The Kathmandu Post
24 March 2003

War against TB

Let's contribute

KHAGENDRA BIKRAM

Every second, someone in the world is infected by tuberculosis (TB), which claims a life every 15 seconds. The fact is tragic since TB is no more an incurable disease; it can be easily cured with anti-tubercular drugs and mainly, under DOTS (Directly Observed Treatment Short-course) strategy.

TB is a bacterial disease caused by a bacillus known as Mycobacterium Tuberculosis. It was considered very fatal few decades ago; but at present its 95 percent curable under DOTS. It is really serious that it still claims lives of 8,000 to 11,000 Nepalis each year.

DOTS is an internationally accepted strategy for TB control. It is being conducted in 148 countries was introduced in Nepal in 1996. Now, it is available in all 75 districts of the country and covers 85 percent of the total population.

Normally, TB treatment lasts for 10 to 12 months under traditional system. This results into low patients' compliance and they don't complete the full term course of treatment. Later, multi-drug resistant TB (MDR-TB) develops in these defaulter patients, which is almost impossible to cure with any available treatment strategy. However, the introduction of DOTS has drastically improved the situation.

DOTS mainly focuses on early detection of all suspected cases; speedy and accurate diagnosis; effective treatment with quality drugs; constant supervision and motivation of each patient to ensure completion of treatment and finally, monitoring and evaluation to assure the quality of services. Because of these attributes of DOTS, if correctly used, it can almost attain 100 percent cure rate. The TB cure rate in Nepal has reached 86 percent.

One of the measure bottlenecks in the struggle against TB is the lengthy diagnostic procedure. Lets take an example, a farmer from high hills of Sankhuwashabha district has a persistent cough that he fears it may be TB. He wants to cure himself; gets up early and walks to the nearest TB clinic, which is several miles away across the rugged mountains. On arriving, he stands in the queue, possibly for several hours to register his name. After he has registered, the clinic will send him to a laboratory, which may be located somewhere far where he will line up again to get his first sputum sample checked up. Then, he would be told to bring two more sputum samples following mornings that he will bring. If he is diagnosed positive, he will take medicines, otherwise will be given cough medicines. And we can only assume what will happen to his farms, poultry and livestock during these, at least three, days.

He will probably advise the others not to go to TB clinic if other members of family or society ask him for suggestion. Let's hope he would suggest the positive but it is unlikely.

TB case detection rate of Nepal is 70 percent. Although it is quiet higher than the world average, there is still a lot of efforts we can put up to help many people save lives. In the war against TB, everybody should contribute.

As a community member, we can help to create an enabling environment for people with TB to get diagnosed and treated. We can help patients to reach DOTS centre or even we can provide information on TB especially during social and community gatherings.

As a family member, we can help the health care provider reach correct diagnosis by giving true and detailed history of patient. Moreover, the family members can help to reduce social stigma attached to TB by talking about it freely since we know that it's curable.

The cured patients can more than other. They can act as advocates; and can share their part of story among others to create awareness about TB and DOTS. Taking this into consideration, the World Health Organisation (WHO) has worked out the slogan for World TB Day 2003 - 'DOTS cured me... and it will cure you too'. The message in the slogan is that the TB cured persons can be truer and convincing than any other people can.

Anyone in policy making or high government official can play pivotal role by showing commitment to stop TB and by formulating plans and strategies.

Anyone, where so ever he/she is and what so ever his/her position and designation is, can contribute in the war against TB. Today, on the occasion of World TB Day, let's vow that we are going to partake in the campaign against TB.