HIV/AIDS

Using state level survey data, the National Aids Control Organization and Indian Council of Medical Research-National Institute of Medical Sciences (NACO and ICMR-NIMS, 2019) report estimated that the adult (15–49 years) HIV prevalence was 0.22% (0.17-0.29%) in 2019. The report found that rates differed by gender, with prevalence being higher among males at 0.24% (0.18-0.32%) compared to 0.20% (0.15-0.26%) among females. There is also a wide variation in the prevalence of HIV by State/UTs. As per the NACO and ICMR-NIMS 2019 report, the highest young adult HIV prevalence rate was reported in Mizoram, [2.32%, [1.85–2.84%]), followed by Nagaland (1.45% [1.15–1.78%]), and Manipur (1.18% [0.97–1.46%]). The lowest prevalence rates were found in Arunachal Pradesh (0.06%), Jammu and Kashmir (0.06%), and Sikkim (0.07%).

TB

According to the Global TB Report (WHO,2019a), 10 million people are infected with TB globally in 2018. India accounts for 27% of the global tuberculosis cases (WHO, 2019a).

State variations in TB:

As per GBD 2019 data, the prevalence of TB in India varies across the states. In 2019, the lowest prevalence rate was in Goa, which has a prevalence rate of 14,835.37 cases per 100,000 people (13,185.25 – 16,832.76) and the highest being in West Bengal with 37,351.82 prevalent cases per 100,000 people (33,258.47 – 41,758.29) (ICMR, PHFI and IHME, 2019). In terms of burden, the measures of the number of deaths and DALY’s are described. The least number of deaths was in Kerala 10.53 deaths per 100,000 people (8.2 – 13.15) and the highest number of deaths was in Uttar Pradesh with 45.24 deaths per 100,000 people (37.23 – 55.08 (ICMR, PHFI and IHME, 2019). With respect to DALY’s (Disability Adjusted Life years), Kerala again had the lowest number of DALY’s per 100,000 people 333.92 (268.22 – 407.48) and Uttar Pradesh had the highest number of DALY’s with 1,744.52 per 100,000 people (1,461.91– 2,074.18) (ICMR, PHFI and IHME, 2019).

According to the Burden of Disease report (National Commission on Macroeconomics and Health (NCMH), 2005), the Health and Development Initiative states that those at the greatest risk of TB are those from a lower socioeconomic status, since the disease spreads in crowded places such as schools, marketplaces, households etc. Moreover, there are also several social and economic costs of being diagnosed with TB. According to the Burden of Disease report (NCMH, 2005), if an adult is diagnosed with TB, on average, they lose 3–4 months of work time, which results in a 20%–30% loss in annual household income (NCMH, 2005). This is of significant concern as the portion of the population which is most affected by TB in India is of working age, with 89% of cases occurring amongst those 15-69 years of age (Central TB Division, 2019). This loss of household income due to illness along with paying for the costs associated with treatment could lead many households to experience catastrophic health expenditures.

 Malaria

There were approximately 228 million cases of malaria reported globally in 2019 (WHO, 2019b). Out of the 15 countries that contribute to the global malaria burden, India accounts for 3% of global malaria burden (WHO, 2019b). However, with national programs and other interventions, the country has reported a decline in malaria, with its incidence having decreased by 24% in 2017 in comparison to the previous year (WHO, 2019b).

State wise variations in Malaria:

As per GBD 2019 data, prevalence of malaria varies across the states in India. In 2019, the lowest prevalence rate was in Sikkim, which had a prevalence rate of 48.82 cases per 100,000 people (37.82 – 63.49) and the highest being in Chattisgarh with 1745 prevalent cases per 100,000 people (905.05– 3389.51) (ICMR, PHFI and IHME, 2019). With respect to burden, the number of deaths and DALYs associated with malaria are also described. The least number of deaths was in Sikkim with 0.0018 deaths per 100,000 people (0.00045 – 0.0075) and the highest number of deaths was in Odisha with 23.51 deaths per 100,000 people (8.1 – 58.11) (ICMR, PHFI and IHME, 2019). In terms of DALYs– Sikkim had the lowest number of 2.55 DALYs per 100,000 people (1.94 – 3.3) and Odisha had the highest number of DALYs with 1,455.04 per 100,000 people (540.73 – 3,375.05) (ICMR, PHFI and IHME, 2019).

