The menace called tuberculosis
Saturday, 8 September 2007
Ishrat Firdousi
"How has this situation come about? It is because of the decline in the socio-economic conditions of the country and not giving the due importance to the reappearance of tuberculosis. The salient points in TB treatment are the intake of medicine as prescribed which may include a combination of drugs and it must be done regularly until the patient is completely cured."
-Dr. Anwarul Azad, Consultant of Chest Disease Clinic, Khulna.
The rapid increase in the incidence of tuberculosis (TB) in developing countries and its re-emergence in the developed world led the World Health Organization (WHO) to declare TB a global emergency in 1993.
Whether we are aware of it or not, nearly 80 lakh people worldwide are newly infected by TB and 20 lakh die every year. In every lakh, 62 persons are smear positive and 78 are other tuberculosis. TB claims 17 new patients every minute and a life every 15 seconds.
WHO ranks Bangladesh the 6th among the world's 22 'high-burden' TB affected countries.
In Bangladesh, tuberculosis is still a major public health problem. It is one of the leading causes of adult deaths, but again is preventable.
It is estimated that over 300,000 new TB cases and 70,000 TB-related deaths occur annually in Bangladesh. Although, the HIV prevalence is still low, the prevailing risky behavior creates potential threats to HIV as well to TB control programs.
Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis that usually attack the lungs, However, TB bacteria can also attack other parts of the body like the kidneys, spine, and brain. If it is not treated properly, TB disease can be fatal.
TB is spread through the air from one person to another. The bacteria are launched into the air by the cough or sneeze of a person with active TB disease of the lungs or throat. People nearby may breathe in these bacteria and become infected.
However, not everyone infected with TB bacteria becomes sick. This is called latent TB infection. These people do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some go on to get TB disease.
In most latent TB infection cases, the body is able to fight the bacteria to stop them from growing. But the bacteria remain alive in the body and can become active later.
People with active TB disease can be treated and cured. Those with latent TB infection can take medicine so that they will not develop active TB disease.
People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.
TB bacteria become active if the immune system can't stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.
Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people who suffer from substance abuse, diabetes mellitus silicosis. cancer of the head or neck, leukemia or Hodgkin's disease, severe kidney disease, low body weight, certain medical treatments (such as corticosteroid treatment or organ transplants) and specialized treatment for rheumatoid arthritis or Crohn's disease.
TB services began in Bangladesh in 1965. In 1993 the Government of Bangladesh (GoB) launched the Directly Observed Treatment Short Course (DOTS) strategy. At present National Tuberculosis Program (NTP) has achieved coverage of all upazilas under the DOTS strategy in collaboration with NGO partners.
In Bangladesh, activities of the TB Control Programme are implemented largely by NGOs in collaboration with National Tuberculosis Program (NTP). Through existing and/or new Memoranda of Understanding (MoU) specific areas are assigned to NGO's for implementation of the activities. The NTP, Ministry of Health and Family Welfare (MOH&FW) is responsible for programme co-ordination, management, national guidelines for treatment and laboratory services, guidelines for Human Resource Development (HRD), strategies for BCC, training of programme coordinators, supervisors and laboratory staff, procurement and distribution of drug and laboratory supplies, monitoring and evaluation.
The aim and objective of the TB control programme is to achieve the global targets of 70% case detection and 85% treatment success among all new infectious cases of TB by 2005. In addition, the Millennium Development Goals (MDG) has set a new benchmark for further reversing the trends of TB.
DOTS is the World Health Organization (WHO) recommended strategy to curb the tuberculosis epidemic. Presently 182 countries are implementing DOTS system out of the 213 countries of the world.
The widespread application of the DOTS strategy is the cornerstone of TB control. DOTS core principles are:
-Early detection of all suspected cases
-A speedy and correct diagnosis
-Effective treatment with quality drugs
-Constant supervision and motivation of each patient to ensure completion of treatment
-Monitoring and evaluation to assure quality of services.
The basic principles are diagnosing TB especially the infective cases, through smear microscopy followed by treatment with a short course of anti-TB medicines given for 6 months with constant monitoring of each patient.
Assistance is needed from every level of the society to control tuberculosis:
-Identify the symptoms of tuberculosis
-Confirm available treatment and services
-Inform importance of DOTS and its benefits
-Take active participation to solve the problems
-Increase social awareness
Presently, the Bangladesh Government, concerned NGOs and BRAC are jointly implementing programmes in 460 upazilas and city corporation areas to control tuberculosis.
Says Dr. Sudhamoy Majumder, Chief Medical Officer of Sylhet City Corporation: 'It is a matter of apprehension that every year, 70 thousand people are dying by tuberculosis. Our target was to build a polio-free Bangladesh and we are doing all we can. The same can be done about TB and here the City Corporation can be of great service. We appealed to everyone to inform us as soon as they find anyone suffering from either polio or tuberculosis. Let us all unite to build a happy, wealthy, peaceful and disease-free Bangladesh."
