Detection of Multi Drug Resistant (MDR) Tuberculosis (TB) and child TB patients has lately been increasing thanks to the introduction of new diagnosis machines and the extensive awareness programme undertaken by the government, experts said.
They, however, expressed concern that the industrial workers were at the highest risk of being infected with TB from co-workers, as they work in close contact. These workers are hard to reach for bringing them under treatment facilities, they said.
The government's national target of detecting 10 per cent child TB patients, out of the total TB cases, is still far below the goal, although the number of child TB cases is increasing gradually.
MDR-TB is defined as the TB which is caused by organisms that are resistant to at least two potent first-line anti-TB drugs --- Isoniazid and Rifampicin. National average cure rate is 68 per cent, although field-level activists said the MDR cure rate was 40 to 50 per cent. In case of cure failure, MDR patients turn into XDR patients or the TB into Extensively Drug Resistant TB (XDR-TB).
XDR-TB is MDR-TB, plus resistant to at least one of the fluoroquinolones, and at least one of the three injectable second-line drugs --- Capreomycin, Kanamycin and Amikacin.
A recent field visit by this correspondent to Kashimpur union of Gazipur district revealed a rise in both the MDR-TB patients and child TB patients compared to the previous years.
Three organisations, along with the government treatment system, work in Gazipur under the TB control programme. Among the non-government organisations (NGOs) Brac, Live, and Bangladesh Garment Manufacturers and Exporters' Association (BGMEA) work there.
Brac sources said they were now referring more MDR-TB suspects for test. In 2013, they referred 50 MDR suspects to the National Tuberculosis Reference Laboratory (NTRL) at Mohakhali in Dhaka, of whom four cases had been identified as MDR-TB patients. In 2012, they referred 35 MDR suspects, of whom three were detected with MDR-TB. But this year, in five months they have detected five MDR patients out of 60 suspects.
In explaining the reason of gradual increase in MDR-TB patients, Brac sources said a GeneXpert machine has been installed at the Gazipur Sadar Hospital, which has made the diagnosis process easier for them in detecting the MDR patients which was difficult earlier. Gazipur is a big area with large industries, where a lot of workers migrate from various places, Brac sources added.
There are 16 MDR-TB patients in Gazipur now, out of total 5119 TB cases.
General TB patients take a six-month treatment for the disease under the Directly Observed Treatment Short-Course (DOTS) provider. MDR treatment normally requires long hospital stays of 24 months and costly treatment with a government expenditure of Tk 1.5 million. With the new GeneXpert technology, an accurate diagnosis of TB is made in two hours, compared to two months with the existing technology. With quick detection, patients can start treatment the same day. A patient spends the first six months at NTRL and then is sent back to the community centre under the care of DOTS provider.
While visiting the Barenda area of Kashimpur union in Gazipur, this correspondent met an MDR-TB patient named Tota Mia (45). He was attacked with TB in 2007 and then completed six months' treatment. After two months, when his cough was being examined, he was found 'smear positive'. Then the category-II treatment was given to him for nine months. When he was diagnosed, MDR was detected in July 2013. He was suffering from severe side-effects. The government provided him with social and nutritional supports as part of the treatment programme.
Another MDR-TB patient Md Rakib, 47, a businessman, was cured two years ago. He had been leading a normal life after undergoing treatment. Upon being attacked in 2007 with TB, he received treatment for six months. After eight months, he was found to be a 'smear positive' relapse case during a cough test. He got cured even in category-II treatment. After one year he was detected with MDR-TB.
Experts say general symptoms of MDR-TB suspects include failure of Category-I and II, close contact with MDR-TB patients with symptoms of TB, delayed converting of category-I (remains positive at month 3), delayed converting of category-II (remains positive at month 4), relapses (category-I and category-II), returns after default (category-I and category-II), group TB-HIV co-infections at the start of TB treatment etc.
When asked for comment on the rise in MDR-TB patients, NTP Line Director Dr Ashaque Husain told the FE that in a sense it was a good sign for Bangladesh that the MDR patients could now be detected in large numbers which was difficult earlier. He attributed the credit for it to the installation of GeneXpert machines at 39 centres, like the chest disease clinics at district level and chest disease hospitals.
He said nationally the new case detection rate of MDR-TB patients is 1.4 per cent, while the re-treatment cases are 29 per cent and the total number of patients is 4200 in the country.
Field-level health workers dealing with TB find access to industries and factories to be a major challenge in identifying TB patients and bringing them under treatment network. In Kashimpur, a densely-populated industrial area in Gazipur, there are 91 TB patients, 80 of whom were factory workers. Among these patients there is a child patient. The number of female patients is 49 and male patients 42.
Brac and other organisations can enter the garment factories and conduct TB orientation campaigns. Garment workers are now better motivated to give their cough and go for TB diagnosis because of various social supports and easy access to treatment facilities free of cost. But it is not easy at many other factories like those of spinning, welding, brick making or other workplaces, where low-income people work.
In Gazipur, child TB patient identification has also increased. In 2013, there were 162 child TB patients, out of 5119 cases, which was more than 3.0 per cent of the total cases. In 2012, the number was 125, out of 4627 TB cases, which was 2.0 per cent. In 2014, from January to March, the number reached 61.
The government targets identifying 10 per cent child TB patients. It is still far below the target because of difficulty in identifying signs, symptoms of TB in children. Usually, they are attacked with extra pulmonary TB and they even cannot produce cough which makes it difficult for experts to decipher the symptoms.
MDR-TB cases up as diagnosis made easy
Kamrun Nahar | Published: May 10, 2014 00:00:00 | Updated: November 30, 2026 06:01:00
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