Bangladesh: TB still a major health problem

Identified by brac's Shashtha Shebika Bedana Khatun, his sputum was sent to Meherpur Sadar Upazila Health Complex for test where doctors diagnosed him as a TB patient after the test. Then drugs were given to him under the supervision of Bedana. Shahidul, a farmer and also small trader, said his condition improved after taking drugs in Directly Observed Treatment Short-course (DOTS) system and he has been engaged in work while taking the drugs for the last five months.       

During the visit to the upazila, a large number of people were found living in unhygienic and overcrowded conditions and also suffering from malnutrition. Meherpur Sadar Upazila Health and Family Planning Officer Dr Mijanur Rahman said those conditions caused TB infection here.   

Before the introduction of DOTS system in Meherpur Sadar uazila in 2004, TB patients faced social exclusion as none agreed to make social relations through marriage with them. After introduction of the DOTS, affected people, being benefited, are now leading normal life like others, which helped dispel the stigma surrounding the TB.

A number of local patients, however, showed negligence in taking drugs regularly, which made the disease complex. Dr Mijan said the upazila is a risky place because it is located in border area and there is huge number of TB affected people over the other side of the border in India. A large number of local people go to India and come back creating a risky situation for TB infection.

Meherpur Sadar Upazila measuring 261 square kilometres has a population of 274,988. A total of 1,275 people were affected by TB in the last five years from 2009 until 2013 in the upazila. Most of them were cured, though 50 of them died mainly due to other complications. Unhygienic and congested living conditions, malnutrition and infection from across the border are the main reasons of TB infection in the upazila. If these problems can be solved, the disease can be checked here, said Dr Mijan.

Even though TB is completely curable, many people still continue to die of the disease across the country. Many cases remain undiagnosed mainly due to lack of awareness of the disease. The failure of some patients to complete the course of treatment is also contributing to the spread of multi drug-resistant tuberculosis (MDR-TB), which is difficult to treat.

TB remains a major public health problem in Bangladesh. The country ranks sixth among 22 highest-burden TB countries in the world.  Although there is no estimate on the prevalence of childhood TB, it is believed that childhood TB is severely under-diagnosed.  Around 64,000 people die due to tuberculosis while 0.33 million get infected afresh every year in Bangladesh, said a report of the National Tuberculosis Control Programme (NTP).

Stronger health services are needed to combat the disease. According to NTP, tuberculosis of the lungs or pulmonary tuberculosis is the most common form of TB and occurs in about 80% of cases. Extra-pulmonary tuberculosis can affect any part of the body other than lungs. The disease, which is preventable, is caused by bacteria called 'Mycobacterium tuberculosis' and spreads from person to person through the air by coughing and sneezing, said doctors. Babies and the elderly are at a greater risk due to their ill-developed and declining immune system respectively.

TB is not a hereditary disease. It is not spread by shaking hands with someone, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, sharing cutlery, bedding or clothes and kissing.

Director General of Health Directorate Prof Dr Din Mohammad Nurul Haque said poverty, smoking, malnutrition, environmental pollution, overcrowding, ignorance and presence of other diseases such as HIV, diabetes and other problems in lung make people more susceptible to TB infections.

People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two-thirds of people ill with TB will die. TB's symptoms include continuation of cold for more than three weeks or more, fever, chills, night sweats, loss of appetite, weight loss, and fatigue.

Anyone having the symptoms should go for check-up immediately and, if affected, should be given treatment. There is no scope of tension as examination and treatment of TB are easily available across the country.

"The affected people should cover their mouth with a piece of cloth while coughing or sneezing. Cough and spit of affected people should be kept under earth apparently for stopping the spread of TB germ. TB does not spread if the affected people live together with others. But normal people should not stay closely with the affected people till 2/3 weeks of the infection. Children of the family, which has TB patient, should be brought under preventive treatment for saving the children from the disease", said National Programme Consultant of NTP Dr Mujibur Rahman.  

The country is at risk of the spread of MDR-TB as TB-infected urban slum dwellers frequently change residences. MDR-TB is a very dangerous form of tuberculosis. Some TB germs become resistant to the effects of some TB drugs. This happens when TB disease is not properly treated. These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs. MDR-TB can be spread to others, just like regular TB. If you have TB, it is important to follow your healthcare provider's instructions for taking your TB medicine so that you will not develop MDR TB.

Dr Mohammad Ashaque Hussain, line director, TB-Leprosy of Directorate General of Health Services, said 1,500 people were diagnosed with MDR-TB from 2008 to 2011. However, World Health Organization says the number is 10,000. According to WHO estimates, MDR-TB rate among all newly diagnosed cases is estimated at 2.2%, and among previously treated cases at 15%.

It takes longer to treat, around two years, and can be cured with second-line drugs, which are more expensive and have more side effects, Dr Ashaque said.

Extensively drug-resistant (XDR) TB is an even more dangerous version of MDR TB. It is resistant to the same drugs as MDR TB, as well as more potent types used to treat MDR TB. Treatment for XDR TB is much more difficult, expensive, and lasts longer.

EDR TB - an even more severe form of MDR TB - responds to even fewer available medicines. Stigma is still prevailing surrounding TB. It is unfounded and steps are needed for eradicating it, said Dr Mujib, stressing the need for involving community leaders and civil society members to raise awareness about the disease. "We should also address MDR-TB and the needs of vulnerable people".

Dr Mujib called for bringing all the TB patients under treatment immediately. He stressed the need for coordinated efforts by the government and NGOs for controlling the disease. Dr Mohammad Akramul Islam, Director, BRAC TB-Malaria, WASH and DECC programmes, opined for increased allocation for TB control programme. The allocation can help reduce death from TB, he said.

Source: Financial Express