1. ‘True Scale’ of India’s Tuberculosis Problem: 2.8 Million New Cases
By GEETA ANAND
OCT. 13, 2016

2. Tuberculosis
NEW DELHI — Finally coming to terms with the enormity of its tuberculosis problem, India is preparing a radical overhaul and expansion of its national treatment program to fight an affliction that kills more adults worldwide than any other infectious disease.
The severity of the matter was underscored on Thursday when the World Health Organization substantially increased its estimate of the number of new patients with TB in India, to 2.8 million in 2015, compared with 2.2 million in 2014 — more than in any other country in the world and more than a quarter of the world total.
The organization’s estimate of new global TB patients rose to 10.4 million, from 9.6 million a year earlier, in large part because of the revised numbers in India. But increases were noted in Indonesia and several other countries.

3. Not reaching everyone
Tuberculosis, an ancient and deadly bacterial disease that most commonly affects the lungs, has been curable for decades using a cocktail of antibiotics taken for 6 months.
India brought this cure to the masses in the 1990s and had early success in reducing the number of cases. But that faded, in part because it failed to reach patients in the private sector, where the vast majority of Indians get medical care.
The disease killed 480,000 people in India last year, accounting for about a quarter of the 1.8 million deaths worldwide, the W.H.O. report said.

4. Tuberculosis (TB)
TB is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.
TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.
Symptoms of TB in the lungs may include
A bad cough that lasts 3 weeks or longer Weakness or fatigue
Weight loss Fever
Loss of appetite Night sweats
Coughing up blood or mucus
NIH: National Institute of Allergy and Infectious Diseases

5. True incidence had been underestimated
Experts say the severe underestimation of TB patients in the country was the result of undercounting of patients in the private sector. The government and international experts simply tallied the patients in government programs and added to those a guess at the number being treated privately.
It turns out the world “had little idea of the true scale of the problem in India — the worst-affected country,” said Dr. Nimalan Arinaminpathy, the lead author of the Lancet paper and a senior lecturer at Imperial College London.
The Lancet authors calculated the amount of TB medicine sold in the private sector and then worked backward to estimate how many people were taking the drugs.

6. The Economics – Conceptual Model
Foster et al, “The economic burden of TB diagnosis and treatment in South Africa,”
Social Science and Medicine 130 (April 2015): 42 – 50.

7. The Economics – Conceptual Model
Foster et al, “The economic burden of TB diagnosis and treatment in South Africa,”
Social Science and Medicine 130 (April 2015): 42 – 50.

8. The Economics – Conceptual Model
Foster et al, “The economic burden of TB diagnosis and treatment in South Africa,”
Social Science and Medicine 130 (April 2015): 42 – 50.

9. What they found
The study found that the cost of TB diagnosis and treatment in SA could be catastrophic and drive the ‘medical poverty trap’.
For those starting on treatment, the costs associated with a TB episode totalled 22% of the average pre-symptoms individual income. The greatest financial cost was incurred in the time between first becoming symptomatic and starting treatment.
This was compounded by the income loss experienced prior to treatment, which made up 72% of the total episode income loss and 26% of the total episode cost.
Findings (in South Africa) suggest that those with no income are experiencing excessive out-of-pocket costs, placing a significant burden on households given that only approximately a third of respondents indicated that another household member had a steady job.
India may look a lot more like S. Africa, than it does like the U.S.