Tuberculosis death rate drops in 6 districts after introduction of Kasanoi Erappila Thittam, study finds

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Tuberculosis mortality has shown a sustained decline in six districts of Tamil Nadu following the introduction of the Erappila Thittam state kasanoi (TN-KET), a new study published in Global Health Action has found.

Study – Sustained reduction in TB mortality reported in six districts of Tamil Nadu Kasanoi Erappila Thittam program in South India undertaken by State TB Cell and Indian Council of Medical Research – National Institute of Epidemiology reported sustained reduction in TB mortality over two years in six districts of Dharmapuri, Salmapura, Kanniyly, Cuemkudralur, Kanniily implementation of TN-KET (No TB Death Project). The programme, which is India’s first national and country-specific differentiated TB care initiative to reduce TB deaths, was launched in April 2022.

Under TN-KET, adults with TB were classified for severe disease at diagnosis, and patients with very severe malnutrition or respiratory insufficiency or poor performance status were prioritized for comprehensive clinical evaluation and inpatient care, the authors said.

They said routine summary data showed a decline in TB mortality in the July 2022 to June 2024 cohort compared to the July 2021 to June 2022 cohort in six districts – Dharmapuri (from 12.6% to 4.8%), Karur (from 7% to 4.6%) (from .6% to Villupura). Kanniyakumari (from 10.4% to 8.1%), Cuddalore (from 6.7% to 4.1%) and Salem (from 7.8% to 4.9%).

“Beyond these six districts, the overall impact of TN-KET has also been seen in the rest of the state, with nearly a 2.5% reduction in TB deaths after its introduction. TN-KET began as an implementation study. We mapped the entire system of secondary care hospitals – district hospital directorates, talukas and sub-taluk hospitals,” and lead authors of Frederick, lead authors were given responsibility, Asherick, state office wherever they were available said.

Addressing comorbidities

For example, if a patient with TB has diabetes, the doctor will take care of blood glucose control. Similarly, they should assess other conditions like liver disease or anemia and provide appropriate care, she said, adding that two to three government hospitals in the district have been asked to designate isolation wards similar to the COVID-19 wards to receive and provide inpatient care to patients. Tertiary care hospitals also came into ownership in a similar way.

“Deaths due to TB complications are different, but we need to deal with comorbidities in TB patients to reduce the number of deaths. The other end of the spectrum is early diagnosis. We need to find the patient early and provide care and support,” emphasized Dr. Asha.

The study also documented a sustained reduction in TB mortality through standardized mortality ratios. TN-KET worked not only in districts with relatively higher TB mortality, but also in districts with relatively lower TB deaths, the authors said.

Consistent adherence to the core components of TN-KET, such as early identification of severe disease, early referral for hospitalization, and continuity of care during the high-risk period of early treatment, have been driving factors in the sustained reduction in TB mortality.

The study detailed what some of these districts were doing and said that the Dharmapuri teaching hospital had sufficient pulmonologists to provide ventilatory support to people with TB whose oxygen saturation had fallen below 85%. In addition to admitting triage-positive TB patients, Karur also admitted elderly TB patients and those with comorbidities (diabetes with suboptimal control, substance abuse requiring medical stroke) regardless of their triage status, while in Villupuram those unwilling to be admitted were consulted by TB champions.

Published – 29 May 2026 12:17 PM IST