Dr. Shahina Qayyum, General Secretary, Pakistan Chest Society (Sindh) , Ojha Institute of Chest Diseases (DUHS) Karachi
Tuberculosis (TB) is an airborne infectious disease that is preventable and curable. World TB Day, which is held on March 24th every year, commemorates the date in 1882 when Dr. Robert Koch announced his discovery of M. tuberculosis, the bacteria that causes tuberculosis. His discovery paved the way for diagnosing and curing of tuberculosis.
The goal of this day is to build public awareness of tuberculosis. TB is a serious problem and still remains an epidemic in much of the world today. WHO is working to dramatically reduce the burden of TB and halve TB deaths and prevalence by 2015. The year 2010 marks the halfway point for the Global Plan to Stop TB (2006-2015). The present situation is that more than two billion people, or approximately one-third of the world’s population are infected with TB. In 2008, there were 9.4 million new TB cases. TB is contagious and spreads through the air. If not treated, each person with active TB disease infects on average 10 to 15 people each year. One in 10 people infected with TB will become sick with active TB in their lifetime. TB is the leading infectious killer of people who are HIV-infected. 5% of all TB cases have MultiDrug-Resistant TB (MDR-TB). In 2007, there were more than 500,000 cases of drug-resistant TB globally. In the new WHO’s Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response, it is estimated that 440,000 people had MDR-TB worldwide in 2008 and that a third of them died. In sheer numbers, Asia bears the brunt of the epidemic. Almost 50% of MDR-TB cases worldwide are estimated to occur in China and India. In Africa, estimates show 69,000 cases emerged, the vast majority of which went undiagnosed.
Pakistan ranks 8th in 22 high burden countries with tuberculosis and is included in the list of 27 high burden countries having MDR TB and now XDR cases are also reported from TB treatment facilities. Pakistan is estimated to have more than 555 thousand patients, estimated incidence is more than 400 thousand out of these 245 thousand are notified. Case detection rate of smear positive cases is 58% (range 49-73). WHO Target is at least 70% detection rate. Estimated number of MDR TB cases in Pakistan is more than 13,000. 1.7% percent of TB patient are co-infected with HIV.
What is the present situation?
The estimated global incidence rate fell to 139 cases per 100 000 population in 2008 after peaking in 2004 at 143 cases per 100,000. The goal is that it should be about 72/100000 by 2015. Rates are falling very slowly in 5 WHO regions (the rate is stabilizing in Europe). The total number of deaths and cases is still rising due to population growth. TB is contagious and spreads through the air. If not treated, each person with active TB, infects on average 10 to 15 people every year across the world. One out of three people who become sick with TB fail to access timely, accurate diagnosis and effective treatment. There were 5.7 million TB case notifications in 2008. 36 million people were cured in DOTS programmes (between 1995-2008), 8 million deaths averted through DOTS. The 87% global treatment success rate exceeded the 85% target for the first time since the target was set in 1991. 53 countries exceeded this 85% patient treatment target.
In Pakistan DOTS coverage was achieved but still many patients are not coming to public sector that account for that target of detection rate is not achieved in many part of the country. The mortality rate is decreased from 143 to 139/100000 patients . Very few centres are equipped to deal with MDR TB patients in term of diagnosis and treatment. MDR TB treatment is expensive and it requires Rs.300000 to 350000 to procure drugs only for one patient. Few canters are providing treatment like in Ojha Institute of Chest Disease in year 2009 by the recourses of Dow University of Health Sciences. 220 patients were registered for treatment. The number is now reaching 300 by the end of this quarter.
It is clearer than ever that, we must scale up efforts and continue to seek new and innovative ways to stop TB if we have to achieve the targets.
We have made considerable progress. But the evidence points to an urgent need to do more, do it better and do it faster. The theme of Innovation speaks to the need for a new way forward.
So ideally what is required?
The standard four-drug course of treatment requires patients to take pills for six months or longer. The routine DST takes more then a month. So it is needed to do research aimed at developing new diagnostics, drugs or vaccines. We got to do operational research, aimed at making existing TB care more effective and efficient. To device new approaches to helping people gain access to TB diagnosis and treatment. To integrateTB care into health systems new approaches to provide support from members of the community to people affected by TB and more over innovative ways of raising awareness about TB ‘This needs commitment from every member of the society.