No time to be complacent with the performance of tuberculosis control activities in tribal areas of India

High incidence of pulmonary tuberculosis in an indigenous Saharia tribe in Madhya Pradesh, central India-A prospective cohort study

BACKGROUND

Lack of TB incidence data is an important evidence gap among Saharia-a high TB burden indigenous community in Madhya Pradesh, central India. The present study was undertaken to calculate the incidence of pulmonary tuberculosis in this tribe.

OBJECTIVE

To calculate the incidence of pulmonary tuberculosis (PTB) among the Saharia tribal population in Madhya Pradesh, central India.

METHODS

A prospective cohort study was conducted among the Saharia tribal population (aged 15 years and above) of Shivpuri district in Madhya Pradesh state in central India. A total of 9,756 individuals were screened for TB in the baseline TB prevalence survey during 2012-13. All available household members were screened for symptoms suggestive of pulmonary TB (presumptive TB). Two sputum specimens were collected from persons having symptoms suggestive of TB and examined by smear and culture tests. A cohort of all non-TB individuals in the baseline survey was followed-up for one year and re-screened for the sysmptoms of PTB in the year 2014-15. Based on the data collected, the incidence of TB over one year period was estimated per 100,000 population.

RESULTS

A total of 9756 and 9044 individuals (≥ 15 years) were screened for symptoms suggestive of PTB during baseline and endline surveys respectively. The sputum specimens of presumptive TB cases were collected and examined by smear and culture tests. The overall incidence of bacteriologically positive (smear and/or culture) PTB over one year period was 1504 (95% Confidence Interval (CI): 1273-1776) per 100,000 in the study population, the incidence of smear-positive PTB was 1106 (95% CI: 910-1343), and the incidence of culture-positive PTB was 1084 (95% CI: 890-1319) per 100,000 population. The incidence for both smear and culture-positive PTB was 686 (95% CI: 535-878) per 100,000 population in the year 2014-15. The incidence of PTB was 2.8 times higher in males compared to females (2259 vs 807 per 100,000) and was positively correlated with age.

CONCLUSION

The findings of the study, the first of its kind in the Saharia tribal population, indicate a high incidence of TB in this tribal community thereby highlighting the urgent need for focused and intensified efforts to achieve the goal of TB elimination in the country.

A comparative study of the socio-economic risk factors for pulmonary tuberculosis in the Saharia tribe of Madhya Pradesh, India

Background

To determine the socio-economic risk factors for pulmonary tuberculosis (PTB) in the Saharia tribal community in Madhya Pradesh, Central India.

Methods

PTB cases detected during the year 2013-14 through a community active TB prevalence survey in the Shivpuri district, Madhya Pradesh were included in the study. For each case, three controls were selected randomly among the non-cases from the same village and the data on socio-economic risk factors were collected. Using logistic regression analysis, the risk factors for PTB disease were identified.

Results

A total of 220 cases and 660 controls participated in the study. Of the 13 risk factors studied, on multivariate analysis the risk of PTB was found to be significantly associated with malnutrition (adjusted odds ratio [AOR] 2.02 [95% confidence interval {CI} 1.46 to 2.79]), living in a kaccha (built of naturally occurring materials) house (AOR 2.72 [95% CI 1.44 to 5.11]) and tobacco smoking (mostly beedis; AOR 1.59 [95% CI 1.12 to 2.18]).

Conclusions

The findings highlight that malnutrition, poor living conditions in a Kaccha house (built of naturally occurring materials) and tobacco smoking are the major risk factors for PTB among Saharias, which need to be studied among other tribal populations in the country. There is a need to strengthen health and nutrition programmes in this community.