High incidence of pulmonary tuberculosis in an indigenous Saharia tribe in Madhya Pradesh, central India—A prospective cohort study

Abstract

Background Lack of TB incidence data is an important evidence gap among Saharia–a high TB burden indigenous community in Madhya Pradesh, central India. The present study was undertaken to calculate the incidence of pulmonary tuberculosis in this tribe. Objective To calculate the incidence of pulmonary tuberculosis (PTB) among the Saharia tribal population in Madhya Pradesh, central India. Methods A prospective cohort study was conducted among the Saharia tribal population (aged 15 years and above) of Shivpuri district in Madhya Pradesh state in central India. A total of 9,756 individuals were screened for TB in the baseline TB prevalence survey during 2012–13. All available household members were screened for symptoms suggestive of pulmonary TB (presumptive TB). Two sputum specimens were collected from persons having symptoms suggestive of TB and examined by smear and culture tests. A cohort of all non-TB individuals in the baseline survey was followed-up for one year and re-screened for the sysmptoms of PTB in the year 2014–15. Based on the data collected, the incidence of TB over one year period was estimated per 100,000 population. Results A total of 9756 and 9044 individuals (≥ 15 years) were screened for symptoms suggestive of PTB during baseline and endline surveys respectively. The sputum specimens of presumptive TB cases were collected and examined by smear and culture tests. The overall incidence of bacteriologically positive (smear and/or culture) PTB over one year period was 1504 (95% Confidence Interval (CI): 1273–1776) per 100,000 in the study population, the incidence of smear-positive PTB was 1106 (95% CI: 910–1343), and the incidence of culture-positive PTB was 1084 (95% CI: 890–1319) per 100,000 population. The incidence for both smear and culture-positive PTB was 686 (95% CI: 535–878) per 100,000 population in the year 2014–15. The incidence of PTB was 2.8 times higher in males compared to females (2259 vs 807 per 100,000) and was positively correlated with age. Conclusion The findings of the study, the first of its kind in the Saharia tribal population, indicate a high incidence of TB in this tribal community thereby highlighting the urgent need for focused and intensified efforts to achieve the goal of TB elimination in the country.

Assessment of Health Aspects of Tribal Adolescent Girls in India's Most Populous Tribal State: A Two-Decadal Review

“…Under five child mortality is alarming (54.6 %) among tribes compared to others 45.4 %; frequency of antenatal care visit by tribes is 55.5% whereas it is 62 % for others; 76.9 % of tribal children belong to 6-59 months age group are affected by anemia, 64.2% women in reproductive age group are anemic 25. Significant number (70%) of anemic adolescent girls were found in Baiga tribe in Mandala district 26 . Child and adolescent malnutrition are exceedingly observed among tribal districts of Madhya Pradesh 27-29. Tuberculosis is disproportionally high among Saharia tribe of Madhya Pradesh compared to not only from general population, but also much high from other tribes of India 30 . Information and knowledge about health and hygiene practices specifically during menstruation period among tribal adolescent girls and women were found to be lower as compared to others 31 .…”

Tuberculosis epidemic in India – a systematic review

“…6,15,16,22,61 Individual patients in tribal areas in India face major challenges due to poor socioeconomic conditions, socio-cultural variables, individual ignorance or discrimination, mental health challenges, limited resources or transportation, gender-specific education, a lack of basic understanding about the disease, and difficulty accessing the healthcare facility. 1,3,22,43,[60][61][62][63] According to studies by Rao et al 29 , Bhat et al 55 , and Thomas et al 16 , PTB exposures were more prevalent among tribal groups, and 2.8 times higher prevalent among males than females. 16,22,29,55,63 Drug-resistant tuberculosis According to current trends, drug-resistant tuberculosis (DR-TB), which is resistant to a variety of anti-tuberculosis drugs, is a serious problem in the Indian population, and as a result, it has become a new impediment to India's efforts to combat the illness.…”

“…1,3,22,43,[60][61][62][63] According to studies by Rao et al 29 , Bhat et al 55 , and Thomas et al 16 , PTB exposures were more prevalent among tribal groups, and 2.8 times higher prevalent among males than females. 16,22,29,55,63 Drug-resistant tuberculosis According to current trends, drug-resistant tuberculosis (DR-TB), which is resistant to a variety of anti-tuberculosis drugs, is a serious problem in the Indian population, and as a result, it has become a new impediment to India's efforts to combat the illness. 33,36,45,56,59,64,65 The four first-line antibiotics for tuberculosis are rifampicin, isoniazid, pyrazinamide, and ethambutol.…”

“…However, not all stra-ta bear the same amount of the TB burden; the tribal community is one of the most severely impacted groups in the country. 15,16,28,48,49,63 Additionally, several studies found that more than two-thirds of TB cases are observed in the economically productive age range (14-59 years). 1,3,4,9,10,20,31,37,38,40,41,43,46,59,73,74 The international health community, which has established multiple 5-year targets for TB elimination, has proposed a method combining improved diagnostics, medications, and vaccinations to identify and treat both latent and active TB infections in order to meet the 2050 target.…”

Burden of tuberculosis & malaria among tribal populations & implications for disease elimination in India

“…One stark example of TB burden is among Saharia community, a particularly vulnerable tribal group, in Madhya Pradesh and Rajasthan, which has the highest prevalence in the country; pulmonary TB incidence is 1504 per 100,000 population in Saharia tribe as compared to the national average of 217 per 100,000 population 9 .…”