"How has this situation come about? It is because of the decline in the socio-economic conditions of the country and not giving the due importance to the reappearance of tuberculosis. The salient points in TB treatment are the intake of medicine as prescribed which may include a combination of drugs and it must be done regularly until the patient is completely cured."
-Dr. Anwarul Azad, Consultant of Chest Disease Clinic, Khulna.
The rapid increase in the incidence of tuberculosis (TB) in developing countries and its re-emergence in the developed world led the World Health Organization (WHO) to declare TB a global emergency in 1993.
Whether we are aware of it or not, nearly 80 lakh people worldwide are newly infected by TB and 20 lakh die every year. In every lakh, 62 persons are smear positive and 78 are other tuberculosis. TB claims 17 new patients every minute and a life every 15 seconds.
WHO ranks Bangladesh the 6th among the world's 22 'high-burden' TB affected countries.
In Bangladesh, tuberculosis is still a major public health problem. It is one of the leading causes of adult deaths, but again is preventable.
It is estimated that over 300,000 new TB cases and 70,000 TB-related deaths occur annually in Bangladesh. Although, the HIV prevalence is still low, the prevailing risky behavior creates potential threats to HIV as well to TB control programs.
Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis that usually attack the lungs, However, TB bacteria can also attack other parts of the body like the kidneys, spine, and brain. If it is not treated properly, TB disease can be fatal.
TB is spread through the air from one person to another. The bacteria are launched into the air by the cough or sneeze of a person with active TB disease of the lungs or throat. People nearby may breathe in these bacteria and become infected.
However, not everyone infected with TB bacteria becomes sick. This is called latent TB infection. These people do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some go on to get TB disease.
In most latent TB infection cases, the body is able to fight the bacteria to stop them from growing. But the bacteria remain alive in the body and can become active later.
People with active TB disease can be treated and cured. Those with latent TB infection can take medicine so that they will not develop active TB disease.
People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.
TB bacteria become active if the immune system can't stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.
Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people who suffer from substance abuse, diabetes mellitus silicosis. cancer of the head or neck, leukemia or Hodgkin's disease, severe kidney disease, low body weight, certain medical treatments (such as corticosteroid treatment or organ transplants) and specialized treatment for rheumatoid arthritis or Crohn's disease.
TB services began in Bangladesh in 1965. In 1993 the Government of Bangladesh (GoB) launched the Directly Observed Treatment Short Course (DOTS) strategy. At present National Tuberculosis Program (NTP) has achieved coverage of all upazilas under the DOTS strategy in collaboration with NGO partners.
In Bangladesh, activities of the TB Control Programme are implemented largely by NGOs in collaboration with National Tuberculosis Program (NTP). Through existing and/or new Memoranda of Understanding (MoU) specific areas are assigned to NGO's for implementation of the activities. The NTP, Ministry of Health and Family Welfare (MOH&FW) is responsible for programme co-ordination, management, national guidelines for treatment and laboratory services, guidelines for Human Resource Development (HRD), strategies for BCC, training of programme coordinators, supervisors and laboratory staff, procurement and distribution of drug and laboratory supplies, monitoring and evaluation.
The aim and objective of the TB control programme is to achieve the global targets of 70% case detection and 85% treatment success among all new infectious cases of TB by 2005. In addition, the Millennium Development Goals (MDG) has set a new benchmark for further reversing the trends of TB.
DOTS is the World Health Organization (WHO) recommended strategy to curb the tuberculosis epidemic. Presently 182 countries are implementing DOTS system out of the 213 countries of the world.
The widespread application of the DOTS strategy is the cornerstone of TB control. DOTS core principles are:
-Early detection of all suspected cases
-A speedy and correct diagnosis
-Effective treatment with quality drugs
-Constant supervision and motivation of each patient to ensure completion of treatment
-Monitoring and evaluation to assure quality of services.
The basic principles are diagnosing TB especially the infective cases, through smear microscopy followed by treatment with a short course of anti-TB medicines given for 6 months with constant monitoring of each patient.
Assistance is needed from every level of the society to control tuberculosis:
-Identify the symptoms of tuberculosis
-Confirm available treatment and services
-Inform importance of DOTS and its benefits
-Take active participation to solve the problems
-Increase social awareness
Presently, the Bangladesh Government, concerned NGOs and BRAC are jointly implementing programmes in 460 upazilas and city corporation areas to control tuberculosis.
Says Dr. Sudhamoy Majumder, Chief Medical Officer of Sylhet City Corporation: 'It is a matter of apprehension that every year, 70 thousand people are dying by tuberculosis. Our target was to build a polio-free Bangladesh and we are doing all we can. The same can be done about TB and here the City Corporation can be of great service. We appealed to everyone to inform us as soon as they find anyone suffering from either polio or tuberculosis. Let us all unite to build a happy, wealthy, peaceful and disease-free Bangladesh."