Active detection of tuberculosis and paragonimiasis in the remote areas in North-Eastern India using cough as a simple indicator

Abstract

One of the essential steps in targeting tuberculosis (TB) intervention is early diagnosis and treatment of patients by reducing the reservoir of infection in the community. In the North-Eastern (NE) region of India pulmonary TB and paragonimiasis are overlapping public health issues. We performed a cross-sectional study in 63 remote villages from the two states Arunachal Pradesh (AP) and Assam to determine the prevalence of undiagnosed TB and paragonimiasis cases using cough as a simple indicator. In AP, 2961 individuals aged five years and above were examined and 1108 (37·4%) were found to have cough for one week or more. Of the 417 individuals who provided sputum, 11 (2·64%) were smear positive for acid-fast bacilli (AFB). All these cases were yet undiagnosed, thus the prevalence of new smear positive TB in AP was 0·37%. In Assam on the other hand 331 (23·5%) subjects out of 1410 individuals who were examined had a cough for one week or more and of the 112 individuals who provided sputum, 13 (11·6%) were smear positive for AFB. The prevalence of new smear positive TB cases was 0·78% in Assam. Sero-positivity of paragonimiasis in coughers of AP was 7·6% (n = 1091), which was significantly higher (p < 0·01) as compared to that in Assam (1·2%, n = 321). The findings of the present study suggest that TB remains a major public health concern in the NE region of India especially in the remote places and there is need to strengthen early case detection of TB.

A systematic review and meta-analysis of active case finding for tuberculosis in India

“… 18 , 19 , 20 , 21 , 22 , 23 One study conducted in 4 states did not report the location details. 22 Amongst 58 study sites in 44 studies, 26 were in South India (14 in Tamil Nadu, 18 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 6 in Karnataka, 18 , 19 , 23 , 34 , 35 , 36 4 in Andhra Pradesh, 20 , 37 , 38 , 39 1 in Telangana, 40 and 1 in Pondicherry 41 ), and 10 in Western India (8 in Maharashtra, 18 , 19 , 42 , 43 , 44 , 45 , 46 , 47 2 in Gujarat 18 , 19 ).

Figure 2 Geographical distribution of active case finding implementations in India.

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“…Of the 45 studies, 40 were conducted in a public sector setting, 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 3 in private sector, 32 , 42 , 61 and 2 were public-private mix. 31 , 46 Ten studies were in urban populations, 25 , 29 , 30 , 31 , 33 , 41 , 42 , 46 , 55 , 58 9 in rural, 21 , 24 , 26 , 27 , 36 , 48 , 49 , 53 …”

Association of multidimensional poverty and tuberculosis in India

“…The prevalence of tuberculosis was the highest in the north-eastern states of Arunachal Pradesh, Manipur, and Nagaland. The state variations observed in the study may be related to human paragonimiasis that occurs in Arunachal Pradesh, Manipur, and Nagaland, which is in turn associated with tuberculosis [ 21 ].…”

Changing face of paragonimiasis

“…[ 3 ] This happened, for example, in NE India and led to the development of combined surveys for TB and paragonimiasis. [ 4 ] It is difficult to say much about trends of paragonimiasis in West and Equatorial Africa, and parts of South America: data are limited. Researchers in Ecuador have been the most active in South America and have reported many cases there.…”