Dr. Abdul Majeed Akhtar is the Provincial Program Manager of TB Control Program-Punjab. He is associated with TB Control Program since 2014. On the eve of World TB Day, team of Medical Review interviewed Dr. Abdul Majeed Akhtar. Following are the excerpts of his Interview.
Q – Please tell us something about yourself?
Ans – I am having experience of working at management positions for more than 20 years. I joined TB Control Program in March 2014. I have special interest of working in the field of public health especially in the control of tuberculosis. I did MCPS (Chest diseases and TB), DTCD, DPH and PhD in Public Health. I have published more than 20 scientific papers in different journals. I am approved supervisor for PhD Epidemiology and Public Health by Higher Education Commission.
Q – How effective is the Provincial TB Control Program in controlling TB in the Province?
Ans – Due to the interventions of Punjab TB Control program, the case detection rate of TB in Punjab is increasing annually. In year 2011, a total of 162534 cases were notified, whereas in 2014, case notification increased to 194628. The mortality rate of TB in Punjab is also declining every year.
Q – What is the program planned for the TB Day on March 24, 2015?
Ans – To commemorate world TB Day 2015, Punjab TB Control Program is planning to conduct various activities with its partners to raise awareness about TB, what it is, how it is spread, its prevention and cure. These include:
* City Branding, print and electronic media ad campaigns to highlight our message
* Seminar with stakeholders and journalists in Alhamra Arts council, Lahore
* Seminar with health professionals and care providers in IPH, Lahore
* A play and concert to raise awareness about TB among the masses in Lahore
* Community gatherings and patient empowerment sessions in all districts of Punjab
* Seminars and walks in all 34 districts of DOTS in Punjab
Q – What is the prevalence of TB in Punjab?
Ans – There are still more than 2 billion people infected with TB in the world and every year, 9 million new cases of TB are reported all over the world. Every year, 1.3 million people still die from TB globally, a disease which is easily curable with a six month treatment regimen. Pakistan ranks fifth amongst high burden countries for TB in the world. The overall prevalence of TB in Pakistan is 348/100000 population, whereas, the incidence is 276 TB cases per 100,000 population. The mortality rate of TB is declining every year in Pakistan. Slow increase in case notification is our biggest challenge. To address this and to detect more cases from community, PTP, in collaboration with NTP, is bringing many new initiatives in the province.
Q – What are the risk factor in contracting TB?
Ans – A TB patient can infect 10-15 or more people in a year. Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk. People who are infected with HIV are 26 to 31 times more likely to become sick with TB Risk of active TB is also greater in persons suffering from other conditions that impair the immune system. Over half a million children (0-14 years) fell ill with TB all over the world. Malnutrition and crowded living spaces without proper ventilation also contribute to the spread of TB in developing countries, such as Pakistan. Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.
Q – The incidence of TB in the world has declined through the efforts of medical community. What are the main interventions of your program to address the issue?
Ans – We are addressing this issue through various interventions that include:
* Training of healthcare staff working with TB Control program on modern diagnostic tools (fluorescent microscopes, Gene Xpert machines)
* Developed electronic databases TBDMIS and MIS DOTS
* Provision of free diagnostic facilities and free of cost medicines to all patients.
* PPM, Involvement of 3 partners (MC,ASD,GSM) specially in chest camps reaching to unreachable.
* Accountability at all levels
* Involvement of other programs including Provincial AIDS Control Program and LHW Program in ensuring DOTS.
Q -How can awareness be created and what are the contributions of doctors?
Ans – Raising awareness about TB, what it is, how it spreads, how it is treated can help to lower TB rates. Pakistan registers number of deaths every year due to TB, a disease that is easily curable with early diagnosis and adherence to DOTS. Media can play a vital role in informing the public and decision makers about TB prevention, control and care. Both our public and private practitioners are the backbone of our program. Their contributions cannot be ignored.
Q – What measures can be taken to minimize occurrence of TB?
Ans – We can minimize the occurrence of TB by preventing its transmission and by ensuring affective and timely treatment. Spreading awareness among the masses about TB, its symptoms, its treatment and how it is spread is essential in eliminating TB from our country. Large scale effective treatment is required to speed up the decrease of TB patients in our society. We must ensure that all sputum positive patients complete effective treatment. Government commitment towards decreasing poverty and improving general nutrition and access to healthcare facilities will also play a key role in eliminating the occurrence of this disease in Pakistan.
Q – Pollution and vehicle emission are factors which create lung disease. How can these factors be minimized or eliminated?
Ans – These factors can be minimized through the establishment of green belts, increase in vegetation, introduction of more effective legislation for their control, replacing technological processes with new processes that do not cause air pollution and reduction of lead in petrol.
Q – Is TB more prevalent in urban areas. What is the prevalence rate in rural areas?
Ans – Yes, TB is more prevalent in our urban areas than rural areas. The population density is much higher in urban areas than rural areas, which leads to a higher occurrence of TB in urban areas. Congested living spaces with lots of people living in poorly ventilated homes in urban areas provide an ideal breeding ground for TB bacteria. The rampant poverty in our rural areas is a major contributing factor to the prevalence of this disease in our villages as people there lack awareness and resources for timely medical checkups and treatment.
Q – What is the ratio in gender i.e. the male and female ratio? Does it affect more males as they are exposed to external environment?
Ans – Tuberculosis disease risks are generally higher among females in young adult years and among males in older age groups the male to female ratio of TB cases reported to the WHO is around 1.50 to 2.10 in all regions of the world.
Q – What is your message on the World TB Day?
Ans – Every year there are an estimated 9 million cases of TB but consistently 3 million are not diagnosed, not treated or not registered by the NTPs and PTPs. Major Efforts are needed to close this gap. So, our message this year is to “Reach, Treat, Cure Everyone”