The World TB Day has been observed around the world including Pakistan on March 24. The health officials and experts renewed pledges in various seminars and workshops to wipe out this disease in the country.
However, the past experience shows that mere high-sounding words are not enough to cope with the threat of TB. Instead, serious efforts are needed on the part of government, healthcare sector and civil society to check the spread of the Tuberculosis and make Pakistan a TB-free country.
The TB is considered as a disease of poor and it is still a major healthcare problem in Pakistan, which ranks as the sixth high-burden TB country of the world. India is at the top of high-burden TB countries with 1788,043 cases, followed by China (1334,066 cases), Indonesia (627, 047 cases), Nigeria (362819 cases), Bangladesh (360767 cases), Pakistan ( 278,392 cases) and Ethiopia (251,685 cases).
According to the World Health Organisation (WHO), Pakistan accounts for 43 percent of the TB disease burden in the WHO Eastern Mediterranean Region. Every year, approximately 270,000 people in Pakistan develop TB, the majority of whom are economically productive adults. The emergence of multi-drug resistance and co-infection rates of TB and HIV/AIDS are growing concerns in Pakistan.
The Pakistan Ministry of Health began implementing the Directly Observed Therapy, Short-Course (DOTS) strategy in 1995, with Balochistan as a pilot province. Between 2000 and 2002, DOTS coverage increased in Pakistan from 9 to 45 percent. In 2001, the government declared TB a national emergency, which led to a TB budget increase from $1.65 million in 2001 to $4.3 million in 2002. In addition, the National TB Control Programme (NTP) has received a $1.5 million grant from the Global TB Drug Facility (GDF).
Despite improvements, the NTP still faces challenges. As TB planning shifts from the national to the district level, technical and managerial capacity at the provincial and district levels requires strengthening. Moreover, the private sector may not be oriented to caring for patients using the DOTS approach.
Despite the fact that TB is curable and drug treatments are available, it kills more than two million people a year - with around 50,000 Pakistanis dying from the bacterial infection. TB is estimated to kill around three million people world-wide each year.
As much as 33 percent of TB cases in the world occur in the South-Asia region. It is estimated that one new person is being infected with TB bacilli every second in the world.
Most TB patients are dissatisfied with the service they receive: drugs are expensive and overworked doctors fail to give accurate information. Many people see TB as incurable so they are less likely to seek or complete treatment.
Access to treatment is particularly difficult for women. Good quality TB care and education are essential for successful treatment programs in Pakistan.
Experts say TB can be treated with a six-month course of drugs, but many people in developing countries fail to finish their treatment, due to high drug prices, cessation of symptoms after three to four weeks, and non patient-friendly care.
It is observed that many people conceal their TB status due to the widespread belief that it is incurable. Young unmarried women fear that they will be unacceptable as brides. The stigma can make it difficult for people to continue with treatment. This increases the perception that TB is incurable, completing a vicious circle.
It is also observed that the majority of TB patients are very poor. Despite this, roughly half initially visit a private practitioner, seeking greater confidentiality and more patient-friendly care. Almost all patients have problems continuing with treatment due to the time, distance and cost of travel to clinics. This is especially true for women, who have limited mobility. There is also an unwillingness to pay for medication for women.
Patients have little knowledge about their disease, and doctors give incorrect or limited healthcare information. The failure of the health system to provide good TB treatment is a major reason why patients stop taking medication.
To successfully cope with the threat of TB it is needed to raise awareness that the disease is curable with proper medication. The patients should be encouraged to complete their treatment through local clinics, community workers or family treatment supporters. It is also a must to advise patients on what treatment will involve and the reasons for the length of treatment.
However, while health services continue to charge for TB drugs, patients with limited resources will struggle to complete their treatment. Financial constraints in the public health sector also mean that doctors are overburdened and give little health education to patients.
The World TB Day is observed on March 24 every year and it commemorates the date in 1882 when Dr Robert Koch presented his discovery of the TB bacillus to a group of doctors in Berlin.
This year the theme for Campaign Planning for World TB Day 2006 is "The global plan to stop TB 2006-2015 - Actions for life: towards a world free of tuberculosis."
The aim of WTBD 06 is to mobilise support for the fight against TB. By mobilising communities, raising awareness, encouraging governments and donors to invest in TB control, and calling for strengthened commitment, we can ensure that TB is placed prominently on the global agenda and is eliminated by 2050. But again the aims could be translated into achievements only through a non-nonsense approach and hard work.
The responsibility in this regard does not lay on shoulders of government only, but the dream of a TB-free Pakistan could only be materialised when all stakeholders including medical experts, healthcare workers, civil society and citizens actively take part in this noble cause.
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