Tuberculosis in South Asia

TB in Bangladesh

World TB Day 2014 (REACH THE 3 MILLION. FIND. TREAT. CURE TB)

TB is a curable disease however our current efforts are not sufficient to find, treat and cure everyone who gets ill with TB. In each year, 24th March is observed as World TB day. To build public awareness about the global epidemic of tuberculosis and efforts to eliminate the disease, the National Tuberculosis Control Programme (NTP) along with BRAC and other partner NGOs commemorate this occasion through different events

Key Messages of World TB Day-

Reach the missed TB cases. Find, Treat and Cure TB

  • Access to TB care has expanded and accelerated from early nineties and remarkable success has been achieved. However, the current efforts to find, treat and cure everyone who gets ill with TB are not sufficient
  • About half of people are “missed” by our present effort every year who get sick with TB
  • We believe that no one should be left behind in the fight against TB.
  • We must enhance our effort to find, treat and cure the missed people and accelerate progress towards zero TB deaths, infections, suffering and stigma.

Ways to fight against TB

  • Early diagnosis of TB symptomatic, specially smear negative, extra pulmonary, child TB and drug resistance TB
  • Notify the diagnosed but not reported TB patients
  • Reach the ultra poor, most vulnerable communities including women, children, migrants, prisoners, drug users and sex workers  and also people living in live in hard to reach areas like isolated chars, Haor/Baors, coastal areas, hill tracts, slums etc.
  • Special campaign on child TB, MDR-TB and TB-HIV
  • Adopting/scaling up  new tools for diagnosis including GeneXpert
  • Ensure Political commitment with adequate and sustained financing
  • Resource mobilization

 Global Tuberculosis Burden (2012)

  • An estimated 8.6  million  people develop TB  in 2012
  • 1.3  million people die every year due to TB
  • About 12 million people are suffering  from the disease
  • 22 countries constitute 80% of the Global TB burden and deaths
  • South East Asia constitutes about 40% of TB burden

Ref: Global Tuberculosis Report, 2013

Bangladesh TB Scenario ( 2012)

Tuberculosis is a major public health problem in Bangladesh. According to the World Health Organization, the estimated incidence and prevalence rates of all forms of Tuberculosis in 2012 were 225 and 434 per 100 000 population respectively.  It is further estimated that about 45 per 100 000 people died of TB in the same year.

Ref: Global Tuberculosis Report, 2013

TB case notified by NTP (2013)

  • Total case notified  in 2013: 1,84,492
  • Notification rate of all cases is 119 per 1, 00,000 population
  • Smear positive case notification:        1,05,530
  • Smear negative case notification:       42,345
  • Extra-pulmonary case notification:     33,653
  • Child TB case notification:                 5,044
  • Treatment success rate of the detected new smear positive cases; 93%

Goal and Objectives of National TB Control Programme

The overall goal of TB control is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem

Objectives of National TB Control Programme:

  • Initial objectives
  • Reach and thereafter sustain the 2005 targets- achieving at least 70% case detection and 85% treatment success among TB cases under DOTS; In order to-
  • Reach the interim target of halving TB death and prevalence by 2010 towards achieving the Millennium Development Goals set by 2015
  • Current objective:
  • Achieve universal access to high quality care for all people with TB

 National TB Control Programme

  • Bangladesh adopted DOTS strategy in 1993
  • MoU signed between Government and NGOs in 1994 for rural and in 2001 for urban area
  • National Tuberculosis Control Programme (NTP), BRAC and 42 NGOs are also collaborating to strengthen DOTS activities
  • Currently 1,089 laboratories and  40 External Quality Assurance (EQA) are providing TB services
  • BRAC initiated community based TB control programme in one sub-district (Manikgonj) in 1984. Currently BRAC supporting NTP  in 297 sub-districts of 42 districts, 27 academic institutions, Chittagong EPZ, Chittagong and Khulna port authority hospitals, prisons and various parts of the 7 city corporations

 Steps taken by National Tuberculosis Control Programme:

– Increase case detection and maintain high cure rates by strengthening DOTS services

–    Establish additional laboratories/DOTS centers

–    Arrange outreach sputum collection centers beyond the sub-district level

–    Ensure DOT under supervision of community volunteers and conduct follow-up

–    Establish External Quality Assurance laboratory to ensure quality microscopy

  • Involve all health care providers in TB control services

–    Orient and involve village doctors, pharmacists, private practitioners, intern doctors of medical college hospitals and factory workers

  • Capacity building of health staff through training, refresher trainings, workshops
  • Create demand for services through advocacy, communication and social mobilization
  • Strengthen supportive supervision, monitoring and evaluation
  • Management of Multi Drug Resistant TB (MDR-TB)
  • Enhance TB/HIV collaborative activities
  • Rapid expansion diagnostic capacity with new techniques like Gene X-pert

Since 2006 NTP is adopting STOP TB Strategy aiming to build on and enhancing DOTS.

Basic facts on Tuberculosis

  • A bacteria  called Mycobacterium Tuberculosis causes TB
  • TB organism spreads from TB patient’s (Pulmonary) to healthy person through air, by coughing, sneezing and spitting
  • The main symptom of TB is persistent cough for three weeks or more. Other Signs and symptoms are pain in the chest, shortness of breath, chest pain, coughing up of blood, loss of weight, loss of appetite, fever, night sweats.
  • Sputum test is necessary for the close contacts of a TB patient’s if they have symptoms suggestive of TB
  • TB medication should be taken regularly and patient should complete full course of treatment to become cured
  • Follow up sputum test should be done in time in the course of treatment to see the prognosis
  • An inadequate or poorly administered treatment regimen develops drug-resistance, as a result TB may not be curable and may cause death
  • Both men and women can suffer from TB and both of them may need to seek TB services

TB Treatment services are  available free of cost:

The TB diagnostic and treatment services are available free of charge all over the country in the following sites

  • All Upazila Health Complexes
  • 44 Chest Disease Clinics, 7 (20 bedded) Chest Disease Hospitals
  • 4 Divisional Chest Disease Hospital
  • The Government Leprosy Hospital in Nilphamary
  • Government and private Medical college hospitals
  • Specialized Hospitals
  • Combined Military Hospital and others defense Hospitals
  • District Sadar Hospitals
  • Workplace: Factories, EPZ, BGMEA
  • Urban Health Care Centers in all metropolitan cities (Govt. and NGO clinics)
  • Prisons

 

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