‘Aiming for TB-free Kashmir’: Dr. Rehana Kousar, State TB Officer

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Of the 78 districts that had applied for tuberculosis-free certification from the Union Ministry of Health, central Kashmir’s Budgam has become the first to be awarded the status after it recorded an eighty percent drop in cases.

The recognition was accorded on World Tuberculosis (TB) Day. The Kashmir Walla spoke with State TB Officer, epidemiologist Rehana Kousar about the efforts made by the TB Control Society for the elimination of the disease from Budgam. 

How did Budgam become TB-free? 

We have a dedicated staff headed by Adhfar Yaseen, who is also the head of the District TB office. When we were checking the data we saw that Budgam had a decline in the number of cases from 2015 to 2020. So we put in our claim for verification. The central government through Indian Council of Medical Research (ICMR), National Institute of Epidemiology Chennai and World Health Organization verified this data. 

They did interviews with patients, private healthcare providers including chemists to check the sale of anti-TB drugs to see if the patients were going to the private sector for treatment. At the same time, there was a survey going on in Budgam by ten teams that went house to house in villages. The selection was done by the National Institute of Epidemiology, so we had no role in where they went or which people they chose. They also had an ICMR developed mobile phone app that would prompt them on whether they had to take samples or not. In this manner, they covered more than 17000 people in 3296 households. From this entire pool of people, only two came positive. 

So when we talk about TB-free, it doesn’t mean there is no case of TB at all, it means that there is an 80 percent decline in the number of cases from 2015 to 2020. 

What role has TB Control Society played? 

We have been doing a lot of activity. Most importantly, diagnosis has improved. We have screened Budgam through house to house surveys in every block to check for symptoms and if they have symptoms of TB, we take their samples and check. So instead of the patients coming to us, we are actually going to the patients ourselves for collecting samples. We also have a very good case holding of patients. TB is a notifiable disease. So once the patient is notified with us, we do our best in holding that case. We ensure that he takes the entire treatment and that he is tested at the end of the treatment till the time he tests negative. 

What steps are taken for the monitoring and surveillance of TB? 

We collaborated with patients who had non-communicable diseases such as diabetes. All the patients with diabetes were screened for TB. At the same time, we checked the blood sugar of the patients with TB to keep a check on their immunity as diabetes affects the immune system really badly. We have been conducting activities to find cases in orphanages and jails. There are no jails in Budgam, so we kept a check on all the orphanages there. But we have been checking jails in other districts. Few years back, we found thirteen cases in an orphanage. 

Then we are doing proper training of medical officers, Asha workers for sensitizing them with the task. We are even engaging with the private medical sector so that they send their patients to us. Once we get the patients, we take the public health action at their homes as well. We basically do the contact tracing. This process has become fashionable due to COVID-19 but it actually comes from these previously existing diseases. We keep a check on the patient’s social contacts and we conduct their tests. And especially for children below the age group of six, if they don’t have TB we give them the profile access to prevent TB in future.

The TB score for TB during 2020 has been 80.67 percent. In 2015, we found out 257 cases of TB in Budgam. This came down to 170 in 2020.

What are the symptoms of TB among people? What do you recommend to the patients diagnosed with the disease?

The symptoms of TB include cough that continues for two weeks and fever that lasts for two weeks as well, sweating, weight loss, bleeding from mouth etcetera. We have been spreading awareness about the symptoms of TB through awareness programmes, posters, Television and radio. 

The most important thing is to not take the disease lightly and to not get disheartened if a person is diagnosed  with TB. People need to go for the treatment as soon as they realise that something isn’t right. The treatment is free of cost wherever they go. So they need to inform us, we ensure that you don’t have to go from one district to another, we will provide the treatment wherever you are through our dot providers. The most important thing is to complete the treatment and not just leave it in between. 

What are the future plans regarding the TB-free certification in the rest of Kashmir? 

The total number of cases in Kashmir division during 2015 were 3,702. This year the number of cases has come down to 2,848 in Kashmir division. So we are aiming to get TB-free certification for the entire Kashmir division. But it is a very hard process and requires a lot of efforts.

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