. Theyo highlighted fluctuations in TB case notifications over the past five years. While there was an initial increase, the onset of the Covid pandemic led to a decline in notifications, resulting in a mixed trend.
In 2017, there were 2,714 cases, followed by 4,149 in 2018, 4,845 in 2019, 3,595 in 2020, 3,715 in 2021, 4,138 in 2022, and a surge to 4,284 in 2023, she said.
The officer emphasised that the peak in 2019 and the subsequent rise post-Covid cannot be solely attributed to reaching saturation point in TB cases. She stressed the importance of identifying all presumptive TB cases, including those that were previously missed, through quality screening and testing using newer diagnostic tools.
She noted that the increase in cases could be attributed to improved case detection through active-case finding, intensified case finding efforts, decentralisation of presumptive case finding involving Health and Wellness Centres (HWCs) and partner NGOs, and the introduction of newer diagnostic tools like Truenat and CBNAAT machines, as well as expansion of testing capacities across all Tuberculosis units.
Additionally, besides enhancing public awareness through regular meetings and sensitisation programs, efforts have been made to improve bi-directional referrals between programs such as HIV and TB. The engagement with the private sector has also been enhanced, with private sectors contributing to notifying about 15% of TB cases annually.
She also highlighted the importance of considering possible transmission among close contacts of index TB patients.
However, Dr. Theyo acknowledged that the decline in cases in 2020 may be attributed to the Covid pandemic, with mitigation measures implemented to address associated challenges. Despite these efforts, some implementation activities were hindered due to factors such as transportation challenges for sample collection and limited human resources at testing labs, and minimal cooperation from the public, due to fear or stigma, resulting in reduced or halted regular case finding activities.
Dimapur with highest TB Burden
According to the officer, in 2023, Dimapur bore the highest burden of TB cases, with 2044 cases, accounting for 48% of the total notified cases in Nagaland. Conversely, Longleng district had the lowest burden, with only 49 TB cases or 1.14% of the total notified cases in the state.
Among the affected population, males aged 15-45 years were predominantly impacted, accounting for 60% of TB cases in Nagaland in 2023.
In terms of co-infections, 412 cases of TB-HIV co-infection were reported in 2023, representing 9.4% of all TB cases among people living with HIV (PLHIV).
Measures for TB elimination
Dr. Theyo also highlighted initiatives undertaken by the department and various stakeholders to combat TB in Nagaland. These include incentivising the best-performing districts and panchayats, as well as mobilising community support for TB patients.
Currently, approximately 350 donors have registered to support over 1000 beneficiaries undergoing TB treatment. Support is provided in the form of monthly food baskets containing protein, cereals, and oils, along with vitamin supplements for a minimum of six months, with the Governor of Nagaland leading this effort.
Additionally, a Tribal TB initiative and a Joint Action Plan for TB elimination have been developed in collaboration with the Tribal Welfare department. A proposal has been submitted for Handheld X-rays and ACSM activities to support TB case finding, prevention, and awareness, she said.
The officer informed that Truenat machines, initially used for COVID testing during the pandemic, are being repurposed for TB and other programmes. Over 30 additional Truenat machines are available in the state, and government directives were issued for their relocation to districts for TB testing and diagnosis.
To address long turnaround times for drug resistance and susceptibility testing, a dedicated Culture DST centre has been launched at NHAK, and the lab is undergoing accreditation to begin testing.
Further, TB screening through the Cough-powered Artificial Intelligence program, in collaboration with JHPIEGO and the Wadhwani Institute for Artificial Intelligence, is supporting healthcare workers in screening clients for presumptive TB using a cough AI-powered app in Dimapur, Mon, Mokokchung, and Kohima. Plans are underway to scale up and replicate this program in all districts, Dr. Theyo said.
78 villages declared TB-free in 2023
In 2023, Nagaland declared 78 villages as TB-free with Phek district on top with 34 villages, followed by Longleng with 19, Wokha with 9, Mokokchung with 4, Kohima with 3, and Zunheboto, Mon, and Kiphire with 2 each.
The districts of Dimapur, Peren, and Tuensang each had 1 village declared TB-free.
India has highest estimated burden of TB infection
Meanwhile, Director Health Services, Dr. Akuo Sorhie, urged the people of the state to collectively pledge to combat TB as a personal responsibility, in order to ensure that the state is free from the preventable and curable disease.
Highlighting the persistent threat of tuberculosis to lives, society, and the nation, Dr. Sorhie emphasised the need for concerted efforts to aggressively combat the disease.
World Health Organisation (WHO) Medical Consultant, Dr. Collins Z Sono, noted that World TB Day, observed annually on March 24, commemorates the discovery of the TB bacillus by Sir Robert Koch in 1882. The day aims to raise awareness about TB and efforts to eradicate the global epidemic.
Stating that TB remains as one of the deadliest infectious diseases globally, he said that despite significant progress in combating TB since 2000, the COVID-19 pandemic and socio-economic disparities have hindered these efforts, particularly affecting vulnerable populations.
He went on to state that India, as per the latest global TB report 2023, contributes 26% of new cases and 30% of deaths worldwide and has the highest estimated burden of tuberculosis infection (TBI) globally. With nearly 35-40 crore Indian population having TBI, about 5–10% of those infected develop TB disease over the course of their lives, usually within the first 2 years after initial infection.
Dr. Sono emphasised this year’s World TB Day focus on translating commitments into actionable steps, including ensuring access to new diagnostics, treatment regimens, digital technology, and community engagement. He called for collective efforts from political leaders, civil society, donors, researchers, TB communities, the private sector, and individuals to end TB, and administered TB-free pledge to the participants.
At the programme, TB Champion Neilakie-ü shared her personal journey of TB diagnosis and recovery, underscoring the importance of early detection and treatment, while Deputy Commandant of the 10th NAP (IR), Zhadima Joseph Thongliu, reiterated the unit’s commitment to fighting TB for a healthier society.
The programme was led by Thungchanbeni M Humtsoe, State IEC Officer (NTEP) and vote of thanks was proposed by Temjennochetla.