TB: an ‘unfinished agenda’

The battle against tuberculosis has been an unfinished tasks in Bangladesh, BRAC said on Wednesday, urging global leaders to retain the eradication of the contagious lung disease in the post-2015 development goals.

“If we lose the priority, the disease may come back as an epidemic,” Md Akramul Islam, associate director of BRAC’s Health, Nutrition and Population Programme, said. Bangladesh has achieved the Millennium Development Goal (MDG) target of 70 percent case detection and 85 percent cure rate in tuberculosis well before the 2015 time frame. But half of the country's adult population happens to be TB carriers. “The germ remains dormant, and can cause disease if it finds favourable conditions,” he said. “So we have to continue our stringent programmes,” he said, adding that a growing number of drug-resistant TB cases could put the progress at risk. He was speaking at a discussion jointly organised by the National Tuberculosis Programme, BRAC that spearheads government’s TB control programme and the Bangladesh Health Reporters’ Forum. The appeal came when global leaders were shaping the post-2015 development agenda as the MDG targets have less than 1000 days. Environmental issues are likely to dominate the next outlay. “Even we have challenges in treating floating TB patients in city slums,” Islam said. TB patients living in city slums and in and around railway stations and bus terminals often leave the place without giving notice, making it difficult for healthcare providers to continue their treatment. The treatment is extensive with a six-month combined medicines regimen that patients often miss if the course is not directly observed. Considering the fact, the national tuberculosis programme carries out the WHO suggested strategy called ‘DOTS’ in which every patient is directly observed when they take the drugs. The combined drugs are available only with the government, except a pharmaceutical company that can offer for the first two months. The government, however, advises all to visit the government centres across the country to get the free drugs. “It’s a challenge to bring all in the national programme,” said Programme Manager Dr Nuruzzaman Haque. He said in the first two months a TB patient has to take a combined dose of four drugs. “From the third month, they need a combination of two drugs that no pharmaceutical companies supply in the market. “Ultimately they have to come to the government centres. But between this they miss the dose raising the risk of drug resistance,” he said. ICDDR,B researcher Dr K Zaman said resistance due to mindless use of drugs did not decline as much as the new resistant cases. Due to early MDG achievements, Bangladesh will get $ 11million from donors in next three years for further implementation of the national tuberculosis programme, BRAC says.