This six year retrospective novel cross-sectional research study included all 36 numbers of different states and union territories (UTs) of India to assess the overall country status regarding the title mentioned research question. All the states and UTs were potentially eligible due to the fact that they (36 states and UTs) continuously and regularly register/communicate/transmit all the of newly detected tuberculosis cases notifications electronically through the NIKSHAY platform of Government of India. NI-KSHAY-(Ni = End, Kshay = TB) is the online web based patient management system in India exclusively for TB (Tuberculosis) control under the NTEP-2020 (National Tuberculosis Elimination Programme, previously RNTCP) with the key aim to eliminate TB by 2025. All the 36 participants’ states and UTs newly detected tuberculosis cases notifications were followed from 1st January 2017 to 31st December 2022 and analyzed to get an answer to the title mentioned research question. All participants participated from beginning to end of this study.
There are wide variations in demographic, clinical, social characteristics of above mentioned 36 participants evident from NITI AAYOG annual reports [22]. Information on exposures and potential confounders of different participants is not taken into account as this is a quantitative research study based on secondary data. There were no missing data.
The total number of newly detected tuberculosis cases notifications from 1st January 2017 to 31st December 2022 was 12290180 (n) including all 36 participants. The (period prevalence) total number of newly detected tuberculosis cases notifications during pre-COVID-19 era (2017–2019) was 5914621 and during the COVID-19 era (2020–2022) were 637559. The total annual newly detected tuberculosis cases notifications (including public and private healthcare facilities) in India including all 36 participants from beginning of year 1st January till 31st December during a year were 1525045, 1997873, 2391703, 1810834, 2145678, 2419047, for years 2017, 2018, 2019, 2020, 2021, and 2022 respectively, see table-1 and 2.
During the base year 2017 of this research study the total newly detected tuberculosis cases notifications from public and private healthcare facilities were 1396259 and 128786 respectively while for consecutive years 2018, 2019, 2020, 2021, 2022 of study it was (1591147, 406726), (1720790, 670913), (1251618, 559216,) (1452198,693480,) and (1686173,732874) respectively, see table-1 and 2.
2017
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2017 was 38784.97 (Std. Err.-8202.51; [95% Conf. Interval]-22132.99 -55436.95; Std. Dev.-49215.05) whereas for private healthcare facilities during 2017 it was 3577.39 (Std. Err.-860.98; [95% Conf. Interval] − 1829.51- 5325.26; Std. Dev. − 5165.85). Among public healthcare facilities Lakshadweep reported minimum 49 newly detected tuberculosis cases notifications whereas maximum 235505 was reported from UP (Uttar Pradesh) during 2017. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 18877 was reported from Maharashtra during 2017, see table-3.
2018
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2018 was 44198.53 (Std. Err.-9905.34; [95% Conf. Interval]− 24089.62-64307.44; Std. Dev.- 59432.04) whereas for private healthcare facilities during 2018 it was 11297.94 (Std. Err.- 2985.37; [95% Conf. Interval] − 5237.322- 17358.57; Std. Dev. − 17912.22). Among public healthcare facilities Lakshadweep reported minimum 19 newly detected tuberculosis cases notifications whereas maximum 303728 was reported from UP (Uttar Pradesh) during 2018. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 82555 was reported from UP during 2018, see table-3.
2019
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2019 was 47799.72 (Std. Err. − 10636.6; [95% Conf. Interval] − 26206.28 -69393.16; Std. Dev. − 63819.58) whereas for private healthcare facilities during 2019 it was 18636.47 (Std. Err. − 5203.06; [95% Conf. Interval] − 8073.698- 29199.25; Std. Dev. − 31218.36). Among public healthcare facilities Lakshadweep reported minimum 15 newly detected tuberculosis cases notifications whereas maximum 326306 was reported from UP (Uttar Pradesh) during 2019. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 159771 was reported from UP during 2019, see table-3.
The mean of newly detected tuberculosis cases notifications from all public and private healthcare facilities during Pre-COVID-19 era (2017–2019) was 164295 (Std. Err. − 37404.92; [95% Conf. Interval] − 88359.01- 240231; Std. Dev. − 224429.5). Among all public and private healthcare facilities Lakshadweep reported minimum 83 newly detected tuberculosis cases notifications whereas maximum 1125934 was reported from UP (Uttar Pradesh) during Pre COVID-19 era (2017–2019), see table-3.
Table-3- Statistical Analysis of tuberculosis cases notifications of Pre-COVID era.
Variable
|
Obs
|
Mean
|
Std. Err.
|
Confidence Interval-Mean
[95% Conf. Interval]
|
Std. Dev.
