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Indian Express
12-07-2025
- Health
- Indian Express
How a novel initiative helped Tamil Nadu bring down TB deaths in the state
Tamil Nadu has witnessed a dip in the number of tuberculosis (TB) deaths in the state after the rollout of the Tamil Nadu Kasanoi Erappila Thittam (TN-KET), or TB death free initiative, in 2022. Due to the initiative, three districts — Dharmapuri, Karur, and Villupuram — witnessed a reduction in the number of TB deaths between 2022 and 2023, according to a paper published in the Indian Journal of Community Medicine. The TB death rate in Dharmapuri went down from 12.5% to 7.8%, in Karur from 7.1% to 5.3%, and in Villupuram from 6.1% to 5.2%. Scientists at the National Institute of Epidemiology told The Indian Express that within the six months of the TN-KET program, Tamil Nadu saw a dip in the number of early TB deaths by 20% across the state. Two-thirds of the districts in the state documented a 20% to 30% reduction in total deaths in 2024, according to scientists. Experts say, the program has been successful for two reasons. One, it uses a quick, easy-to-use tool, which helps a doctor determine whether a patient is severely ill and needs to be hospitalised soon after being diagnosed with TB. The tool does not require any laboratory-based investigations. Two, the initiative follows a differentiated care model which offers a patient-centred approach instead of a one-size-fits-all treatment. Tamil Nadu health workers use a paper-based triage tool which prioritises patient care based on the severity of the illness. To determine the severity, health workers record five key parameters for all TB patients in the state. If a patient has a BMI of less than 14 kg/sq m, or suffers from respiratory issues, or performs poorly on any of the other metrics, they are tagged as 'severely ill'. Such a patient is immediately referred for comprehensive assessment and inpatient treatment (care provided in a hospital or in some sort of medical facility). Note that this paper-based triage tool is simpler than other tools where health workers have to record 16 parameters of a patient, and send them for laboratory-based investigation. This makes the process of diagnosis at least a week long. Using the TN-KET program's triage tool, a diagnosis can be made within a day. Since the implementation of the initiative, 98% of the patients diagnosed with TB in Tamil Nadu get examined using the triage tool, and 98% of those confirmed to be severely ill are admitted to hospitals within seven days of diagnosis, according to scientists. The Tamil Nadu government has also launched a portal called Severe TB Web Application, where once the recorded parameters are entered, one can assess 'the probability of a patient dying', Manoj Murhekar, head of the National Institute of Epidemiology, told The Indian Express. 'This will help guide the health workers to take immediate action and prevent TB deaths,' he said. The TN-KET is one of India's first initiatives to implement the differentiated care guidelines issued by the National Tuberculosis Elimination Programme (NTEP) in 2021. By following a patient-centred model, it provides treatment based on a patient's medical history and medical parameters such as age, weight, and specific disease conditions. It also considers the severity of the disease in all patients diagnosed with TB, and provides comprehensive care to the worst affected. Combined with a quick examination of TB patients through the triage tool, this model has been highly effective in preventing early deaths of the worst affected patients. Usually, 50% of those who die due to TB, lose their lives within the first two months after being diagnosed. 'Immediate inpatient care can reduce the probability of early death in severely ill patients by 1% to 4%. Usually, the probability of death in such patients is between 10% and 50%,' said Hemant Shewade, senior scientist at the National Institute of Epidemiology, who has studied the implementation of the TN-KET. Currently, India bears the highest burden of TB across the world. With an estimated 28 lakh cases, the country accounted for 26% of the global TB burden in 2023, according to the Global TB report, which was released last year. With 3.15 lakh deaths due to TB in 2023, India accounted for 29% of the global burden, the report revealed. The success of the TN-KET program has demonstrated that a differentiated care model combined with the use of a simple triage tool could save the lives of TB patients. This initiative can now be emulated by other states, helping reduce the number of TB deaths across the country. Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government's management of the Covid-19 pandemic and closely followed the vaccination programme. Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports. Dutt also takes a keen interest in the country's space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan. She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University's Dart Centre. Dutt has a Bachelor's Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times. When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More
