By James Militzer.

Taken from the NextBillion Health care blog.

In the developed world, tuberculosis hasn’t been a pressing concern for years. Thanks to antibiotics and improved living conditions, “consumption” has evolved from a dread disease to a cliché of 19th century novels.

In the developing world, of course, tuberculosis never went away – it’s second only to HIV/AIDS as the deadliest infectious disease, sickening 8.7 million people in 2011, and killing 1.4 million.

And now there’s growing fear that TB may be poised to make a comeback, as drug resistance and the microbe’s own evolution threaten to once again make it a global menace.

Though treatments are currently highly effective if taken properly, they require intensive support from trained health workers – starting with accurate diagnosis, and continuing through a standard six-month course of four antimicrobial drugs.
Without supervised treatment, the disease can persist, spread to others, and develop into more drug-resistant strains. And unfortunately, new research from the international charity Lepra suggests that proper treatment is a rarity among the informal medical practitioners common at the BoP.

Rajnikant Singh, head of Lepra’s Bihar program, conducted a survey assessing TB knowledge among 561 rural health care providers in the northern Indian State of Bihar.

The results were alarming: though the vast majority are treating TB, only 3 percent have received any TB training, and misconceptions about the disease are widespread.

In response, Lepra, which also tackles leprosy and other neglected diseases affecting BoP communities, is hoping to train Bihar’s informal providers on providing the right TB treatment, and integrate them into India’s National TB Control Programme.

Rajnikant Singh and Sarah Nancollas, Lepra’s chief executive, spoke with NextBillion Health Care about the importance of these providers, and how best to enlist them in the fight against diseases like tuberculosis in the developing world.

Read the full interview at