Every year thousands of people lose their life to tuberculosis (TB) in Pakistan. The disease load of tuberculosis is as high 0.4 million in our country, including more than 15,000 children; every year we lose 70,000 of these patients. Of the top 22 countries in the world with TB, Pakistan ranks sixth. Regrettably, our country also has a high prevalence of multi-drug resistance form of tuberculosis (MDR-TB).
The World Health Organization (WHO) and partners are working to raise awareness regarding TB, and reduce the global prevalence of the disease.
Why is the disease prevalence high in Pakistan?
According to the head of community medicine at CMH, Lahore, Professor Ashraf Choudhary, there are numerous causes of such high disease load in Pakistan. Many people when infected do not get diagnosed with Tuberculosis, due to lack of healthcare facilities, general physicians and poverty. Moreover, people do not have awareness about how this disease spreads, and don’t take precautions.
Furthermore, there is negligence on part of public sector hospitals when it comes to proper implementation of the DOTS program. DOTS program—Directly Observed Treatment Short Course—is a treatment protocol whereby patients are observed when given treatment because the treatment for tuberculosis is a lengthy one, and many patients are not compliant.
This negligence by public sector hospitals is due to lack of medical staff and facilities. According to Dr. Choudhary, the rise in MDR-TB is due to unproficient use of anti-tubercular treatment (ATT), as well as poor quality of medicines.
Who is at risk?
Tuberculosis develops in people who are malnourished and ailing. People with diabetes, HIV, and those taking corticosteroids, and smokers are, particularly at risk. Moreover, people living in overcrowded setting, like slums or prisons are also at risk because TB is an infectious disease.
Smoking greatly increases the risk of incurring this disease. Globally, 20 percent of cases of TB can be attributed to this risk factor. The chemicals and carcinogens contained in smoke have an adverse impact on health, and when the immunity of the body decreases, the bacteria of tuberculosis spread in the body.
The dissemination of this bacteria is through air droplets. Coughing, sneezing, talking and spitting are all ways by which other people can contract it from close contact.
How to control the disease?
Research data suggests that TB case detection should be increased in Pakistan especially in the areas of Sindh, Gilgit-Baltistan, as well as Azad-Jammu and Kashmir. Surveillance and early detection will ensure timely treatment because undiagnosed people can further spread disease. Moreover, surveillance should be increased in areas with natural disasters such as floods, because they have a significant impact on accessing healthcare. Between 2010 and 2011, considerable number of TB cases were reported in flood-affected areas of Sindh, as more than 8 million people were affected.
Even though TB can be treated with a nine-month course of antibiotics, prevention and spreading awareness still remain the mainstay of treatment.
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