Citizen Matters had earlier reported that dengue cases in Bengaluru are severely under-reported, that the official dengue figures are only a fraction of the actual numbers. But when it comes to non-communicable diseases (NCDs) like diabetes, heart diseases, respiratory diseases etc., the situation is worse - these diseases are not tracked at all in the city.
NCDs are now emerging as the leading cause of deaths in India, since communicable diseases like malaria and TB are under better control. But in Bengaluru, like in the rest of the country, no one is tracking them.
Without data on these diseases, policy-making to tackle them becomes difficult. For example, only upon knowing the extent of a disease in a particular region, can enough programmes and resources be allocated to tackle it. Accurate disease statistics will also help in further research on the causes and patterns of these diseases.
Currently the Bruhat Bengaluru Mahanagara Palike (BBMP) and state Health and Family Welfare Department continuously track communicable diseases like Tuberculosis and dengue, though not quite effectively. But in the case of NCDs, BBMP does not track them at all, and state Health Department only tracks them in three government hospitals in the city’s peripheries.
OPD records are the only data
A senior officer at the BBMP Health Department, who did not wish to be named, says that the only NCD data available for the city now is the Out Patient Department registries of BBMP hospitals. “We have no data on NCDs as we don’t collate hospital data now,” he says.
While BBMP Health Department caters to 135 BBMP wards, the remaining 63 wards in BBMP peripheries come under the state Health Department. The state Health Department collects data for only three government hospitals in the entire Bengaluru Urban district - Yelahanka, KR Puram and Anekal general hospital. For these three hospitals, data is collected every month for NCDs like cardiovascular, neurological and lung diseases. No data is collected from private hospitals.
Dr N H Vijaya Mohan Reddy, state Health Department’s District Health Officer for Bangalore Urban says, “Private hospitals are supposed to send data, but they don’t send it regularly. So we only have government hospital data now”. Thus, for the entire Bangalore Urban district with its 20 plus government hospitals and hundreds of private hospitals, NCD data is available now for only three government hospitals.
'Data collection to start in June'
But the BBMP officer says that they may start NCD data collection in June for BBMP hospitals. “We have submitted a technical proposal to the State NCD Cell for NCD data collection from BBMP’s hospitals. Once this is approved, we may start,” he says. Even then, private hospital data will be excluded.
The State NCD Cell is a part of the NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke). NPCDCS was started in 2010 for prevention and treatment of NCDs, due to the increasing prominence of these diseases.
In Karnataka, the NCD Cell had started working in 2010-11 itself, but the Cell got its own office building only in March 2016. Its pilot project was for Kolar and Shimoga districts alone, and hence no data is available for Bangalore. Dr Padma M R, State Programme Officer for NPCDCS, says, “Data collection is not our focus now, we are still recruiting staff.”
Hence at the state level, there is very little information on NCDs. At the national level, there is only one NCD - cancer - that has a proper registry. The National Cancer Registry Programme (NCRP), which started in 1982, covers 29 regions in India, including Bengaluru.
Data shows increase in lung cancer cases
NCRP trend reports clearly show an increase in cancer cases in Bengaluru, especially lung cancer. A trend report by NCPR shows that in 2008-09 lung cancer became the most common type of cancer among Bengaluru men, from being only the third most common type in 1982-83.
The report shows a steep upward trend in lung cancer cases among both Bengaluru men and women since the late 90s. Dr C Ramesh, who is co-principal investigator for the Bengaluru registry, says that air pollution is a major risk factor for lung cancer in the city. Dr Ramesh also heads the Epidemiology Department at Kidwai Memorial Institute of Oncology.
Dr Ramesh says, “In developing countries like India, at least 30% of lung cancer cases can be attributed to air pollution, as per IARC (International Agency for Research on Cancer). Trends show that lung cancer is increasing in India and decreasing in the West. All 29 cancer registries in India are showing increase in lung cancer, and projections show that it will further increase in all urban areas.”
Digitised data doesn't exist in most govt hospitals
But even the NCRP has only limited reach overall. Dr Ramesh says that even now, the registry covers only 8.2% of India’s population; some big states like Bihar and UP don’t even have a registry. “Diseases are underreported, there is lack of resources for diagnosis and treatment, and lack of awareness among people about symptoms. So reporting for disease registries is generally low.”
Recently, a new centre called NCDIR (National Centre for Disease Informatics and Research) was set up to develop disease registries for diabetes, cardiovascular diseases and stroke, in addition to maintaining the existing cancer registry. But the new registries have not taken off yet. Dr R S Dhaliwal, Scientist ‘G’ at the NCD Division of ICMR (Indian Council of Medical Research) in Delhi, says that disease registries, for instance, can help find correlations between different health problems and air pollution.
Dr Dhaliwal says that most Indian hospitals do not have digitised patient records either, which can be used for epidemiological research. “Government hospitals still have handwritten records or incomplete information. Only a few private hospitals in urban areas may have digitised patient records.”
Doctors in Bengaluru are talking about increase in cases of asthma, heart diseases etc., but the picture won’t be clear until authorities realise the importance of data.