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Why tuberculosis control programmes fail? Role of microlevel and macrolevel factors: an analysis from India
Sudip Bhattacharya1, Amarjeet Singh1
1Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
BMJ Case Reports
|April 23, 2017
Summary
India faces a significant tuberculosis burden, with the Revised National Tuberculosis Control Program (RNTCP) improving outcomes but still struggling with defaulter cases. A case study explores addressing both macrolevel and microlevel factors for tuberculosis defaulters in rural India.
Area of Science:
- Public Health
- Infectious Diseases
- Global Health
Background:
- India bears a substantial portion of the global tuberculosis (TB) burden, necessitating robust national control programs.
- The Revised National Tuberculosis Control Program (RNTCP) in India improved case detection and cure rates but persistent challenges with relapse and defaulter cases remain.
- Drug-resistant TB management has advanced with diagnostics like GenXpert and medicines like bedaquiline, yet macrolevel social determinants are often overlooked.
Observation:
- Despite RNTCP's successes, a notable percentage of TB cases in India are reported as defaulters.
- Rural healthcare settings face unique challenges in managing tuberculosis treatment adherence.
- A case study in North India highlights a resident doctor's efforts to address defaulter TB cases.
Findings:
- The case study investigated the interplay of microlevel (diagnostic and treatment interventions) and macrolevel (social determinants) factors influencing TB defaulter rates.
- Strategies were implemented to tackle both clinical and socioeconomic barriers contributing to treatment abandonment.
- The study aimed to provide practical insights into resolving issues related to defaulter TB cases in resource-limited settings.
Implications:
- Addressing social determinants alongside clinical interventions is crucial for comprehensive tuberculosis control.
- Integrated approaches are needed to reduce TB defaulter rates and improve treatment outcomes in India.
- This case study offers a model for healthcare providers to tackle complex public health challenges in rural areas.
Keywords:
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