India Gazette
09-07-2025
- Health
- India Gazette
ICMR-NIE introduce alert feature to reduce TB deaths in Tamil Nadu
By Shalini Bhardwaj Chennai (Tamil Nadu) [India], July 9 (ANI): More than half of all tuberculosis (TB) deaths occur within the first two months of treatment. In response, the Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE) has introduced a new alert feature designed to immediately notify frontline healthcare workers when a patient is identified as severely ill following a TB diagnosis. The predictive model is expected to reduce the average time from diagnosis to hospital admission for severely ill patients with tuberculosis. The ICMR-NIE has recently launched a predictive model that helps the state reduce TB deaths. The predictive model was developed using data from 57,803 adults diagnosed with TB from public health facilities. 'In 2023, of 57,803 adults with TB diagnosed from public facilities, 57,070 (99%) were triaged and 6864 (12%) were triage-positive (eligible for referral). Of 6864 eligible, 6105(89%) were referred, comprehensively assessed and confirmed as severely ill at nodal inpatient facilities. Of 6105 confirmed, 5926 (98%) were admitted for inpatient care and 5413 (92%) were successfully discharged for ambulatory directly observed treatment. The median admission duration was seven days,' the study noted. The new feature introduced by the ICMR-NIE would merge with the existing TB SeWA (Secere TB Web Application), which was launched in 2022 and integrated into the state's TN-KET (Tamil Nadu Kasanoi Erappila Thittam). According to experts from ICMR-NIE, 'This new feature will be useful to Alert front-line staff on how to recognise severely ill TB patients to avoid delay in treatment.' They further added, 'The Majority of TB deaths are being reported early (within 2 months), India TB program's information management system (Nikshay) dependent death prediction models are not feasible for prospective use as few variables are captured at diagnosis. Utilising routinely captured triage variables for severe illness in TB SeWA that are available under TN-KET at diagnosis (body mass index, pedal oedema, respiratory rate, oxygen saturation, and ability to stand without support), robust models for prospective use were developed.' (ANI)
The Print
08-07-2025
- Health
- The Print
Bringing dramatic drop in TB deaths, how TN set an example for rest of India with one-of-a-kind model
While TB-related death simply refers to a death among a person with TB within 12 months of notification (diagnosis), early TB death refers to deaths that happen within two months, often within the first few weeks of the notification. It is estimated that around 70 percent of TB deaths in the state are early TB deaths. An analysis by the agencies implementing the Tamil Nadu Kasanoi Erappila Thittam (TN-KET, which means TB death-free project) has shown that within six months of the launch of the initiative in April 2022, overall TB-related deaths have come down by nearly 10 percent while early TB fatalities reduced by nearly 20 percent. Chennai: A first-of-its-kind statewide differentiated tuberculosis (TB) care initiative in Tamil Nadu has significantly brought down TB deaths in the state, prompting researchers to pitch it as a model that can be replicated across the country. These results from TN-KET hold significance for India which continues to report the highest burden of TB and TB-related mortalities globally despite making significant strides in curbing the burden of the bacterial disease over the last several years. India is considered a TB endemic country, a highly infectious disease caused by a bacteria called Bacillus Mycobacterium Tuberculosis, which is spread when people who are sick with TB expel the pathogen into the air, mostly by coughing. Spearheaded by the Tamil Nadu State TB Cell and Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE), the TN-KET initiative involves triaging (preliminary assessment) adults with TB at diagnosis, and those identified as severely ill based on specified indicators are prioritised immediately for referral, comprehensive assessment, and inpatient care. 'The key aim is to gauge or predict the patients who are likely to die due to the infectious disease while first identifying the disease in them and immediately offer them hospitalised care to treat the severe symptoms they have,' said ICMR-NIE director Dr Manoj Murhekar. The initiative, also supported by the World Health Organisation (WHO) India and the ICMR National Institute for Research in TB (ICMR-NIRT), has been implemented in all 38 districts of Tamil Nadu, except for Chennai. 