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, which 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 ICMR National Institute of Epidemiology (ICMR-NIE), which was launched last week and will aid the State in bringing down the TB mortality rate said Asha Frederick, State TB Officer of Tamil Nadu.
She added that 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.
Globally, India has the highest burden of TB with two deaths occurring every three minutes. But these deaths can be prevented. With proper care and treatment, TB patients can be cured, notes the World Health Organisation.
Research further adds that TB is among the leading causes of morbidity and mortality worldwide, and more than 70% of the deaths of TB patients occur during the first two months of treatment.
Speaking about the addition of the new feature in the Tamil Nadu TB elimination programme Dr. Frederick explained that this new addition will merge with the 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).
“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 he is given priority in hospital admission and that 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 1–4 per cent,” explained Hemant Shewade, a senior scientiat at NIE.
He added that while the average time from diagnosis to admission of a TB patient in Tamil Nadu is one day, around a quarter of severely ill patients still face delays of up to six days in the state.
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 increased the mortality during TB treatment, notes a study titled ‘Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia’, which adds that a special follow up of TB patients during the intensive phase, of older patients and TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment.
