Tamil Nadu first state to implement TB death prediction model
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Indian Express
2 days ago
- 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
4 days ago
- 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)
Indian Express
6 days ago
- 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