|
Min
|
Max
|
2017-Total Public Notified
|
36
|
38784.97
|
8202.51
|
22132.99 -55436.95
|
49215.05
|
49
|
235505
|
2017-Total Private Notified
|
36
|
3577.39
|
860.98
|
1829.51- 5325.26
|
5165.85
|
0
|
18877
|
2018-Total Public Notified
|
36
|
44198.53
|
9905.34
|
24089.62-64307.44
|
59432.04
|
19
|
303728
|
2018-Total Private Notified
|
36
|
11297.94
|
2985.37
|
5237.322- 17358.57
|
17912.22
|
0
|
82555
|
2019-Total Public Notified
|
36
|
47799.72
|
10636.6
|
26206.28 -69393.16
|
63819.58
|
15
|
326306
|
2019-Total Private Notified
|
36
|
18636.47
|
5203.06
|
8073.698- 29199.25
|
31218.36
|
0
|
159771
|
Pre-COVID-19 Total Public & Private Notified
|
36
|
164295
|
37404.92
|
88359.01- 240231
|
224429.5
|
83
|
1125934
|
2020
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2020 was 34767.17 (Std. Err. − 7838.52; [95% Conf. Interval] − 18854.13- 50680.21; Std. Dev. − 47031.11) whereas for private healthcare facilities during 2020 it was 15533.78 (Std. Err. − 4142.46; [95% Conf. Interval] − 7124.13 -23943.43; Std. Dev. − 24854.78). Among public healthcare facilities Lakshadweep reported minimum 18 newly detected tuberculosis cases notifications whereas maximum 242722 was reported from UP (Uttar Pradesh) during 2020. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 125317 was reported from UP during 2020, see table-4.
2021
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2021 was 40338.83 (Std. Err. − 9743.34; [95% Conf. Interval]− 20558.81 -60118.86; Std. Dev.- 58460.02) whereas for private healthcare facilities during 2021 it was 19263.33 (Std. Err.- 5064.32; [95% Conf. Interval] − 8982.22-29544.45; Std. Dev. − 30385.93). Among public healthcare facilities Lakshadweep reported minimum 12 newly detected tuberculosis cases notifications whereas maximum 315422 was reported from UP (Uttar Pradesh) during 2021. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 140843 was reported from UP during 2021, see table-4.
2022
The mean of newly detected tuberculosis cases notifications from public healthcare facilities during 2022 was 46838.14 (Std. Err. − 11485.15; [95% Conf. Interval] − 23522.05- 70154.23; Std. Dev. − 68910.89) whereas for private healthcare facilities during 2022 it was 20357.61 (Std. Err. − 5426.21; [95% Conf. Interval] − 9341.82 -31373.41; Std. Dev. − 32557.27). Among public healthcare facilities Lakshadweep reported minimum 11 newly detected tuberculosis cases notifications whereas maximum 372651 was reported from UP (Uttar Pradesh) during 2022. Among private healthcare facilities Lakshadweep reported minimum 0 newly detected tuberculosis cases notifications whereas maximum 149230 was reported from UP during 2022, see table-4.
Table-4- Statistical Analysis of tuberculosis cases notifications of COVID-19 era
Variable
|
Obs
|
Mean
|
Std. Err.
|
Confidence Interval-Mean
[95% Conf. Interval]
|
Std. Dev.
|
Min
|
Max
|
2020-Total Public Notified
|
36
|
34767.17
|
7838.52
|
18854.13- 50680.21
|
47031.11
|
18
|
242722
|
2020-Total Private Notified
|
36
|
15533.78
|
4142.46
|
7124.13 -23943.43
|
24854.78
|
0
|
125317
|
2021-Total Public Notified
|
36
|
40338.83
|
9743.34
|
20558.81 -60118.86
|
58460.02
|
12
|
315422
|
2021-Total Private Notified
|
36
|
19263.33
|
5064.32
|
8982.22-29544.45
|
30385.93
|
0
|
140843
|
2022-Total Public Notified
|
36
|
46838.14
|
11485.15
|
23522.05- 70154.23
|
68910.89
|
11
|
372651
|
2022-Total Private Notified
|
36
|
20357.61
|
5426.21
|
9341.82 -31373.41
|
32557.27
|
0
|
149230
|
COVID-19-Total Public & Private Notified
|
36
|
177098.9
|
43081.17
|
89639.43 -264558.3
|
258487
|
41
|
1346185
|
The mean of newly detected tuberculosis cases notifications from all public and private healthcare facilities during COVID-19 era (2020–2022) was 177098.9 (Std. Err. − 43081.17; [95% Conf. Interval] − 89639.43 -264558.3; Std. Dev. − 258487). Among all public and private healthcare facilities Lakshadweep reported minimum 41 newly detected tuberculosis cases notifications whereas maximum 1346185 was reported from UP (Uttar Pradesh) during COVID-19 era (2020–2022).
Other Analyses
Incidence Rate (newly detected tuberculosis cases notifications) per lakh population
= Total newly detected tuberculosis cases notifications in a specified year x 100000
Population (forecasted value as real census is not done) at risk (we considered whole population at risk)
Table − 5- Incidence Rate of newly detected tuberculosis cases notifications in a specified year per lakh population
Year
|
Population
|
Newly detected tuberculosis cases notifications from all public and private
|
Incidence Rate/lakh
|
2017
|
1354195680
|
1525045
|
112.62
|
2018
|
1369003306
|
1997873
|
145.94
|
2019
|
1383112050
|
2391703
|
172.92
|
2020
|
1396387127
|
1810834
|
129.68
|
2021
|
1407563842
|
2145678
|
152.44
|
2022
|
1426099353
|
2419047
|
169.63
|
Population Data Source- The World Bank available at - https://data.worldbank.org/indicator/SP.POP.TOTL?locations=IN
The populations for year 2022 was forecasted with the help of Microsoft excel by utilizing the previous all year available data.
The incidence rate of newly detected tuberculosis cases notifications per lakh population was 112.62; 145.94; 172.92; 129.68; 152.44; and 169.63 respectively for years 2017, 2018, 2019, 2020, 2021, 2022, see figure-1.