Most people in India have been exposed to the infection

As you will see, tuberculosis has two stages of infection. In the first stage, a person who gets exposed to tuberculosis undergoes some immunological reactions in the body without getting the frank disease.This can only be detected by special skin tests, like purified protein derivative (ppd). These people are at a 25% higher risk of developing frank disease later in life. In America they are treated with just one medicine for six months to reduce this risk.

It seems that India has such a big load of proper tuberculosis diseases that all the data available is on sputum testing of tuberculosis bacterium. These are "Open cases" and spread disease by coughing and spitting. There is no data available on the ppd. converters (Exposure, without getting the disease yet).

So the only ways to guess the converter status (Exposure to tuberculosis, as mentioned in the slide) are indirect. One way is to see its incidence in people who have been tested. Before getting an immigration visa to the US, all Indians need a chest X ray and all who enter the country must be proven to be clear of the Tuberculosis disease. Yet when tested for exposure, as is needed before entering some jobs and schools, nearly all Indians test positive. Children born in the west are normally ppd negative, but trips to India convert them to positive ppd's, too. The people in the upper strata of India also test ppd positive. It is therefore reasonable to guess that the rest of the population has the same status.

Tuberculosis is rampant in India (maximum in the world, as per the above website of Govt. of India ). According to the Tuberculosis Association of India, the annual cost of managing this disease in India is more than 13000.00 crores ($3 billion).


The word “worms” has been used to denote all parasitic infections. Common parasites include:

Faeco- Oral contaminants: Amoebiasis , intestinal worms (Ascariasis, thread worm, pin worm and hook worm etc.),

Vector born disease: Vector are the agents that carry diseases from one source to another.Mosquitos, flies and mice are responsible for most vector born diseases in India.

Parasites are responsible for majority of diarrhea ( along with the bacterial diarrhea , which is also due to faeco oral contamination). Most of these are treated by anti amoeba or diarrhea medicines. These are available at the pharmacies without prescription, so the exact incidence is unknown. General impression is that most of the Indian population has suffered with diarrhea some times in their lives.

Most common cause of abdominal pain in India is Amoebiasis or other worms.

Dermatologists in India routinely “deworm” the patients, as many skin rashes are result of intestinal worms.

Hook worm is one of the most common cause of Anemia ( low blood hemoglobin) in India. Anemia cases weakness and multiple other complications.

Worm infestation is an important cause of malnutrition and its aftermath.

Worms affect lungs, lymphatics , blood and many other systems of the body, besides gastro intestinal tract.

Incidence of diseases related to poor Hygiene and Sanitation:

Although there are no official data in this regards, the following facts will help reach some educated guess of the problem;

If we do not include trauma ( injury) related medical conditions and draw information from the disease load of government run hospitals and dispensaries, majority of them are directly or indirectly are the aftermath of poor sanitation and hygiene practices.

Directly related diseases: Diarrhea, Tuberculosis, Abdominal pain, Skin disease, Anemia, Meningitis, Malnutrition, tetanus,typhoid, Malaria, Filaria, Respiratory problems due to molds, dust mite and cockroaches, guinea worm and food poisonings etc.

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Indirectly related diseases

Malnutrition and anemia reduce body’s ability to fight other diseases. Tuberculosis has higher mortality in smokers. Dirty river and pond waters pollute the fish that we eat. Boiling the water can kill the germs but does not get rid of chemicals and metal of infected water. These have been related to some chronic diseases, birth defects and cancers. In addition high lead level in blood is a known cause of slow mental development. Children in America are routinely tested for it.


Some spellings in the presentation are American, which is different that the British. Examples are:

Anemia= Anaemia.

Feces= Faeces.

Ameba= Amoeba .

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