Tuberculosis

Tuberculosis (yaksmarog) a chronic, infectious disease caused by the tubercle bacillus Mycobacterium tuberculosis. Tuberculosis or TB, as it is more commonly referred, is one of the oldest diseases known. It seems to have been recognised as a dangerous disease as early as the fifth century. Different strains of the bacterium also cause tuberculosis in domesticated and wild animals. It frequently affects the lungs, but may also involve the larynx, the bones and joints, the skin, the lymph nodes, the intestine, the kidney, and the nervous system. The disease is usually contracted by the inhalation of the bacilli into the lungs or by swallowing contaminated food. Droplets of sputum spread by an infected person during sneezing and coughing spread the germs directly to others and into the air. The germs can survive for long periods in the air, in dried sputum and in dust. The disease in more likely to spread among members of a family than to others because members of a family are closely associated, live in the same house and eat at the same table. Tuberculosis, however, is not hereditary.

The most common and familiar form of the disease is Pulmonary tuberculosis (tuberculosis of the lungs). In its early stages, pulmonary tuberculosis may not exhibit any detectable symptoms. The symptoms of active or post-primary pulmonary tuberculosis are coughing, weakness, loss of weight, blood-streaked sputum, pleuritic chest pain, and fever that tends to rise gradually during the day. Miliary tuberculosis is caused by the spread of large number of bacilli to other parts of the body. This type of tuberculosis can affect the membranes covering the brain causing a serious infection called tuberculous meningitis.

For centuries all over the world tuberculosis has been a major killer. Today it still ranks as one of the greatest health problems. The incidence of tuberculosis decreased significantly until around 1990, when multidrug-resistant strains began appearing. The disease is most commonly seen in homeless people and refugees, and those in prison. TB alone took more than 200 million lives in the last century. The disease now spreads at the rate of one person per second or claiming lives of 2,000 people per day in the South East Asian region. Official estimates say that TB infects one person every two minutes and kills one person every 10 minutes in Bangladesh. According to World Bank report the annual death toll from this dreaded disease is about 52,000, the fourth highest in the world. Over 300,000 people are being infected with this preventable disease every year, the rate being 111 per 100,000. The rate of infection was less than 40 per 100,000 ten years back.

Since November 1993, when the National Tuberculosis Programme (NTP) was launched by the Government of Bangladesh and the WB with technical support from WHO, about 313,800 TB cases have so for been detected. However, more than 80 per cent of those were treated successfully. Despite the success, the rate of spread of the disease is quite alarming in Bangladesh since the country has a very high density of population, poor housing and living conditions, poverty, and low literacy rate. After WHO declared TB a 'global emergency' in 1993, Bangladesh like other countries with high rate of infection, took the lead aiming at stopping the transmission of TB bacteria through supervised intervention of drugs, popularly known as DOTS (Directly Observed Treatment - Short Course). This proved to be a cost-effective measure. The first nation-wide survey on TB prevalence was done in 1964-66. It showed that 56% of the population was infected with the commonest form of TB infection, pulmonary TB, caused by inhalation. The TB control programme in this region started as early as 1948 when BCG vaccination programme was introduced.

The first treatment facility for TB patients in Bangladesh was set up in 1953 at Nimtali in Old Dhaka with the establishment of a TB Hospital. Subsequently three more centres were set up at divisional headquarters. Treatment facilities are now available in hospitals of district headquarters, Institute of Diseases of the Chest and Hospital, Dhaka, National Tuberculosis Programme (NTP) Clinic at Shyamoli, Dhaka, and NTP headquarters at Mohakhali, Dhaka.

Under National Tuberculosis Programme more than 30,000 health professionals including paramedics have been trained during 1993 to 1998 on diagnosis and detection of TB. Some NGOs which are currently working with the government are BRAC, Damien Foundation, Danish Bangladesh Leprosy Mission (DBLM), Health, Education and Economic Development (HEED), Rangpur-Dinajpur Rural Services (RDRS), and National Anti-TB Association of Bangladesh (NATAB). The success of TB control programme largely depends upon an efficient monitoring mechanism. There is also a need for proper training and public awareness. Involvement and participation of private practitioners, different health institutions at upazila level, and medical colleges are essential for successful control of tuberculosis. [SM Humayun Kabir]