Making Bangladesh Tuberculosis-free

Md Al Mamun :
Tuberculosis can be cured if patients take drugs regularly in Directly Observed Treatment Short-course (DOTS) system under the supervision of health worker. However, people are suffering from the disease mainly due to lack of awareness.  
Housewife Salma Begum, 30, a resident of Kanchan Nagar in Jhenidah, had been suffering from fever, weight loss and loss of appetite for five month. Poly Khatun, one of the Shasthya Sebikas (community health volunteer appointed by BRAC) identified her and sent her sputum to the Sadar upazila Health Complex for test where she was detected as TB patient. Salma is now feeling well after taking medicines provided from the Health Complex free of cost.
Anyone having symptoms of TB should take step for check-up immediately and, if affected, should be given treatment. Examination of sputum and treatment of TB is available at free of cost across the country. Sputum test is the most reliable for determining TB.
TB patients should take drugs regularly and complete its full course. If patients do not take drugs regularly and failed 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.
In Bangladesh, the TB is still a major public health problem and one of the leading causes of adult mortality and preventable deaths. WHO ranked Bangladesh 6th among the world’s 22 high-burden TB countries.
According to the National TB Control Programme (NTP), in Bangladesh, incidence of all forms of TB (per 100,000 population per year) is 225, prevalence of all forms of 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.
Tuberculosis is an infection caused by Mycobacterium tuberculosis. This is a bacterium or germ that mainly affects the lungs, though it can harm any part of the body, said physicians.
Tuberculosis is spread from person to person through tiny droplets of infected sputum that travel through the air. If an infected person coughs, sneezes, shouts, or spits, bacteria can enter the air and come into contact with uninfected people who breath the bacteria into their lungs.
If untreated, a TB patient can affect 10-15 people with TB germ in a year. Infants and children under 5 years are at particular risk of developing disease. You cannot get TB by sharing cutlery, bedding or clothes. TB is NOT spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes and kissing.
Latent TB Infection:
TB bacteria can live in the body without making you sick. This is called latent TB infection. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick and do not have any symptoms. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease.
Symptoms:
General symptoms include continuation of cold for more than three weeks or more, fever, chills, night sweats, loss of appetite, weight loss, and fatigue.
Risk factors:
A number of factors make people more susceptible to TB infections. The most important risk factor
globally is HIV.
Tuberculosis is closely linked to both overcrowding and malnutrition. Those at high risk thus include:
people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g. prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health care providers serving
these patients.
Chronic lung disease is another significant risk factor. Those who smoke cigarettes have nearly twice the risk of TB than non-smokers. Other disease states can also increase the risk of developing tuberculosis.
Drug-resistant TB:
Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged.
Examples include:
When people do not complete the full course of treatment;
When health care providers
prescribe the wrong treatment, the wrong dose, or wrong length of time for taking the drugs;
When the supply of drugs is not always available; or
When the drugs are of poor quality.
Drug-resistant TB is more common in people who:
Do not take their TB drugs regularly;
Do not take all of their TB drugs;
Develop TB disease again, after being treated for TB disease in the past;
Come from areas of the world where drug-resistant TB is common;
Have spent time with someone known to have drug-resistant TB disease Drug-resistant TB is spread the same way that drug susceptible TB is spread.
Prevention:
Tuberculosis prevention and control efforts primarily rely on the vaccination of infants and the detection and appropriate treatment of active cases.
The only currently available vaccine as of 2011 is BCG, which, while it is effective against disseminated disease in childhood, confers inconsistent protection against contracting pulmonary TB.
The BCG vaccine is used in several parts of the world where TB is common. It usually protects children and infants from the disease.
Better methods of preventing tuberculosis or TB relapses include eating a healthful diet that boosts the immune system, having regular TB tests if you work or live in a high-risk environment, and completing a TB medication regimen.
To prevent transmitting the disease to others if you are infected, stay home, cover your mouth, and ensure proper ventilation.
The authorities concerned should take proper steps for identifying TB patients, to provide treatment and raise awareness among people about the TB and its related matters for eliminating the disease.
WHO recommended the Stop TB strategy, which builds on the Directly Observed Treatment Short-course (DOTS) system, which was adopted for field implementation at the end of 1993. DOTS means that an observer watches the patient swallowing their drugs, which is essential for completion of treatment and recovery from TB.
Shasthya Sebikas play a pivotal role of connecting individuals with TB control services during household visits and health forums. Under the DOTS system, they ensure daily intake of medicine for identified TB patients and refer for proper management of the side effects during TB treatment across the country.
TB control is a concern for all and the TB control goal/objectives could not be achieved by NTP or even by public health services under the Health Ministry alone.
Strong partnerships and collaboration across the health sector is needed to expand and improve the DOTS services. Well-established and effective partnership between the government and NGOs helped to increase coverage, case detection and quality of treatment in the past few years.
BRAC and 42 other NGOs are implementing TB interventions in partnership with the government with an objective to reduce morbidity, mortality and transmission of TB until it is no longer a public
health problem.
Dr Mohammad Akramul Islam, Associate Director of BRAC Health Programme, said, “All concerned including mass media should play strong role to fulfil our vision to ensure health services to all the TB patients and build a TB-free Bangladesh.” n