On The Occasion Of World T.B. Day
Causes And Cure Of T.B.

By Dr.Thir Man Shakya

TUBERCULOSIS popularly called T.B. had been in existence in the human history for centuries. The actual cause of this desease was not known till 24th March 1882 when Robert Koch placed before the medical world his momentous discovery of rod shaped organism, which he named the Tubercle Bacillus as the cause of the disease tuberculosis.’ Knowledge of tuberculosis advanced more and more with the advent of the anti-tuberculosis drugs in mid 29th century, which is potentially cent per cent effective in curing this disease if properly used. Thus, the rays of hope of wiping out this dreadful disease spread naturally. ‘We are privileged to live in the age when we have every effective tools of diagnosis, detection and treatment of tuberculosis but inconceivably these medicines proved not to be the only answer for the effectiveness of the treatment of tuberculosis and its control. Inadequate and improper use of this medicine has produced drug resistance bacilli not affected by the treatment. The disease still claims three million lives every year. Of the total global death due to T.B., nearly 95 per cent are in developing countries. In Nepal about 15,000 people die from tuberculosis alone every year mostly in their most productive age (15-59 yrs.) It estimated that about 80,000 people have tuberculosis. Nearly 50,000 people develop tuberculosis annually in Nepal. The disease mainly affects the lungs but can also involve other organs of the body.

T.B. which once called’ consumption ‘ i.e. wasting disease in the past, ranked among the common causes of the death in the world. Today, the improved methods of prevention, detection, diagnosis and treatment have greatly reduced the number of deaths from this disease in developed countries. However, the above mentioned improvements have not reached to majority of the people living in adverse situations in the developing countries. The anti T.B. drugs which are potentially effective have been found not properly or adequately used by the patients and treatment providers. In developing countries due to slender resources, inadequate health facilities, difficult terrain and ignorance, majority of cases of tuberculosis are still lying undetected thus not being treated. Such untreated T.B. patients live for about 2 years infecting 15-20 others in contact with them.

The tragedy of tuberculosis cannot be measured by death rates alone. Think of the breadwinner of a poor family becoming a victim of this disease. The entire resources of the family are turned over. Further being an infectious disease, T.B. is not uncommon for two or more members of the same poor family to be affected at about the same time. Therefore, in countries, like ours the disease has to be conceived as socio-economic problem.

T.B remains as health problem for the coming generations too because of the facts that children and young adults continue to be infected with T.B. some 40 per cent of the children below 15 years have been found infected with tubercle bacilli in Nepal. Infection does not mean diseased. Only 10 per cent of those infected with T.B. bacilli develop disease annually, the rest 90 per cent remain as symptomatic or healthy. But such healthy carriers however run the risk of developing disease for life long.

What prevents most of the infected persons from developing the disease? Our body possesses innate immunity system, which are able to prevent infection from spreading into disease. Due to various causes, emotional or physical, such immunity of the body may be lessened, the potential cause of it ever known is Human Immuno Deficiency Virus (HIV) infection. One of the important causes of increase of tuberculosis patients in this world today specially in Africa and South East Asia is due to the pandemic nature of HIV infection.

In Nepal, nearly 40,000 people have been estimated to have HIV infection. One of the opportunistic disease that HIV infected people gets is tuberculosis. What is most essential to be done in the field of tuberculosis in such situation is to protect individuals from getting infection of tuberculosis which is possible only through proper and adequate treatment of infective, T.B. excreting T.B. bacilli in their sputum. Treatment itself is the most effective method of preventing infection.

Developed countries also experienced the increase of prevalence and incidence of T.B. due mainly to T.B. in immigrants and refugees and also due to spread of HIV infection. It has thus stimulated those countries as well to concentrate on tuberculosis control activities. Considering the rapid worsening situation of T.B. in the world. WHO requested all member countries to improve the case detection of infections. T.B. and treatment of those cases until cured with standardised short course chemotherapy (6-8months).

Directly Observed Treatment with short course chemotherapy popularly known by DOTS, is the strategy recommended. This has been felt necessary because many patients of tuberculosis not closely supervised, often stop taking anti T.B. drugs prematurely because they feel letter soon. Certainly it needs a good network of primary health care throughout the country and as nearer to the patients home as possible, had fulfillment of stuff and regular supply of drugs in them. Above all, the commitment of the government and people participation are utmost important to make DOTS successful.

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