'This initiative has shown that it is possible to bring down TB-related deaths remarkably by following some scientifically designed tools and methods. Severe illness can be quickly identified through triaging and they can be promptly admitted after diagnosis,' Dr Hemant Deepak Shewade, a senior medical scientist with ICMR-NIE who is associated with the initiative, told ThePrint. While the impact of the project in the first year has been analysed, the analysis of the second year (2023-24) is still underway but the early indications from routine monitoring of TN-KET suggest that it is even better than the previous results, Shewade said. 'We feel that scaling the model across India will be beneficial in bringing down the number of people dying every year due to the disease,' he added. The senior scientist, however, cautioned that such an initiative could only bring down TB-related deaths by up to 30 percent, and measures like detecting all TB incidents, early detection, comorbidity management, universal health coverage, among others, were crucial to further reduce TB deaths in the country. Dr Asha Frederick, Tamil Nadu's State TB Officer, said that district TB officers and Nodal physicians have played a key role in the implementation of the initiative. 'We recommend that these triage variables are captured elsewhere including other Indian states and high TB burden countries to guide patient management,' Dr Frederick said. On the future plans for the TN-KET, the state has started identifying other severe comorbidities like uncontrolled Diabetes (requiring insulin) among people with TB. 'If this goes well, we plan to cover other severe comorbidities like severe addiction to alcohol and tobacco,' Frederick added. According to the World TB report 2024 by the WHO, there were an estimated 28 lakh incident people with TB in 2023, 26 percent of global TB burden. Also, the country had an estimated 3.1 lakh TB deaths that year which was 29 percent of all TB mortalities globally. Tamil Nadu is among the states with high TB burden in the country. Also Read: Lancet report highlights gaps in immunisation—no routine vaccine for 14.4 lakh Indian kids in 2023 How the strategy works As part of the project, health workers triage every new TB-diagnosed adult (all above 15 years) for very severe undernutrition, respiratory distress or poor physical condition on five variables—body mass index (BMI), pedal oedema (swelling of feet and ankles), respiratory rate, oxygen saturation, and ability to stand without support. This is carried out as a health system initiative in routine operational settings by existing health workforce. Whether or not a patient is severely ill is confirmed by entering the details into a software application TB SeWA (Severe TB Web Application). All those identified as severely ill are then prioritised for in-patient care by nodal physicians in nodal inpatient care facilities of the districts, using TN-KET case record form and in-patient care guides specifically developed for such patients. A study published on the early implementation of the project and its feasibility underlined that 80-90 percent of severely ill patients (as per triage tool) are getting detected and admitted within one day of diagnosis. The admission of severely ill patients (triage-positive) has improved over the years: 67 percent in 2022, 86 percent in 2023 and 91 percent in 2024. The median admission duration was five days in 2022 and this has improved to seven days in 2023 and 2024. Over the years, the focus has been to ensure quality comprehensive assessment and inpatient care during the admission of the severely ill patients with focus on therapeutic nutrition for very severely undernourished patients as half of those eligible for admission have very severe undernutrition. Between April 2022 and June 2023, as per details shared by ICMR-NIE scientists, 66,765 of 72,404 notified adults were triaged, and 7,950 were triage-positive (identified as severely sick due to TB). Among these, 5,870 (or 74 percent) patents were referred and admitted. The analysis later showed 21 percent decline in early TB death rate and 11 percent reduction in overall TB death rate during treatment. By improving the admission among triage-positive patients, there is scope to further reduce TB death rate, the researchers noted, adding that once the goal of 30 percent mortality rate reduction among notified TB patients using this strategy is achieved, they will consider adding follow up triaging for all patients at two months for further reduction in mortality rate. As per the Sustainable Development Goals (SDG), India has to eliminate TB by 2030. (Edited by Ajeet Tiwari) Also Read: COVID-19 vaccines linked to cardiac-related deaths? Siddaramaiah, Biocon founder Shaw spar on X
Indian Express
08-07-2025
- Health
- Indian Express
How this TB triage tool experiment in Tamil Nadu reduced death by 20 per cent: Can it be used in national programmes?
