[Comment] Tuberculosis: Global emergency and our national priority

from The Daily Star

Dr Riffat Hossain Lucy

Tuberculosis (TB) has been a major public health problem for centuries. It is a leading infectious disease that represents more than a quarter of the world’s preventable deaths. Increase in the incidence of TB in the developing countries and its re-emergence in the developed world led the World Health Organisation (WHO) to declare TB as a global emergency in 1993.

Despite the availability of affordable, effective treatment, the annual total of 8.8 million new cases and an estimated 1.6 million of deaths from TB (WHO Report 2007) represents an intolerable burden of human suffering.

TB can be completely cured through the Directly Observed Treatment Short Course (DOTS). DOTS is currently practiced as the most effective way of controlling the disease. Even though TB is completely curable, a large number of people still continue to become ill and die from the disease. Many cases remain undiagnosed due to the lack of awareness.

Moreover, many smear positive cases do not complete the course of their treatment. This inevitably led to development of multi drug-resistant tuberculosis (MDR-TB), which is very difficult to treat.

In Bangladesh, TB is a major public health problem and one of the leading causes of adult mortality and preventable deaths. WHO ranks Bangladesh 5th among the world’s 22 high-burden TB countries.

TB is cause of illness of one person every 2 minutes and death of one person every 10 minutes in the country.

In 1993, the Government of Bangladesh started national Tuberculosis Control Programme (NTP) adopting the DOTS strategy in 4 pilot sub-districts. It was progressively expanded to 460 sub-districts by June 1998. At present the coverage is said to be 99% including metropolitan cities, as, Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet.

The Strategic Plan for TB Control 2006-2010 developed by the NTP in close consultation with technical agencies and partners highlights the key strategic approaches towards achieving the targets.

Short-course treatment for all cases of TB has been further standardised with the introduction of new treatment regimens and of fixed-dose combinations (FDCs) in all regimens. New approaches are being developed to address major challenges.

The treatment of chronic TB patients is beginning to be standardised within the framework of the DOTS-Plus strategy. The collaboration with NGOs has been expanded. The joint efforts of the partners involved has allowed for the Country Coordinating Mechanism (CCM) to be successful in obtaining grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

World Tuberculosis Day on 24th March allows calculating and evaluating the anti-tuberculosis activities in the country. MDGs adopted by the United Nations reflect a strong commitment on the part of the world leaders to reduce global poverty. One of the eight goals is halting of HIV/AIDS, Tuberculosis and malaria. A concerted effort and unified approach with significant inputs from both public and private sectors is imperative and essential.

The writer is a Coordinator, Country Coordinating Mechanism, Global Fund to Fight AIDS, Tuberculosis and Malaria.