Trends and sub-national disparities in TB notifications in India: Insights from HMIS data

Abstract

Background/objectives: Tuberculosis (TB) is a public health crisis across the globe, especially in the developing world including India. Around 27% of 10 million TB cases and 33% of 1.2 million TB deaths were contributed from India alone during 2018. Present study aims to estimate TB notification rates at national and sub-national levels up to District administrative blocks, which is very important with policy perspective.

Methods: The study mainly uses data from India's Health Management Information System (HMIS) for three consecutive years, 2017-18, 2018-19 and 2019-20. TB notification rates were calculated for India up to the lowest administrative level of health Districts. GIS maps were being used for mapping District-wise TB notification rates for 2017-18 and 2019-20.

Results: Results show that TB notification rates have increased from 152/lakh population in 2017-18 to 197 in 2019-20, an increase of 30%. Similarly, the increasing trends in TB notification rates were also observed at State as well as District level. However, wide rural-urban and public-private differences were observed in TB notification rates. Further, results illustrated huge inter-State and inter-District variations; and half of the TB cases in India were contributed only by six larger States.

Conclusions: The findings of the study shows the increasing notification in India since 2017-18, which is a clear indication of the efforts put in the TB program to achieve targets and goals committed to end TB by 2025. In this regard present estimates based on HMIS data significantly contributes to the policy formulation even at the lowest administrative level of health Districts.

Keywords: Burden of TB disease; HMIS; India; Notification rates; Tuberculosis.