Other communicable diseases

Apart from these, emergence of new forms of infections and re-emergence of several infectious diseases, mainly due to viruses are a matter of concern for India. Respiratory viral infections (e.g., H1N1, Avian influenza, H5N1, and Covid-19), arboviral infections (e.g., Chikungunya, Japanese encephalitis, and Kyasanur forest disease [KFD]) and bat-borne viral infections (e.g., Nipah viral disease and severe fever with thrombocytopenia virus [SFTV]) are the three major categories of emerging viral infections in India (Mourya et al., 2019).

The Integrated Disease Surveillance Programme (IDSP) in their 2017 surveillance report stated that a total of 1683 outbreaks were due to epidemic prone diseases (Mourya et al., 2019). Of these, 71% were caused due to viral pathogens (Mourya et al., 2019).

COVID-19:

The COVID-19 pandemic has caused unprecedented challenges to the Indian health system. While the first case in the country was confirmed on January 30^th in 2020, there has been a significant rise in cases with a total of 43 million cases and 521,691 total deaths confirmed in the country as of 30^th April 2022 (Johns Hopkins University, 2022). People with co-morbidities and the elderly have been the most affected (MoHFW, 2020; Press Information Bureau, 2020). The government has taken multiple measures to protect vulnerable populations and reduce disease spread including a complete nationwide lockdown from March 25^th to May 31^st in 2020. The government also introduced a mass vaccination campaign in phases and 633 million doses have been provided as of 30^th August 2021 (MoHFW, 2021).

References:

Central TB Division. (2019). Revised National TB Control Programme, Annual Report. Available from https://tbcindia.gov.in/WriteReadData/India%20TB%20Report%202019.pdf

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

Johns Hopkins University (2022). Coronavirus Resource Centre. Available from: https://coronavirus.jhu.edu/map.html

Ministry of Health and Family Welfare (2020a). It is more important now to follow COVID Appropriate Behaviours because of the upcoming festival season, arrival of winter, opening up of economy: Dr. V.K. Paul [Press Information Bureau Website]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1664105

Ministry of Health and Family Welfare. (2021). Ministry of Health and Family Welfare. Available from: from https://mohfw.gov.in/

Mourya, D., Yadav, P., Ullas, P., Bhardwaj, S., Sahay, R., Chadha, M., …& Singh, S. (2019). Emerging/re-emerging viral diseases & new viruses on the Indian horizon. Indian Journal of Medical Research, 149(4), 447. https://doi.org/10.4103/ijmr.ijmr_1239_18

National Aids Control Organization and Indian Council for Medical Research-National Institute of Medical Science. (2019). India HIV Estimates 2019. Available from: http://naco.gov.in/sites/default/files/INDIA%20HIV%20ESTIMATES.pdf

National Commission on Macroeconomics and Health, Ministry of health & Family Welfare, Government of India. (2005). Burden of disease in the India: Background Papers, NCMH. Indian Journal of Medical Research, 124(3), 235–244.

Press Information Bureau (2020). India’s case fatality rate is 1.53% compared to 17.9% with comorbid people and 1.2% for people without comorbidities: Secretary [PIB Twitter].  Available from: https://twitter.com/pib_india/status/1315978147792211970

World Health Organization (2019a). Global Tuberculosis Report. Available from: https://www.who.int/publications/i/item/9789241565714

World Health Organization (2019b). World Malaria Report. Available from: https://www.who.int/india/health-topics/malaria#:~:text=According%20to%20the%20WMR%202019,of%2050.5%25%20compared%20with%202017.