Tuberculosis: Efforts needed to shorten its path towards elimination

Tuberculosis (TB),despite being a preventable and curable disease, continues to affect a significant number of people in Bangladesh. Globally it is one of the major killer infectious diseases. Bangladesh is one of the WHO’s high burden countries for TB. The celebration of World TB Day on March 24, symbolises the discovery of the TB germ in 1882.

Poverty, malnutrition, a subpar standard of living, certain pre-existing disease conditions, and a low immune system are among the risk factors for TB. However, anyone can be infected by a TB organism. TB used to be known as the poor people’s disease and had been neglected for years. As a public health specialist, I had been asked by people including some clinicians,if TB is still prevalent in the country.

In the recent years, the Bangladesh National TB Control Programme has successfully been treating nearly 300,000 patients per year with free medicines and free TB diagnostic tests. Many NGOs have been assisting the Government in reaching out to the people on the ground,enhancing access to the service points for early diagnosis and treatment support.This huge number of affected patients are yet unheard to many.

For many years, there was no treatment for TB and it was considered as deadly. Now, TB can be cured by taking a full course of medicine which require usually a six-months course. Continuation of treatment is very important to become cured, and to prevent drug resistant type of TB. Drug resistant TB is a complicated form whichrequire different coursesof treatment which is often challenging. Bangladesh has treatment options for drug resistant TB with shorter treatment period. Long term research efforts actually reduced the duration of drug resistant TB treatment, which was historically long. Damien Foundation, a Belgium based NGO working in Bangladesh was one of the pioneers on thisresearch on reducing the duration of drug resistant TB treatment.

Only BCG vaccine is available as prevention of TB which gives some protection to the children. However, preventive medicines are also available for those who are at risk of developing TB. Early diagnosis using available advanced technologies will also stop the spread of the disease.

The recent Covid-19 pandemic, which caused numerous shocks in various settings, taught us that health system resilience is an important factor. However, we also have seen the pace of the control effortsin vaccines and other developments which had been remarkable for Covid-19.The long journey of TB epidemics was not the same as we have seen for Covid-19.TB has to be included under the highest-level of commitmentof the country and global efforts. Again, commitment is reflectedby allocation and availability of resources.

Bangladesh has shown commitment towards TB elimination in terms of diagnostic expansion, treatment, prevention and community engagement all over the country, which needs to be sustained. The disease is not a stand-alone clinical disease. It brings together some social issues including stigma.

Community engagement and people centered care is needed for better outcome of this multifaceted disease.Timely adoption ofnewer advancements in diagnosis, treatment,prevention,and engaging all stakeholders at different levels, evidence-based decision makingwill surely shorten the long path of TB elimination effort.

The writer is a public health expert and Country Representative of Damien Foundation Bangladesh