Annually around 430,000 people including 15,000 children contract Tuberculosis (TB) in Pakistan while not less than 70,000 deaths every year can be attributed to the disease in the country.
TB is a leading infectious cause of death worldwide. Pakistan ranks 6th globally among the 22 high TB burden countries and contributes an estimated 43 per cent of the disease towards the Eastern Mediterranean region of the World Health Organisation. Pakistan is also estimated to have the fourth highest prevalence of multi-drug resistant TB (MDR-TB) globally. Whereas globally 9.6 million fall ill and 1.5 million die due to TB every year. Over 95 per cent of TB deaths occur in low and middle-income countries.
An estimated one-third of the world population is infected with TB. Someone in the world is newly infected with TB bacilli every second.
Head of Community Med-icine at CMH Lahore Medical College Professor 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, 2016, WHO calls on governments, communities, civil society and private sector to 'Unite to End TB'. It outlines global impact targets to reduce TB deaths by 90 per cent and to cut new cases by 80 per cent between 2015 and 2030. WHO and partners are promoting dialogue and collaboration that unites individuals and communities in new ways to end the TB epidemic. World TB Day is an opportunity to raise awareness about the burden of disease worldwide and status of TB prevention and control efforts. It is also an opportunity to mobilize political and social commitment for further progress.
Professor Ashraf said a large number of people, though infected with the TB bacilli, do not get diagnosed, either because of poverty, or lack of awareness about the seriousness of the disease. Moreover, management of public sector hospitals has 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, he added.
He 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 said that there are 480,000 new cases of MDR-TB each year worldwide. In Pakistan, annually approximately, 15,000 patients contract this severe form of tuberculosis; the standard antibiotics do not work anymore. A primary cause of MDR-TB is incorrect use of anti-TB drugs or use of poor quality medicines, said Dr. Ashraf.
He believes 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.
To reduce the burden of the disease in Pakistan, he said that there is a dire need to increase awareness among general public and especially among the youth through mass media. 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, health care workers, and alcoholics and people living in overcrowding institutions like prisons, said Dr. Ashraf. He added that contacts of infectious TB patients are at high risk to develop TB.
He said that tobacco use greatly increases the risk of TB disease and death. More than 20 per cent of TB cases worldwide are attributable to smoking. A person living with HIV is also about 30 times more likely to develop active TB. TB is a leading killer of HIV-positive people, he said.
Professor Ashraf explained 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, he said.
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, he said.
He said the main symptoms of disease are persistent cough for more than three weeks, low grade fever, coughing up blood, night sweats, loss of appetite and weight and feeling of tiredness all the time. If somebody has these symptoms, he or she should report to the nearest Health Centre, Government Hospital or TB centre and get his sputum tested free of cost.
He said if somebody is diagnosed with TB, he or she should not get upset, because TB is now treatable with six months course of antibiotics, but the current efforts to find, treat, and cure everyone who gets ill with the disease are not sufficient.
Professor Ashraf said that there is a need to create awareness among public that 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."
Never leave treatment without advice of doctor. During anti-TB treatment, mother can also breastfeed her child. 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, said Dr. Ashraf.
However, he said the 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, he said.
On prevention, he said 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 spit on different spots. Newborn infants must be immunized against TB with BCG vaccine immediately after birth. Celebrating of World TB Days also play part in creating awareness about the disease among general masses, said Professor Ashraf.