Communities

Facilitating TB Treatment in Bihar

About

Bihar is an eastern state in India, and the third largest by population, with an estimated 94 million people. It is one of India’s most underdeveloped states. Measured by its per capita income of $200, it is India’s poorest. (Adjusted for purchasing power, this translates to living on about $1.5 a day in the U.S.) Only half of Bihar’s population is literate, and more than 80% live in rural communities.

Encouragingly, a new state government elected in 2005 has arrested the steep decline of the past two decades and led an economic revival. Bihar’s economic output grew by an unprecedented 18% in 2006. Progress is also being made, for instance, in combating maternal mortality, which fell by 15% recently.

Tuberculosis

  • There are an estimated 158,000 new cases of TB annually, of which 71,000 are actively infectious.
  • There are an estimated 26,000 deaths due to TB annually. This is about 70x the per capita TB mortality rate in the United States.
  • Every year, about 34,000, or less than half of those with actively infectious TB receive treatment for the first time.
  • 78% of those who receive treatment are cured.
  • Every year about 8,000 previously treated patients who remain infectious re-enroll for treatment.
  • Since an estimated 17% of retreatment cases present with drug resistant TB (MDR-TB) in India, this suggests that interrupted delivery might cause 1,400 new cases of MDR-TB in Bihar annually.

Our Work

IIH works in Bihar with the Prajnopaya Foundation. Together, we have trained 15-20 community workers in each of three townships in Bihar – Dhanarua, Dalsingh Sarai, and Bihar Sharif – with the following objectives:

  • Enable workers to effectively supervise TB treatment in their communities.
    Workers were educated about TB, with an emphasis on the risks of intermittent treatment, drug resistance, and holding the program, rather than patients responsible for reliable delivery.
  • Test IIH technology and gather feedback.
    Workers were trained to use the uBox and uPhone and detailed feedback on usability was gathered. Both devices were refined to incorporate the feedback.
  • Lay the groundwork for controlled trials.
    Workers conducted surveys to evaluate typical treatment trajectories and outcomes in patients presenting symptoms associated with TB. Possible approaches to collecting sputum and conducting bacteriology were developed.

In addition to these activities, IIH also collaborated with the Birla Institute of Technology (BIT, Patna) to test the feasibility of using cell phone based solutions in the townships around Dalsingh Sarai in Bihar. Students and faculty from BIT took extensive measurements using IIH’s custom software to characterize both the coverage and quality of voice and data services.

With these activities completed, IIH and Prajnopaya are preparing to pilot the complete uNotify system in 2010.