# Epidemiological Trends and Treatment Outcomes: Findings of a TB Survey From Selected Districts of Madhya Pradesh, India

## TL;DR

This study analyzed TB trends and treatment outcomes in two districts of Madhya Pradesh, India, from 2018 to 2022, revealing progress in some areas but ongoing challenges.

## Contribution

The study provides district-level insights into TB epidemiology and treatment outcomes in Madhya Pradesh, highlighting regional variations and implications for TB control.

## Key findings

- Pediatric TB cases decreased in both districts, while extrapulmonary TB cases increased.
- Private sector TB notifications rose significantly, but drug-resistant TB cases declined.
- TB-related mortality increased in both districts despite improvements in some treatment outcomes.

## Abstract

Background and objective: Tuberculosis (TB) remains a significant public health challenge in India, particularly in Madhya Pradesh. In this study, we aimed to examine epidemiological trends and treatment outcomes in TB patients in the Datia and Tikamgarh districts of Madhya Pradesh, from 2018 to 2022, to inform targeted TB control strategies.

Methods: We conducted a retrospective observational study using data from the National TB Elimination Program (NTEP), accessed through the Nikshay portal (a Government of India initiative). We analyzed trends in TB notifications, rates of microbiological confirmation, treatment outcomes, and co-infections. Statistical tests, including the Mann-Whitney U test, Kruskal-Wallis test, and chi-square test, were employed, with a p-value of less than 0.05 indicating statistical significance.

Results: In Datia, the proportion of pediatric TB cases decreased from 6% to 3% (p = 0.04), while extrapulmonary TB (EPTB) cases rose from 11.3% to 13.8% (p = 0.02). Notifications from the private sector significantly increased from 4% to 28% (p = 0.03), whereas drug-resistant TB (DR-TB) cases fell from 2% to 1% (p = 0.02). TB-related mortality rose from 3.28% to 3.93% (p = 0.008), with the proportion of patients lost to follow-up remaining stable at 9%-10% (p = 0.02).

In Tikamgarh, pediatric TB rates declined from 7.7% to 6.3% (p = 0.04), and EPTB cases increased from 4.77% to 9.37% (p = 0.02). Notifications from the private sector surged from 1.13% to 20.75% (p = 0.03). DR-TB rates decreased from 4.33% to 1% (p = 0.02), but TB-related mortality increased from 1.87% to 5.46% (p = 0.008). The rate of patients lost to follow-up improved slightly, decreasing from 12.71% to 10.09% (p = 0.02).

Conclusion: The reduction in pediatric TB and DR-TB indicates progress in diagnosis and treatment adherence. However, the rising incidence of EPTB and increasing mortality rates highlight ongoing challenges. Enhancing private sector involvement, improving patient adherence, and integrating HIV-TB care are crucial for achieving India’s TB elimination objectives.