Budgam’s journey towards becoming India’s first TB-free district

Budgam in Jammu and Kashmir has recently been declared the country’s first TB-free district. How did the district achieve this feat? Read on to find out.

Mudassir Kuloo
| Updated: May 8th, 2021

A doctor while checking a patient’s chest X-ray for signs of tuberculosis. Photo: UNICEF/Vinay Panjwani

Budgam, J&K 

While the country’s battle against the COVID-19 is getting tougher by the day, a battle against another potentially serious infectious disease — tuberculosis (TB) — has made some headway. Budgam district in Jammu & Kashmir (J&K), and the union territory of Lakshadweep have recently been declared TB-free, the first to get such a tag in India, which has nearly 30 per cent of the world’s TB cases, and is also known as the TB capital of the world.

Lauding the efforts, the Union health minister Harsh Vardhan called it a “landmark achievement” in the fight against tuberculosis. He was addressing a meeting of the World Health Organization’s (WHO) National Tuberculosis Elimination Programme Technical Consultant Network Teams in March this year. The Government of India has set a target of declaring the country TB-free by 2025.  

Budgam’s journey towards the TB-free status wasn’t easy. Sixty five districts in the country had applied for certification to be declared tuberculosis-free. The data collected from the districts was verified by the central TB division under the Ministry of Health and Family Welfare, in collaboration with Indian Association of Preventive and Social Medicine (IAPSM), Srinagar. Of the 65 districts, the health ministry declared Budgam and Lakshadweep TB-free on World Tuberculosis Day on March 24. 

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“In order to be declared TB-free, a district has to record 80 per cent decrease in the number of incidents compared to the baseline year,” Rehana Kousar, TB officer, based in Srinagar, J&K, told Gaon Connection.

Around 3,296 households were surveyed in the district where the data was verified by the IAPSM team from the department of community medicine, Government Medical College, Srinagar. The survey was undertaken by the Indian Council of Medical Research (ICMR), New Delhi, and the National Institute of Epidemiology, Chennai. 

“Budgam has been declared TB-free based on various parameters. Survey per lakh population, drug sales data and numbers of patients needed to be tested were all part of this process to declare Budgam TB-free,” Adhafar Yasin Qadri, district TB officer of Budgam, told Gaon Connection. At present, Budgam district, with over 735,753 population (2011 census), has 170 TB patients.

Disease and stigma

Much like the COVID19, which has a stigma attached to it as the coronavirus can spread through touch or even air droplets, TB also comes with a strong stigma attached, as 35-year-old Javid Ahmed found out. 

Also Read: Testing Times: Screening, diagnosing and treating tuberculosis in 2020 took a backseat in India which has the world’s highest burden of TB cases

In October 2019, when Ahmad, a grocery store owner, started coughing up blood and experienced chest pain, he visited a doctor in Srinagar’s Chest Disease Hospital where several tests were done and he was found suffering from TB.

“When people got to know about my disease, they stayed away from me, branding me as ‘a TB patient’,” Ahmad, a resident of Central Kashmir’s Budgam district, told Gaon Connection. But, the government hospital immediately started him on a Directly Observed Treatment Short (DOTS) course, where he was given medication every day for six months after which he was TB-free. 

“But these six-months were painful. Even my close friends stayed away from me,” Ahmad said. “I don’t know why TB patients face discrimination, social isolation and neglect by their loved ones. Anyone can catch this airborne disease. How is it the patients’ fault,” he asked. “It was only my wife and elder brother who stood by me,” he added. 

A doctor examines the X-ray of a TB patient. Photo: Bijoyeta Das/IPS

Road to recovery

Ahmad is one of the TB survivors in Budgam, who was treated at a government health centre free of cost. There are many others like him in the district, who received treatment for TB and are now leading normal lives.

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Aliya Jaan from Budgam suffered a dry cough for a couple of weeks and went to the hospital to get herself tested and found she had TB. “I visited the health centre in Budgam and continued the treatment for six months. Health officials were continuously monitoring me,” the 28-year-old told Gaon Connection. “Along with me, my parents were also kept under observation, in case they were infected too,” she added. 

According to Jaan, the worst thing was not so much the disease as it was the social isolation that was traumatic. “My relatives kept commenting how it would be difficult for me to marry because of the social stigma attached to TB. The discrimination is the worst,” she said.

Surveillance, screening and testing

Explaining how Budgam district accomplished the feat of controlling TB, Kousar said: “Over the years, TB surveillance teams were formed. They went from house-to-house to screen and test people for TB.” 

“Once a case is notified, we start the treatment to the patient and it continues till the disease is eliminated,” she said. She also pointed out that the patients were carefully observed so that they did not pass on the infection to others. “One patient can infect 10 people in a year. We do contract tracing of patients and also their follow up for two years,” she said. 

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It takes six-months for a pulmonary (lungs) TB patient to be cured. For extra-pulmonary TB patients, she said, it takes them anything from 18 months to two years to be TB-free. Cough, fever for more than two weeks and unexplained weight loss are some of symptoms of TB. The central government also provides Rs 500 a month to enable the patient to follow a nutritious diet.  

Efforts of the district administration have paid off. According to Kousar, in 2015-2016 there were 257 cases of TB in the district. In 2020-2021, till March, there were 170 cases. “There is about 35 per cent drop in the total number of cases but an 80 per cent reduction in the disease incidence,” she said.

Qadri explained: “The number of TB incidents has declined to eighty per cent in per lakh population of the district. For instance, in 2015 if ten samples were collected and we found one positive case; now we have to take hundred and eighty samples to find one positive case,” she told Gaon Connection. All the current 170 TB cases in the district are not from the local population but outsiders too, including labourers staying in the district.

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“Budgam is declared the first TB-free district in the country. But, being-TB free does not mean zero cases. It means that there will be a lot fewer cases now because of measures taken to contain its spread,” Kousar clarified.    

Source: India TB Report 2020

Meanwhile, there has also been a sharp decline in TB cases in all 10 districts of the Kashmir division. In 2018, the division recorded 4,774 cases and the following year, in 2019, it was down to 4,080 TB cases. In 2020, the number further declined to 2,836 cases. Thus, a drop of 41 per cent in two years. 

Lauding the efforts of Budgam district, Mohammad Salim Khan, head of the Department of Community Medicine at Government Medical College (GMC), Srinagar, said that only Budgam district from Kashmir had applied for the TB-free survey.

“A team from GMC Srinagar verified data and monitored their activities. It was found that Budgam district has achieved maximum results with eighty per cent reduction in TB incidents, which was highest in the country,” Khan, who is also the nodal officer of the verification team (IAPSM) for Kashmir, told Gaon Connection.

According to him, Budgam would be under observation for the next three years. “There will be proper monitoring so there is no increase in TB cases,” he said. He attributed the improved situation to the efficient health workers and the cooperation from the public.

(Names of TB survivors have been changed on their request)