Puducherry implements verbal autopsy to investigate TB deaths

Puducherry: Puducherry has adopted the verbal autopsy model to assess reasons behind tuberculosis deaths, identify patterns for treatment delay, and the referral process.

The Indira Gandhi Medical College and Research Institute (IGMC&RI) in Puducherry has undertaken the task of analysing 160 TB deaths that had been reported in the UT in 2024 and would be submitting its findings to the Centre's TB division," State TB Officer of Puducherry, Dr C Venkatesh, told PTI.

"Using this method, doctors at IGMC&RI, Puducherry, are investigating the causes behind deaths due to tuberculosis and identifying both patient-related and health system related factors," Dr Kavita Vasudevan from the Community Medicine Department at Medical College, who is leading the project, said, news agency PTI reported.

A verbal autopsy is an interview-based process where close relatives or caregivers of the deceased are asked questions about circumstances and factors leading to death. For example, they are asked about the deceased's symptoms, treatment history, hospital admission time, treatment received and the circumstances at the time of death.

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This information is collected in a structured format, after which doctors assess the probable cause of death.

This technique involves mixing both quantitative and qualitative methods to arrive at factors that lead to mortality in TB patients. For the quantitative method, clinical records of TB deaths are being reviewed, while for the qualitative component, stakeholder interviews are being conducted with National TB Elimination Programme (NTEP) staff as well as the kin of the deceased patients, Dr Vasudevan explained.

Preliminary analysis has revealed that the majority of TB deaths are occurring within seven days of being diagnosed, implying there is a delay in patients accessing the health facility and reaching the hospital late, she said.

"A significant number of patients who died belong to the neighbouring districts of Tamil Nadu. These patients have come to health facilities in Puducherry for availing treatment and often give false addresses or addresses of their relatives in Puducherry," she said.

Social factors also play a role, and in some cases, social stigma related to TB or family neglect prevented patients from seeking timely treatment, Dr Vasudevan explained.

Verbal autopsy is an important tool for public health, especially when the cause of death and the factors leading to death cannot be clearly determined from medical records.

Puducherry's health department is reportedly planning to make verbal autopsies mandatory for every TB death case, Dr Venkatesh informed.

Identifying the reasons for TB mortality can provide critical insights into the factors leading to these deaths, he said.

In addition, the differentiated TB care approach recommended by the Central TB Division is also implemented in Puducherry. This approach involves the provision of comprehensive evaluation and supportive treatment services at various healthcare levels. By employing this risk stratification process, healthcare providers can tailor their approach to ensure appropriate care for individuals identified with specific risks, he said, reports PTI.

The World Health Organisation (WHO) has also advised use of verbal autopsies as an important tool in the fight against TB to better understand early symptoms, symptom duration, treatment initiation and interruptions, and the diagnostic process.

Verbal autopsy provides insights into patient as well as health system delays, social or financial challenges faced during illness, perceptions of healthcare services and barriers to accessing timely diagnosis and treatment.

Tuberculosis is one of the top ten causes of death worldwide and the second leading cause of death from a single infectious agent after coronavirus disease, surpassing HIV. India's TB burden remains a major public health challenge, highlighted Dr Vasudevan.

According to recent estimates, number of deaths due to TB in India was 23 per lakh population. In Puducherry, the total TB notifications for the year 2022 was 3,835 which translates to nearly 247 TB notifications per one lakh population with a death rate of eight per cent, she said.

As part of the National Strategic plan and WHO End TB Strategy, one of the milestones is to reduce global TB deaths by 90 per cent by 2025, using 2015 as the baseline, she stated.

A comprehensive approach is essential to effectively tackle TB, which includes provision of quality TB care through access to quality diagnostics, effective drugs for therapy, prevention strategies and identifying the underlying causes of mortality associated with the disease.

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