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TB Awareness still a challenge in Kashmir

Indian administered Kashmir fares better in the execution of Revised National TB control Programme in the country, but overcoming misconceptions about the dreaded disease is still a challenge that hampers its control. Peerzada Arshad Hamid reports.

Srinagar, Jan 16, 2012:

On December 19, newspapers in Kashmir carried a news about the unclaimed body of a woman who died to tuberculosis at the chest disease hospital Srinagar.

The woman had been suffering from Tuberculosis (TB) and had been admitted in the hospital by her relatives on November 14. Doctors kept her in the isolation ward for treatment.

Hospital records identified the deceased as Rubeena, wife of Sulman Khan, a resident of Kupwara district, around 100 km northwest of Srinagar city.

“On the day (Nov. 17) she breathed her last inside hospital, surprisingly none from her family was present at the hospital,” said Imran Farooq, the Police spokesman in Srinagar. “The hospital officials informed us they had tried to contact her family but couldn’t.”

The police officials said they too tried to get in touch with the family but failed.

“Subsequently, we put up a public notice and a photograph of the deceased along with our contact details in local newspapers,” said Farooq. “The aim was to inform the family about the death so that they approach us and the body is given a proper burial.”

Officials at the Chest Diseases hospital say the incident speaks of the attitude of people towards TB patients.

“The news in the newspapers may have passed off as a routine item but abandoning TB patient and leaving the body unclaimed in hospital by the family however speaks of the indifference with TB patients,” said a doctor posted in the hospital.

TB is a highly contagious disease. Officials say a Revised National TB control Programme (RNTCP) is going on in full swing in Kashmir valley to treat the TB patients.

Data available from the RNTCP areas of Jammu and Kashmir (J&K) for first quarter of 2011 puts case detection rate of TB at 71 percent of those tested, while as treatment success rate at more than 92 percent. As per data J&K fares better than other Indian states in the execution of the programme.

Critics, however, say the data talks about the TB cases registered under the RNTCP programme, while it is silent about the total number of patients in the state.


Like most parts in India TB in Kashmir has a social stigma attached to it which makes the situation worse particularly in the rural areas.

* Tuberculosis is an infectious disease that usually affects the lungs

* It spreads through air via droplets from the lungs when TB patient coughs, sneezes or talks

* If not treated, each person with active TB can infect on average 10 to 15 people a year

* Symptoms of TB include coughing for two weeks, chest pains, weakness, weight loss, fever and night sweats

* Tuberculosis is treatable with a course of antibiotics

* Tuberculosis is completely curable

* TB is not hereditary

* Improper treatment can lead to a drug resistant form of TB- MDR or XDR

* TB is a leading killer among people living with HIV, who have weakened immune systems

* Among the 15 countries with the highest estimated TB incidence rates, 13 are in Africa, while a third of all new cases are in India and China.

The doctors posted at government hospitals said private consultants aggravate the situation by advising patients not to rely on Direct Observed Treatment Short course (DOTS) provided at government run hospitals.

"This year a woman patient suffering from TB came to me and subsequently she was put on DOTS,” said Dr Mohammed Yosuf Naikoo, District T B officer at Shopian district. “After few days, she called me over telephone and was literally shouting, because a private doctor has told her she was not a TB patient.”

Naikoo says most of the TB patients after diagnosis approach other doctors to cross check whether they are suffering from TB.

People have a perception that whosoever gets infected is rendered handicapped for whole life, doctors say.

“First the people find it difficult to accept they have TB and somehow when they realize, the private consultants instead of advocating our treatment put the patient on some other treatment thereby denting our efforts,” Naikoo says.

The paramedical staff at the Shopian RNTCP centre said the patients taking medicine under DOTS usually ask for anonymity.

“We have kept the names of the patient taking medicine on their respective cardboard boxes,” said Mohammed Ashraf Ganai. “Every time they come for taking medicine, they request their names written on the boxes should be kept away from the people’s sight.”

Shopian district last year recorded the highest number of TB patients in Kashmir valley. Most of the detections were done through sputum tests.

“The way programme has been designed is aimed at achieving maximum results,” said Dr Naveed Nazir at Chest Diseases hospital Srinagar. “If patients will cooperate they will certainly be relieved of the disease within a stipulated time.”

Officials at the RNTCP centre Shopian said 293 patients were registered for the treatment. Of them 148 have completed treatment and have been declared cured and remaining 145 are still undergoing treatment.

The district recorded three deaths of TB patients.


Chest specialists posted at various RNTCP centres say awareness about the programme is the need of the hour to get cooperation from patients and their families.

“The notions attached with the TB need to be dispelled, so that more and more people come forward for the treatment,” said Abdul Jaleel Lone, a humanitarian aid worker, who has worked in Kupwara villages. “People especially women say diagnosis of this disease usually make the chances of marriage bleak.”

At various RNTCP centres there are instances where in patients give up taking medicine midway. Despite the repeated calls from the RNTCP workers, such patients don’t turn up.

In Kashmir it has been found that the people living in crowded homes with poor ventilation usually fall prey to this disease. And further close contact of the patient with people increases its spreading.

Aid workers say mass media should be used to propagate messages that dispel myths about the disease.

“Why not to formulate a similar awareness strategy for TB as is being carried out regarding AIDS programme,” asks Lone.


India carries the burden of one third of the World’s TB patients. Despite being fully curable, TB is considered an economic burden on India as the disease left untreated leads to chronic illness, loss of livelihood and pushes families into poverty.

Experts say patients who do not finish their lengthy course of treatment present the bacterium with the perfect environment for developing further resistance. The resistant form of TB (MDR- Multi Drug Resistant TB or XDR- Extremely Drug Resistant TB) is difficult and expensive to treat and fails to respond to standard first-line drugs.

As per RNTCP data 236 suspects were identified per 100,000 in the first quarter of 2011 in Jammu and Kashmir.

However, no data about MDR-TB or XDR-TB is available from the state.

(Under the aegis of REACH Lilly MDR-TB Partnership)




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