A potentially life-saving digital calculator, proven to significantly reduce tuberculosis (TB) deaths, has been awaiting a nationwide rollout for months. This delay persists despite a strong recommendation from a branch of the Indian Council of Medical Research (ICMR) for its inclusion in India's national TB elimination programme.
The Proven Success of TB SeWA
The web-based application, named 'TB SeWA' (Severe TB Web Application), was developed and implemented in Tamil Nadu. The results have been striking. In its home state, the tool contributed to a 20% to 30% reduction in total TB deaths in 2024. This success story highlights its potential impact on a country that witnesses over three lakh (300,000) TB-related deaths annually.
Mumbai's situation underscores the urgent need for such interventions. The city records the highest number of TB deaths in Maharashtra, with between 1,000 and 2,000 fatalities each year. Furthermore, Mumbai reports an estimated 5,000 drug-resistant TB cases annually, making advanced triage tools critical.
How the Calculator Works to Save Lives
The model originated in Tamil Nadu in 2022 as a simple pen-and-paper system. It relies on five straightforward checks performed by trained community health workers to identify severe TB cases. These indicators are:
- Whether the person is too weak to stand.
- If they have low oxygen levels on a finger monitor.
- If they are dangerously thin.
- The presence of swollen feet.
- If they are breathing too fast.
This initial model showed immediate results, leading to a 20% dip in early TB deaths within the first six months and a 10% reduction in overall deaths. In July 2023, the ICMR's National Institute of Epidemiology (ICMR-NIE) enhanced the model by taking it online and adding a predictive feature. Now, the tool not only identifies severe illness but also calculates an individual patient's mortality risk, which ranges from 10% to 50% based on the indicators.
A senior doctor from ICMR-NIE explained the urgency, noting that for severely ill patients, most early deaths occur within the first two months. "If you need to save them, their cases must be treated as emergencies, with immediate triage," the doctor emphasized. For patients flagged by the calculator, prioritized treatment can reduce their risk of dying by 1% to 4%.
A Call for National Action
Frustrated by the wait for action from the Central TB Division, ICMR-NIE took a decisive step last month. They announced on the social media platform X (formerly Twitter) that they would release the death prediction calculator as an open-for-all tool in the public domain. Their post highlighted the "Contribution of Tamil Nadu Kasanoi Erappila Thittam (Tamil Nadu Tuberculosis Death-Free Project) to India."
When approached, an official from the Central TB Division stated that the division had "considered" the triaging model and affirmed that the national programme is "all-inclusive." However, the continued delay in formally adopting and scaling a tool with demonstrated efficacy raises questions about the pace of innovation in the public health fight against TB.
The story of TB SeWA presents a clear juxtaposition: a state-level triumph of data-driven healthcare against the backdrop of a national bureaucratic pause. As India strives to eliminate TB, the swift integration of such proven, low-cost technologies could be the key to turning the tide against one of the country's oldest and deadliest diseases.
