Latest news with #TamilNaduKasanoiErappilaThittam
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
The Hindu
07-07-2025
- Health
- The Hindu
Tamil Nadu first to integrate ‘predicted possibility of TB deaths' in patients to its State TB elimination programme
To reduce the average time from diagnosis to hospital admission for severely ill tuberculosis (TB) patients, Tamil Nadu has become the first State in the country to integrate a model that predicts the possibility of TB deaths among patients with the existing State-wide application which screens them at diagnosis. The predictive model, developed by the Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE) and launched last week, will aid the State in bringing down the TB mortality rate, Asha Frederick, State TB Officer, Tamil Nadu, 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. Research shows TB is among the leading causes of morbidity and mortality worldwide, and more than 70% of TB deaths occur in the first two months of TB treatment. Globally, India has the highest burden of TB, with two deaths occurring every three minutes from TB. These deaths can be prevented. With proper care and treatment, TB patients can be cured, the World Health Organization has said. The addition of the new feature in the Tamil Nadu TB elimination programme, Dr. Frederick said, would merge it with the existing TB SeWA (Severe TB Web Application), in use since 2022 under the Tamil Nadu Kasanoi Erappila Thittam (TN-KET) differentiated care model initiative. 'What this new feature will do is to alert frontline staff on how to recognise a severely ill TB patient from a given list of medical indications, including body weight, ability to stand without support, etc., so that they are given priority in hospital admissions, and treatment is initiated without delay. The predicted probability of death ranges widely — from 10% to as high as 50%, depending on how many of the five risk factors are present. In contrast, for patients not flagged as severely ill, the predicted probability drops sharply to just 1% to 4%,' Hemant Shewade, senior scientist at the NIE, said. The average time from diagnosis to admission of a TB patient in Tamil Nadu is one day, and around a quarter of severely ill patients still face delays of up to six days in the State, Dr. Shewade said. 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. Old age, TB/HIV co-infection, and a baseline body weight of <35 kg increase mortality during TB treatment, a study titled 'Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia' has found. Special follow-ups of TB patients during the intensive phase, and of older patients and TB/HIV co-infected cases, as well as nutritionally supplementing underweight patients, may be important interventions to consider in order to reduce deaths during TB treatment.
New Indian Express
19-05-2025
- Health
- New Indian Express
6,237 tested positive for tuberculosis in Madurai district in 2024; males most affected
MADURAI: In 2024, a total of 6,237 people tested positive for tuberculosis (TB) in Madurai district, and the treatment success rate for the bacterial disease stood at 87% (4,934 people cured), according to official records. Besides, 1,809 cases were detected in the first three months of this year, with health officials saying TB is more prevalent in the district among men. As per records, in 2023, 5,879 new cases were detected in the district, and the total number of people cured stood at 4,719 (87% treatment success rate). Similarly, 6,075 tested positive in 2022, and the treatment success rate was 88% (3,761 cured). Dr Rajasekar, Deputy Director of Medical Services (Tuberculosis), Madurai, told TNIE, "In Madurai district, besides a majority of the TB patients being men, the disease is prevalent among the age group of 15 to 65 years, as they travel to many places and also play a role in spreading the infection." Under the Nikshay Mitra scheme, the officials have carried out screening for tuberculosis across the district, along with the support of donors, who offered support to the patients, including nutritional aid (food baskets), diagnostic assistance, and vocational training. Till 2024, 114 volunteers were involved in the district under the scheme. On the role of immunity in the spread of the disease, Rajasekar said, "According to their immune status, 5-10% of the infected individuals, who had contracted tuberculosis through airborne transmission, develop the disease. Thus, the disease is common among the elderly, people with uncontrolled diabetes, HIV patients, and those taking immunosuppressants. So, we take into account the friends or relatives who are closer to the TB patients for screening." In the urban areas, mobile diagnostic units were sent to factories, garment showrooms, and construction sites. Officials said around 440 camps were held in Madurai, and 16,086 X-rays were taken for the purpose. As a result, 82 new TB cases were identified in 2024. An official from health department said, "Under the TN-KET scheme (Tamil Nadu Kasanoi Erappila Thittam) 267 patients suffering from severe infection were identified and were admitted as inpatients. Besides, 20 NAAT (Nucleic Acid Amplification Test) centres also played a significant role in TB diagnosis in the district." Explaining that the disease could either be drug sensitive or drug resistant, Rajasekar said, "The treatment period for patients with drug-sensitive TB is nearly five months, whereas for those with drug-resistant TB, where the infection has spread to the nervous system, the treatment could take up to two years."
