World Tuberculosis Day and challenges for Pakistan

Islamabad : Pakistan has huge Tuberculosis burden being fifth in the world. We could not reach the three million positive cases that are missing. Each positive case spreads the disease to around 10 persons. If not detected and treated, he or she may die in two years’ time. It is such a sad story that people are dying due to a disease that is 100 per cent treatable and curable.

Patient becomes non-infectious if he or she takes regular medicines for just two months and gets cured in just six months by following regular treatment. Its management and diagnostics are free. The most horrible aspect of the disease is that its resistance is now becoming common as Multi Drug Resistant TB is on the rise and Pakistan is at 4th number in the world.

Horrible is the fact that each Resistant TB case does not spread simple treatable TB to his or her contacts, but spreads the Resistant TB that is not curable by oral medicines. Epidemiologist Dr Muhammad Najeeb Durrani who is Member Global Outbreak Alert & Response Network (GOARN) expressed this while talking to ‘The News’ in connection with World TB Day which is commemorated March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis, and to step up efforts to end the global tuberculosis epidemic.

The date marks the day in 1882 when Dr. Robert Koch announced he had discovered the bacterium that causes tuberculosis, which opened the way towards diagnosing and curing this disease. Dr. Durrani said the Sustainable Development Goals (SDG) target 3.3 also includes TB and calls for, by 2030, ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. The theme of World TB Day 2022 is ‘Invest to End TB. Save Lives’.

He said Pakistan is also celebrating World TB day across the country highlighting success stories resulting from landmark achievements done by National TB Control Program over the years. The program has ensured provision of logistics support, medicines and quality diagnostics across the country in all provinces besides developing treatment centers for Multi Drug Resistant cases.

However, he added, as we go through the challenges, still we find very little work done so far on TB awareness among masses particularly about the disease being curable, its routes of transmission, type of tests required, bio-safety measures and infection control. Secondly, very little efforts have been done on discovering the disease among contacts around each positive case and there may be a huge burden of disease that continues to increase, he said.

Thirdly, another milestone left unachievable is poor hospital linkages among various units/wards of the tertiary care hospitals. The patients land with undiagnosed, extra pulmonary TB, where doctors continue treating them for other ailments never suspecting the root cause of viseral, spinal or bones tuberculosis and when at the end they discover TB incidentally, a lot of time is already lost at the cost of patients’ lives and money, said Dr. Durrani.

He said great amount of effort is needed in developing hospital linkages where each unit including Medicine, Surgery, Gynae, Neurology, ENT, Skin or Orthopaedic must suspect TB among their patients presenting with various symptoms.

He added the fourth challenge is that a lot of work and efforts are needed for case detection in Childhood TB. As such we find TB the most neglected disease and a killing machine, affecting millions each year. Due to its peculiar silently killing nature, it is the top most common communicable infectious disease only after HIV/AIDS, said Dr. Durrani. He said unfortunately, the disease has no access to the political corridors and it does not attract media too to create panic or uproar among various social or political circles, never creates emergency while people go on missing (disappearing by dying) silently.

We wish each suspected patient must immediately be tested and detected for the disease at the earliest possible stage that will not only cure the disease rapidly but also limit its spread to others, he said. TB has been on the rise as in 2020, the number of TB deaths in the WHO Eastern Mediterranean Region (our part of the world) rose for the first time in over a decade, from 77,700 to 83,000. In 2021, WHO estimated that TB has killed more people worldwide than any other infectious disease, except COVID-19. Treatment coverage decreased to 52 per cent meaning that approximately half of all people with TB were neither diagnosed nor treated, concluded Dr. Durrani.