A simple five-question triage tool — without the need for any laboratory tests — may be the key to saving lives of people diagnosed with tuberculosis (TB). Within two quarters of implementation in Tamil Nadu, the tool resulted in a state-wide reduction of early TB deaths — deaths recorded within the first two months of initiating TB treatment — by 20 per cent. In fact, two-thirds of the total districts in the state documented a 20 per cent to 30 per cent reduction in total deaths in 2024. Discussions are ongoing to implement a similar tool under the national programme. There were an estimated 28 lakh TB cases and 3.15 lakh deaths in India in 2023, according to the latest available data from the Global TB Report. Health workers in the state record five key parameters for all TB patients in the state — height and weight for calculating the body mass index (BMI) which can flag undernutrition in TB patients, swelling of the leg by pressing it for 15 seconds, respiratory rate per minute in a sitting position, oxygen saturation on a pulse oximeter and ability to stand without support. A patient is tagged severely ill if they have any one condition — severe undernutrition indicated by BMI of less than 14kg/m2, respiratory insufficiency as indicated by the respiratory rate and oxygen saturation, or poor performance status as indicated by their inability to stand. The 'severely ill' patients are immediately referred for comprehensive assessment and inpatient treatment. 'Immediate in-patient care can reduce the probability of early death in the severely ill patients between one per cent and four per cent. Otherwise, the probability of death in these patients is between 10 per cent and 50 per cent,' said Dr Hemant Shewade, senior scientist from the National Institute of Epidemiology, who has studied the implementation of the initiative called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET). The initiative, rolled out in 2022, is the first state-wide implementation of the country's differentiated treatment guidelines, which aims to provide more support to severely ill patients. The implementation over the last couple of years demonstrates the feasibility and effectiveness of differentiated care models. And, it goes a step beyond, to show that the triaging process can be shorter and quicker. The tool used in Tamil Nadu depends on just five parameters, instead of the nationally recommended 16 parameters. The triaging is performed by the health workers in the state within a day of diagnosis, with 98 per cent of those confirmed to have severe illness admitted to a hospital within seven days of diagnosis. While the tool can be used with just pen and paper, the TN government has a portal called Severe TB Web Application. 'Now, this portal will have a prediction of the probability of a patient dying when the parameters are entered. This will help guide the health workers to take immediate action and prevent TB deaths,' said Dr Manoj Murhekar, head of the National Institute of Epidemiology. The research from the institute has not only led to successful reduction of deaths due to TB but also in several interventions that have now been included in the national programme. One such intervention was increasing the monetary nutritional support provided by the government from Rs 500 to Rs 1,000. Importantly, the first three instalments of this monetary support are provided at the time of diagnosis. Dr Shewade said, 'Our research found that in many cases there were delays in providing the monetary support, with many experiencing adverse outcomes before they got the support. We know that half of all the TB deaths that have to happen, happen within the first two months. And, without proper nutrition, the treatments are not likely to be as effective. This was the evidence behind the change in policy.' An evaluation of the national programme by the NIE showed that patients, on average, received the first instalment of their monetary nutritional support 91 days after the diagnosis. In fact, two thirds of the patients with an unfavourable outcome received the support after their outcome was declared, according to the evaluation. The evaluation also suggested doubling the monthly rations for those with severe and very severe under-nutrition — a suggestion that has not yet been implemented as part of the national programme. Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government's management of the Covid-19 pandemic and closely followed the vaccination programme. Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports. Dutt also takes a keen interest in the country's space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan. She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University's Dart Centre. Dutt has a Bachelor's Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times. When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More
Time of India
07-07-2025
- Health
- Time of India
