The potential impact of the COVID-19 response related lockdown on TB incidence and mortality in India.
The potential impact of the COVID-19 response related lockdown on TB incidence and mortality in India.
复制标题
DOI：
10.1016/j.ijtb.2020.07.004
复制
发表时间：
2020-12-01
期刊：
影响因子：
--
通讯作者：
Shewade, Hemant Deepak
中科院分区：
文献类型：
--
作者：
Bhargava, Anurag;Shewade, Hemant Deepak
印度是全球结核病（TB）发病和死亡负担最高的国家。结核病与贫困密切相关，而印度的营养不良在很大程度上介导了这一风险。与COVID-19应对相关的封锁导致了经济危机，这可能使贫困程度增加一倍，加剧了粮食不安全，并扰乱了结核病服务。这些发展可能对印度的结核病进展和传播产生严重影响。人口的营养状况是结核病发病率的一个重要决定因素，仅成人营养不良就占印度结核病发病率的32-44%。一项系统性综述表明，在体重指数（BMI）18.5- 30 kg/m2范围内，每降低一个单位，结核病发病率就会增加14%。我们认为，由于封锁及其后果，BMI下降一个单位（相当于体重减轻2- 3公斤）可能会导致印度的贫困。这可能导致估计（不确定区间）事件TB增加185 610（180 230，190 990）例。在2020年3月底至5月期间，结核病病例检测减少59%，可能导致2020年估计（不确定区间）增加87 711例（59 998，120 630）结核病死亡[增加19.5%（14.5，24.7）]。不同的社会群体和生活在贫困、营养不良程度较高的州的人以及移徙工人面临的风险特别大。我们建议通过公共分配系统增加口粮，包括豆类，并在恢复生计之前向穷人直接转移现金。应立即恢复结核病服务，加强病例发现工作，包括积极发现病例。为了防止在国家结核病规划中发现的结核病患者死亡，应考虑在接到通知时对严重疾病进行系统性识别、转诊和管理。
India has the highest burden of incident tuberculosis (TB) cases and deaths globally. TB is strongly associated with poverty and this risk is largely mediated by undernutrition in India. COVID-19 response related lockdown has resulted in an economic crisis which may double levels of poverty, has exacerbated food insecurity, and disrupted TB services. These developments may have serious implications for TB progression and transmission in India. The nutritional status of a population is a strong determinant of the TB incidence, and undernutrition in adults alone accounts for 32-44% of TB incidence in India. A systematic review has shown that a 14% increase in TB incidence can occur per one unit decrease in body mass index (BMI), across the BMI range of 18.5-30kg/m2. We believe that one unit decrease in BMI (corresponding to a 2-3kg weight loss) may result in the poor in India as a result of the lockdown and its aftermath. This may result in an increase in estimated (uncertainty interval) incident TB by 185 610 (180 230, 190 990) cases. A 59% reduction in TB case detection between end March and May 2020, may result in an estimated (uncertainty interval) additional 87 711 (59 998, 120 630) TB deaths [19.5% increase (14.5, 24.7)] in 2020. Disadvantaged social groups and those living in states with higher levels of poverty, under-nutrition,and migrant workers are at particular risk. We suggest enhanced rations including pulses through the public distribution system and direct cash transfers to the poor pending restoration of livelihoods. TB services should be resumed immediately with enhanced efforts at case detection including active case finding. To prevent deaths among TB detected within the national TB programme, systemic identification, referral and management of severe disease at notification should be considered.