Tuberculosis death rates showed a sustained decline in six districts of Tamil Nadu following the rollout of the State’s Kasanoi Erappila Thittam (TN-KET), a new study published in Global Health Action has found.
The study – Sustained reduction in program-reported TB death rate in six districts following Tamil Nadu Kasanoi Erappila Thittam in southern India, which was taken up by the State’s TB Cell and Indian Council of Medical Research – National Institute of Epidemiology, reported sustained reduction in TB death rate for over two years across the six districts of Dharmapuri, Karur, Villupuram, Kanniyakumari, Cuddalore, and Salem following the implementation of TN-KET (TB death-free project). The programme, which is India’s first State-wide and State-specific differentiated TB care initiative to reduce TB deaths, was launched in April 2022.
Under TN-KET, adults with TB were triaged for severe illness at diagnosis, and those with very severe undernutrition or respiratory insufficiency or poor performance status were prioritised for comprehensive clinical assessment and inpatient care, the authors said.
They said that routine aggregate data showed a decline in TB death rates in the July 2022-June 2024 cohort compared with the July 2021-June 2022 cohort across the six districts – Dharmapuri (from 12.6% to 4.8%), Karur (from 7% to 4.7%), Villupuram (from 6.1% to 4.6%), Kanniyakumari (from 10.4% to 8.1%), Cuddalore (from 6.7% to 4.1%), and Salem (from 7.8% to 4.9%).
“Beyond these six districts, the overall impact of TN-KET was also reflected across the rest of the State, with a nearly 2.5% reduction in TB deaths following its implementation. TN-KET started off as an implementation study. We did a mapping of the entire secondary care hospital system – district headquarters hospitals, taluks and sub-taluk hospitals, and physicians, wherever available, were given the responsibility,” Asha Frederick, State TB Officer and lead author, said.
For instance, if a patient with TB has diabetes, the physician will take care of the glycemic control. Similarly, they should assess other conditions such as liver diseases or anaemia and provide appropriate care, she said, adding that two to three government hospitals in a district were asked to identify isolation wards similar to that of COVID-19 to admit and provide in-patient care to patients. In a similar way, ownership was also given to tertiary care hospitals.
“Deaths due to TB complications are different but we need to address co-morbidities in patients with TB to reduce deaths. The other end of the spectrum is early diagnosis. We need to find the patient early and provide care and support,” Dr. Asha pointed out.
The study also documented sustained TB death rate reduction through standardised mortality ratios. TN-KET not only worked in districts with relatively higher TB death burden but also in districts with relatively lower TB death burden, the authors said.
Consistent adherence to core components of TN-KET such as early identification of severe illness, timely inpatient referral, and continuity of care during the high-risk early treatment period were the driving factors behind the sustained reduction in TB death rates.
Specifying what some of these districts did, the study said that the teaching hospital in Dharmapuri had an adequate number of pulmonologists with provision of ventilatory support for people with TB whose oxygen saturation fell below 85%. Karur, in addition to admitting triage-positive TB patients, also admitted elderly TB patients and persons with co-morbidities (diabetes with suboptimal control, substance abuse requiring medical deaddiction) irrespective of their triaging status, while in Villupuram, those who were unwilling to get admitted were counselled by TB champions.
Published - May 29, 2026 12:17 pm IST
Source: The Hindu - India News
