TB remains top infectious killer worldwide

WORLD TB DAY

Rawalpindi

Globally an estimated 10.4 million people fall ill and 1.8 million die due to Tuberculosis every year while over 95 per cent of TB deaths occur in low and middle-income countries. Six countries account for 60 per cent of new cases including India, Indonesia, China, Nigeria, Pakistan and South Africa.

Pakistan ranks fifth amongst TB high burden countries worldwide and the disease can be termed as one of the major public health problems in the country. It accounts for 61 per cent of TB burden in the WHO Eastern Mediterranean Region. TB kills about 44000 people every year in Pakistan. Annually around more than 300000 people, including 14000 children contract TB in Pakistan. Pakistan is also estimated to have the fourth highest prevalence of multi-drug resistant TB (MDR-TB) globally.

Two of five people infected with the TB bacilli, do not get diagnosed and treated either because of poverty or lack of awareness about the seriousness of the disease. Moreover, the managements of public sector hospitals in Pakistan have failed in properly implementing the Directly Observed Treatment Short Course (DOTS) to support tuberculosis patients which is mainly due to apathetic attitude of deployed medical staff. Left untreated, one person with active TB will infect 10 to 15 people during one year.

Head of Community Medicine at CMH Lahore Medical College Professor Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with World TB Day which is observed on March 24 around the globe.

For World TB Day, 2017, WHO calls on governments, communities, civil society and private sector to “Unite to End TB: Leave No One Behind”, including actions to end stigma, discrimination, marginalization and overcome barriers to assess care.

Dr. Ashraf said the delay in diagnosis, unsupervised, inappropriate and inadequate drug regimens, poor follow up and lack of social support programme for high risk populations are some of the reasons for not reaching the target cure rates and emergence of drug resistant forms of tuberculosis. Multi-drug resistant TB (MDR-TB) is the upcoming threat for TB control.

He added that there are 480000 cases of MDR-TB each year worldwide. In Pakistan, annually approximately, 15000 patients contact this severe form of TB; the standard antibiotics do not work anymore. The treatment of MDR-TB is lasting longer and is more expensive than the treatment of common TB. Besides, it has severe side-effects. A primary cause of MDR-TB is incorrect use of anti-TB drugs or use of poor quality medicines that can cause drug resistance, he explained.

It is important that multi-drug resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB), HIV-associated TB and weak health systems are major challenges in fight against TB.

Dr. Ashraf said there is a dire need to increase awareness among general public and especially among the youth through mass media and TB weeks and advocacy seminars should be held to spread the message that TB is preventable and treatable.

TB is a disease of poverty and poor, malnourished, diabetics, patients using corticosteroid drugs, drug addicts, smokers, elderly, HIV infected patients, migrants, refugees, ethnic minorities, miners, health care workers, alcoholics and people living in overcrowding institutions like prisons where as contacts of infectious TB patients are at high risk to develop TB. 

Studies reveal that TB is spread from person to person through air. When infectious TB patients cough, sneeze, talk, spit, they propel TB germs into the air. When healthy persons inhale the air, they become infected. However, in healthy people, infection with Mycobacterium tuberculosis often causes no symptoms since the person’s immune system acts to wall off the bacteria.

TB is not spread through casual contact, utensils, eating together, shaking hands, sharing clothes, bed sheets, books, furniture, marital relations and it is not an inherited disease, said Dr. Ashraf.

The main symptoms of disease are persistent cough for more than three weeks, low grade fever (evening pyrexia), coughing up blood, night sweats, loss of appetite, loss of weight and feeling of tiredness all the time. If somebody has these symptoms, he or she should report to the nearest health centre, public sector hospital or TB centre and get his sputum tested.

If somebody is diagnosed with TB, he or she should not get upset, because TB is now treatable with six months course of four antimicrobials that are provided under supervision of health worker, but the current efforts to find, treat, and cure everyone who gets ill with the disease are not sufficient, said Dr. Ashraf.

To a query, he said a TB patient should take anti-TB drugs as advised by the doctor under the supervision of health worker or some responsible person for six months without interruption. These anti-TB drugs can be obtained free of cost from any health centre, government hospital or TB Centre. Without proper treatment, up to two thirds of people ill with TB will die, he said.

He warns that a patient should never leave treatment without advice from doctor. During anti-TB treatment, mother can also breastfeed her child. Stigma associated with TB that it was a death sentence was often a false impression. Patients should not be stigmatised and must receive full support from family and community. TB patient can lead an active normal life after receiving full course of treatment. However, current default rate in Pakistani TB patients is still 11 per cent, which leads to Multi-drug resistant TB (MDR-TB) and in some cases extensively drug-resistant TB (XDR-TB), which is the most dangerous form of TB with no treatment. Complete TB treatment is the most effective means of TB prevention, said Dr. Ashraf.

He added that TB can be prevented by BCG vaccination and by awareness raising campaigns on mass scale. TB patient should be advised to cover his mouth while sneezing or coughing and not to spit on different spots. Newborn infants must be immunized against TB with BCG vaccine immediately after birth.

Talking of remedies to reduce burden of TB in the country, he said the healthcare systems must ensure uninterrupted supply of anti-TB drugs to all patients.

This needs to accelerate to a four to five per cent annual decline by 2020 to reach the first milestones of the End strategy. The goal aims for a 35 per cent reduction in the absolute number of TB deaths and a 20 per cent reduction in the TB incidence rate by 2020, compared with levels in 2015, concluded Dr. Ashraf.