TB Cure For All
Meeting The Challenge

By Jhabindra Bhandari

GLOBALLY, one third of the world’s population is infected with Tuberculosis - TB, in short. Every year, millions of people suffer from this disease and have to lose their lives – though it could be cured. As this affects largely the population in the productive age, its socio-economic impacts on individuals, families and communities are potentially larger.

Like so many other problems and challenges of health and development, TB is one of the major public health problems in Nepal. This is why it is regarded as a major threat to socio-economic development. According to National TB Centre’s newsletter of 2001, there are approximately 20,000 infectious TB cases and over 8000 deaths each year.

Joint Efforts

"Stop TB, Fight Poverty" is the main message of this year’s World TB Day which is annually marked on 24 March. This important day is very important to raise public awareness on TB – mainly on modes of transmission, symptoms and cure in the local health facilities. More specifically, this day draws attention of policy makers, planners, health workers, and civil society to initiate joint efforts in the global fight against TB and hence reduce poverty.

Inaugurating the TB museum and web site on National TB programme and other prevention initiatives at National Tuberculosis Centre, Health Minister Shart Singh Bhandari stressed the needs of community awareness on various public health issues at the grass roots as illiteracy and poverty are the growing challenges in the country. For this, media is undoubtedly the most important vehicle for generating community awareness on TB and other health problems.

On the other side, the Health Minister urged the emerging need of integrated approach in health sector so that building partnership with civil society offers ample opportunity to yield maximum impacts in the health and development sectors. The role and responsibility of local bodies like District Development Committees (DDCs) and Village Development Committees (VDCs) are increasingly crucial for effective planning and implementation of public health programmes in a gender sensitive approach. The challenge ahead is to ensure accountability of these local bodies in all aspects of health and development planning and programmes.

There needs a very clear vision of the intended target population or groups for which health care are is most urgent and the effective ways of reaching them. Unless there is public awareness on serious health problems like TB, only supply of drugs may not help at all. So, information, education and communication programmes should focus on behaviour change interventions.

Direct Observed Treatment Short course (DOTS) was introduced in 1996 after a joint HMG/WHO review and is thus regarded as a very cost effective and successful strategy. " This has been a major landmark in curing TB, and more importantly, the implementation and expansion of this innovative strategy throughout the country have significant impacts on reducing mortality and morbidity – thereby declining the incidence in this disease." claims Dr. Dirgha Singh Bam, Director of National and SAARC TB Centre.

Dr. Bam further emphasises that Nepal has made excellent progress with the DOTS implementation since 1996. The benefits of the DOTS are multiple as it has the higher cure rates, a fewer relapses and longer life expectancy in people with TB and HIV/AIDS. Partnership with media sector is one of the remarkable achievements in the fight against TB as it is the most important bridge for political commitment, advocacy and massive awareness of poor communities on TB cure who have generally limited access to health care services.

National TB Programme which is one of the highest priority of programmes among many others, aims at reducing mortality, morbidity and transmission of TB. In order to accomplish this, health management information systems, training and supervision, laboratory services, research and social mobilisation are some of the key areas policy makers and planners have realistically to think in order to meet the needs of population for TB cure.

In order to make TB programme more effective, the National TB Centre benefits from technical support from donors and other development agencies like Norwegian Aid (NORAD), Japan International Co-operation Agency (JICA), World Health Organisation (WHO), Depatment for International Development (DFID, and many others.

Other international NGOs like Britain Nepal Medical Trust (BNMT), United Mission to Nepal (UMN) and International Nepal Fellowship (INF) and many others are supporting to make the government’s TB services more effective for quality care. They are particularly focussing on training, supervision, logistics, drug supplies, laboratory quality control and community mobilisation.

SAARC TB Centre which is closely located with the National TB Centre has been providing technical assistance in the DOTS expansion. Besides, its support is more vital to provide technical assistance in the area of human resource development so as to make the DOTS more effective and sustainable.

In a country like ours where majority of the population live in rural areas, the health care services are still limited in the remote parts of the country. On the other side, there is poor awareness among rural communities about TB and the very fact that it can be cured. The social stigma attached to TB is still fuelling to spread the problem. In such a case, training and orientation about basics of TB and the DOTS to elected representatives, NGO workers, community health volunteers, teachers and local media will help a lot in the fight against TB.

Commitment

But the good news is that there is a cure for TB. Apart from adequate supply of drugs, there is therefore an urgent needs of strong political will and commitment to meet the growing challenges of infectious diseases like TB and HIV/AIDS. In order to save the lives of millions of people from TB, let us now join our hands to initiate innovative efforts to achieve the goal of TB cure for all.

Understanding TB

By Batu Krishna Sapkota

ON MARCH 24, 1882 an eminent German Scientist Mr. Robert Koch (1843-1910) discovered TB bacillus in Berlin. We commemorate the world TB day on 24th March every year all over the world in memory of the land mark discovery.

Tuberculosis is an infectious disease caused by a bacteria called Mycobac-terium Tuberculosis. It has been identified as major public health problem in the developing countries. Even after half century of the introduction of effective chemotherapy, tuberculosis still remains the single biggest killer of young people, women and children in the world. Today one third people of the world are infected with TB where as 16 million people are living with active TB. Every year there are 9 million new cases with 3 million deaths. In case of Nepal there are around 100,000 total cases of TB, 8 to 11 thousand deaths and 50 thousand new cases every year.

An infectious TB patient can spread the disease to 10 to 15 persons if he is not treated. TB cases is a disease of the poor, which further increases poverty. Mostly TB cases occur in overcrowded areas, poor air circulation, malnutrition and poor sanitation. All these factors are associated with poverty. In developed countries there was significant decline in TB cases even before the advent of TB drugs. It was possible because they had improved working and living conditions and less crowd. While 95 per cent TB cases and 98 per cent TB deaths are in developing countries.

Poverty is the main cause of spreading the disease in Nepal. Poverty and lack of awareness among the community are the main causes of the epidemic. People even after diagnosis are unable to meet its requirement due to various socio economic factors though the medicines are available free of cost.

TB spreads from infected patients to other persons by coughing, sneezing, spitting or talking. It is an air born disease. The symptoms of the pulmonary TB are: cough more than three weeks, evening rise of temperature, blood stained sputum, loss of appetite, loss of weight, chest pain and shortness of breath.

TB mainly affects the lungs and though them affects the brain, skins, bones and other organs of the body too. It is detected by examining the sputum, skin and chest X-ray.

Tuberculosis has now become a fully curable disease. The time when medicines had not been invented, this disease had been dreadful. It has its own principal of treatment. After detection the medicines prescribed should be taken regularly without any interruption. The medicines of this disease are available free of cost in all government health centres, and hospitals. Total duration of the treatment of this disease is 6 to 8 months depending on status of health condition. Treatment must not discontinue before completion of full course. If interrupted the disease may relapse which may be life threatening and difficult to cure too.

The countries of South-East Asia including Nepal are currently suffering from the discontinuation of drugs consumption by the patients of TB. A patient of TB feels comfortable within a month of the commencement of drug consuming, whereas the span of full course is 6 to 8 months. Patients often discontinue to consume drugs resulting relapse of the disease which become more dangerous. To avoid such circumstances Directly Observed Treatment Short Course (DOTS), programme has been initiated in most of the countries. This is a new strategy to control TB by giving drugs to patients under direct observation of health workers. It has been found effective to cure TB and to prevent multi-drug resistance, which prevents relapses and deaths.