Bangladesh: Finding those who are missed
After the implementation of revolutionary Directly Observed Treatment Strategy (DOTS) for Tuberculosis (TB), Bangladesh has been experiencing a very high rate of cure from TB. However, the country continues to have high burden of TB and considered as one of the 22 countries with highest burden of TB in the world. Experts identified poor detection rate of TB cases as the major challenge to fight TB in this country.
Like Bangladesh, TB, an infectious disease that spreads through air, is still a major public health problem in many countries. According to the Global Tuberculosis Report 2013, of the 8.6 million incident cases of TB estimated to have occurred in 2012, only 5.7 million were both detected and notified to national TB programmes (NTPs) or national surveillance systems. This leaves a gap of about 3 million people with TB who were “missed”, either because they were not diagnosed or because they were diagnosed but not reported. Many of the missed will die, some will get better, and some will continue to infect others.
Bangladesh is one of the 12 countries where about 75% of these missed cases in the world are found. The proportion of missed cases has been nearly the same for the past seven years and the number of missed is accumulating every year causing a huge burden.
There are a number of reasons why people with TB are missing out. Many people with TB first seek medical attention of private healthcare, often from multiple providers like pharmacy drug seller, general practitioners and hospitals. Unfortunately the TB management practices of these providers are not always aligned with national guideline and many of these patients are not notified to national health systems for lack of information, incentives or tools.
There is another challenge in the diagnosis as well. Many with active TB do show only mild symptoms for moths, resulting in delay in diagnosis and treatment while spreading the disease to others.
Many people do not simply have the access to TB diagnostic services or do not have the information of available services. Reaching these missed cases is crucial to win the fight against TB. For this, strengthening human resources, the laboratory diagnostic network and health system capacity in general should be improved supported by increased financing.
Access to diagnosis of TB needs to improve urgently. We need to increase TB diagnostic capacity and expand existing coverage. The existing awareness programme should be strengthen with greater engagement of community workers and volunteers. There is a clear need to greater collaboration between NGOs and government for coordinated services to increase reporting of TB cases and better management TB.
Bangladesh already overburdened with drug susceptible TB, is now experiencing high burden of multidrug-resistant TB (MDR-TB) and has taken a place among the 12 countries that account for 80% of estimated MDR-TB cases.
TB could be a disaster in highly densely populated country like Bangladesh. The recent report shows that Bangladesh is not on track to reach the targets set for reductions in incidence, prevalence and mortality from TB. Only a concerted and coordinated effort from all sectors can reach those unreached and end the epidemic.
Source: The Daily Star
