Shohag Sheikh (35), a carpenter by profession of No 1 Jagoti Colony of Kushtia Sadar upazila, had been feeling fever, dyspepsia and cold. Detected by Momtaj Begum, one of the Shastha Sebikas (community health volunteers appointed by BRAC), his sputum was taken to Kushtia Sadar upazila health complex where he was diagnosed as a TB patient. Medicines were prescribed for him free of cost. He took the medicines under the supervision of Momtaj. The man was cured after taking the drugs for six months.
Shohag is engaged in work with renewed vigour after recovery
Though TB is curable if patients take drugs regularly under the supervision of health workers, many people are unaware of it and hence they suffer from the disease.
According to National TB Control Programme (NTP), Tuberculosis of the lungs or pulmonary tuberculosis is the most common form of TB and occurs in about 80 per cent of cases. Extra-pulmonary tuberculosis can affect any part of the body other than lungs.
Tuberculosis is a global disease which is not only specific to humans. There are variants of the TB bacterium that infect cattle (milk was known to transmit the disease from cattle to humans before heat treatment - pasteurization - efficiently removed the risk), birds, fish, turtles and frogs, said physicians.
TB is ultimately caused by the Mycobacterium tuberculosis, a bacterium that is spread from person to person through airborne particles. Inhaling infected particles does not necessarily mean that a person becomes infected.
One of three things may happen when Mycobacterium tuberculosis enters the human body:
l The bacterium is destroyed because the body has a strong immune system.
l The bacterium enters the body and remains as latent TB infection. The patient has no symptoms and cannot transmit it to other people.
l The patient becomes ill with TB.
About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease.
The bacteria causing tuberculosis is called Mycobacterium tuberculosis. It is spread through inhaling tiny droplets from the coughs or sneezes of an infected person. Spread of tuberculosis is facilitated by several factors like overcrowding, living in close quarters like in orphanages, prisons etc and presence of other medical problems.
Other medical problems that raise the risk of getting tuberculosis include malnutrition, alcoholism, presence of other infections like HIV infection that suppresses the immunity etc. Babies and the elderly are at a greater risk due to their ill-developed and declining immune system respectively.
You cannot get TB by sharing cutlery, bedding or clothes.
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. Most people who become infected with Mycobacterium tuberculosis do not present symptoms of the disease.
However, when symptoms are present, they include:
l unexplained weight loss, fatigue, shortness of breath
l fever, night sweats, chills, loss of appetite.
Symptoms specific to the lungs include:
l coughing that lasts for 3 or more weeks, coughing up blood, chest pain, painful breathing and pain when coughing.
Anyone having those symptoms should go for checkup immediately and, if affected, should be given treatment. Examination of sputum and treatment of TB is available across the country at free of cost. Sputum test is the most reliable for determining TB.
If it is not treated, TB can be fatal. But TB can almost always be treated and cured if you take medicine as directed by your healthcare provider, said the NTP.
Multidrug-and Extensively Drug-Resistant TB
Multidrug-resistant tuberculosis (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.
If any patient does not take drugs regularly and fails to complete full course, then this problem turns complex and there is very little chance of his recovery even if he takes drugs regularly and adequately later.
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.
Extensively drug-resistant TB (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.
TB in Children
According to BRAC Health and Nutrition Programme, children also may be affected by TB, but its identification is tough, because the disease may not be detected even by sputum test. Children (aged 0-05) are more vulnerable to TB. Besides, measles, malnutrition, whooping cough, HIV/AIDS reduce immune system and make them fall victim to the disease. Children mainly fall victim to extra pulmonary TB.
Children are most likely to become infected if their mothers or other adolescent/adult household members have sputum smear-positive TB.
According to the BRAC Health Programme sources, children comprise 3.0 per cent of total TB patients.
Preventing TB
If you have become infected with TB, but do not have active TB disease, you may get preventive therapy. This treatment kills germs that are not doing any damage right now, but could so do in the future.
If you take your medicine as instructed by your healthcare provider, it can keep you from developing active TB disease.
BCG vaccine can provide effective protection against tuberculosis in most individuals. It is recommended in persons who are at a greater risk of the infection. Infants living in countries endemic for tuberculosis should routinely be vaccinated with BCG.
The most important way to stop the spread of tuberculosis is for TB patients to cover the mouth and nose when coughing, and to take all the TB medicine exactly as prescribed by the physician.
Patients should take full doze drugs regularly under the observation of Shastha Sebika. At one stage of treatment, sputum and other test should be carried out as per doctor's advice in order to ascertain the latest condition of the patient.
Even though TB is completely curable, a large number of people still continue to become ill and die from the disease.
According to NTP, in Bangladesh, incidence of all forms TB (per 100,000 population per year) is 225, prevalence of all forms TB (per 100,000 population per year) 434, TB death rate (per 100,000 population per year, excluding deaths among TB/HIV co infected) 45, estimated MDR among new cases of TB 1.4 per cent and estimated MDR among old cases of TB 29 per cent.
TB is a global burden with estimated 8.7 million new cases and 1.4 million deaths due to TB annually. About 40 per cent of global TB burden is from South-East Asia.
Dr Asheque Hossain, Line Director of NTP, said lack of awareness mainly caused the deaths in Bangladesh. Patients showed negligence in taking treatment, which caused the deaths. Sometimes, complications from other diseases also caused the deaths.
The highest priority for TB control is identification and successful treatment of patients who are suffering from smear-positive pulmonary TB. Patients diagnosed with any form of TB should always be asked whether there is anybody living in the same house that has chronic cough and be encouraged to bring or send that person to the health facility for sputum examination.
The writer is a journalist. E-mail: [email protected]
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