Tamil Nadu first state to implement TB death prediction model
New Delhi: Tamil Nadu has become the first state in the country to implement a model which predicts the probability of deaths among adults with Tuberculosis and has integrated it with the existing state-wide application TB SeWA, which triages them at diagnosis. The predictive model, developed by ICMR's National Institute of Epidemiology (NIE) that was launched last week, aims to reduce the average time from diagnosis to hospital admission for severely ill TB patients , thereby bringing down the mortality rate further, said Dr Asha Frederick, State TB Officer of Tamil Nadu. The new feature has been added to Tamil Nadu's existing TB SeWA (Severe TB Web Application), which has been in use since 2022 under the state's differentiated care model initiative Tamil Nadu - Kasanoi Erappila Thittam (TN-KET), she told PTI. Under TN-KET, healthcare workers screen a triage every newly diagnosed adult with TB for very severe undernutrition, respiratory distress or poor physical condition using five variables -- body mass index (BMI), pedal oedema (swelling of feet and ankles), respiratory rate, oxygen saturation, and the ability to stand without support. Then, health staff feeds these variables into TB SeWA, which then tells whether a particular patient is severely ill or not. Under TN-KET, all severely ill (very severely undernourished or having respiratory distress or poor physical status) have to be prioritised for admission, Dr Frederick said. Until now, TB SeWA flagged patients as 'severely ill' based on these variables, helping health staff prioritise them for inpatient care, Dr Manoj Murhekar, Director of NIE said. "The new feature goes a step further - calculating and displaying predicted probability of death for adults with TB," Dr Murhekar said. This objective risk percentage aims to overcome any subjective inference regarding severity and guide frontline staff to act immediately and firmly for the hospital admission of severely ill adults with TB at the time of diagnosis, he said. "How this feature addition is helpful is that the predicted probability of death varies widely between a 'severely ill' and 'not severely ill' patient. The predicted probability for a severely ill adult with TB death ranges from 10 per cent to as high as 50 per cent, depending on how many of the conditions are present. "In contrast, for patients not flagged as 'severely ill', the predicted probability drops sharply to just 1-4 per cent," explained Dr Hemant Shewade, a senior Scientist at NIE. Data of last three years show that about 10- 15 per cent of adults with TB in Tamil Nadu are found to be severely ill at diagnosis, he told PTI. "This clear risk estimate will help ensure that the sickest patients are admitted to hospitals without delay," Dr Shewade stated. Elaborating further, Dr Shewade said that while the average time from diagnosis to admission of a severely ill patient under TN-KET is one day, around a quarter of severely ill patients still face delays of up to three to six days in the state. "There are still some severely ill patients - like 25 per cent roughly who get admitted after some delay. This feature will advocate and motivate healthcare workers to take immediate decisions on their referral for admission," he said. "Over the time it will also help us analyse whether the average time from diagnosis to admission for a severely ill TB patient has reduced or not and eventually this will contribute towards further reducing TB deaths in the state. Two-thirds of TB deaths occur within two months of diagnosis," he said. The predictive death model has been developed using data from nearly 56,000 TB patients diagnosed in public health facilities across Tamil Nadu between July 2022 and June 2023. Dr Frederick said that for predicting TB deaths, the five triage variables used under TN-KET alone were as accurate as all baseline variables captured in India's national TB portal Ni-kshay. Dr Shewade further added that all baseline variables in Ni-kshay are available only by around three weeks (too late to use for prediction) while the five-triage variable are captured within a day in Tamil Nadu. All 2,800 public health facilities in Tamil Nadu -- from primary health centres to medical colleges -- currently use the TB SeWA application alongside a paper-based triage tool, said Dr Frederick. "Tamil Nadu is so far the only state in India to systematically record and use these five triage variables to guide patient management," she said. According to a study by the NIE, after implementing TN-KET for around three years now, the losses in the care cascade have significantly reduced and around two-third districts have documented reduction in TB death rates. The ICMR-NIE scientists emphasised that the initiative sets an important example for other states, where TB deaths, especially the early fatalities, remain a persistent challenge despite free diagnosis and treatment.
