Has open spitting culture in India contributed to the rise of tuberculosis?

New Delhi: For the past few centuries, tuberculosis has been the leading infectious disease in terms of morbidity and mortality. India recorded the highest number of cases of tuberculosis (TB) in 2022, according to the World Health Organization’s Global TB Report 2023.  About 27 percent of the total tuberculosis patients in the world are in this country.

Tuberculosis is primarily spread through the air when an infected person coughs, sneezes, or talks, releasing tiny infectious droplets into the air. Therefore, one of the possible causes could be the open spitting, a common cultural habit in some parts of India.

While it’s difficult to attribute the rise of tuberculosis solely to this behavior, it certainly can contribute to the spread of infectious diseases like TB.

Dr Parthiv Shah, Chest Physician (Pulmonologist) from Apex group of Hospitals Mumbai, explains, “Tuberculosis germs (Mycobacterium tuberculosis) are microscopic germs that are present in the respiratory secretions of infectious (sputum-infected) tuberculosis patients. It mixes with the air outside and enters the body of other persons through inhalation. Because we have open spitting that is universal and accepted, germs spread easily. Whether or not a person develops tuberculosis after being infected with tuberculosis depends on the person’s physical condition and nutrition. If the immune system is good, the disease does not occur even after infection. But if immunity is low, tuberculosis can develop immediately or after some time.”

Spitting openly can potentially spread these infectious droplets onto surfaces or into the air, where they can be inhaled by others, thus increasing the risk of transmission. However, TB transmission is influenced by a multitude of factors including overcrowding, poor ventilation, inadequate healthcare infrastructure, poverty, and lack of access to healthcare, among others.

“The tendency to hide TB (tuberculosis) even today is found among educated and uneducated citizens. Public unsanitary conditions such as spitting, lack of sunlight in the house due to dense settlements, poor condition of public toilets are many factors that contribute to the problem of tuberculosis. It is a fact that the increase in tuberculosis in any country means increased poverty, malnutrition, economic disparity, poor industrialization and urbanization in that country,” adds Dr Shah.

Efforts to control tuberculosis in India have included not only medical interventions such as vaccination and treatment but also public health campaigns to raise awareness about the importance of hygiene and reducing behaviors like open spitting that can contribute to the spread of infectious diseases.