Tuberculosis (TB) is a major public health problem in Bangladesh. Although a comprehensive expansion of TB control strategies is being implemented in Bangladesh and logistical challenges exist, there is significant uncertainty concerning the disease burden. As one of Bangladesh’s significant public health problems, TB has been an issue of comprehensive discussion. A significant number of patients are dying every year, despite the government providing free treatment. The country’s health sector has reported that about 978 people are infected with TB every day, 16 of which are drug-resistant TB, and on average, 129 people are dying from this disease. Officials blame the situation on a lack of trained workforce, modern equipment, and funds. Additionally, there are problems with the production of medicines in the country, as reported by the World Health Organization (WHO). According to the National Tuberculosis Control Program (NTP) from 1995 to 2016, about three million TB patients have been identified in Bangladesh, including twenty thousand children. TB is a deadly infectious disease caused by sneezing and coughing with Mycobacterium Tuberculosis. The main symptoms of this disease are cough, fever, and chest pain for more than three consecutive weeks. A cough test is the only reliable way to diagnose the condition. The World Health Organization (WHO) advises six months of therapy for new patients with presumed drug-susceptible pulmonary TB. This is divided into two phases: a. a two-month intense phase and b. four-month continuing phase. They should get the following throughout the two-month intense TB therapy phase: Isoniazid + rifampicin pyrazinamide + ethambutol, then Isoniazid+ rifampicin after four months of therapy. Patients should take their TB medications every day for six months. The WHO no longer recommends taking the medicines three times a week, which was formerly deemed adequate. It is critical to take all the TB medications that have been prescribed. The TB therapy will most likely fail if just one or two medicines are used.
For Bangladesh, until recently, the therapy of MDR-TB had an extremely poor success rate. The duration of the treatment regimen and the adverse effects of many second-line TB medicines are thought to be two of the major causes for this. In 2016, the World Health Organization (WHO) approved the nine-month Bangladesh treatment regimen for MDR-TB patients.
Medicines used to treat drug-resistant tuberculosis are known as second-line drugs. Levofloxacin, moxifloxacin, bedaquiline, delamanid, and linezolid are among the second-line antibiotics. Pretomanid is a novel second-line medication that was suggested in 2019 for the treatment of drug-resistant tuberculosis. All second-line medicines should be used only under the guidance of a qualified physician. Not only should they be used in accordance with WHO guidelines, but also with the recommendations of a country’s National Treatment Program.
So, if the infected person does not undergo treatment, there is a risk that up to ten more people will be infected by it. Bangladesh is a particularly TB-prone area, as there are many people with diabetes and within the aging population. Open space is declining, and air pollution is increasing, which increases the risk of spreading TB. Moreover, delays in diagnosis have also become a significant challenge
TB specialists say that Bangladesh struggles to control TB outbreaks for several reasons. First, many infected people hide their symptoms of this disease due to poverty. A rickshaw puller or a slum dweller may think that when they are ill, they will have to go to the hospital to visit a doctor, and therefore, their earnings will be lost, and family sufferings begin. As a result, many people continue to get sick due to others hiding the symptoms and then spreading the disease. Moreover, in Bangladesh, there are massive crowds on public transport. If there is a TB patient in the group, they can infect many people.
The risk of developing active TB after being exposed to tuberculosis bacteria is a two-stage process driven by both external and endogenous risk factors. Exogenous variables, such as the bacillary load in the sputum and the closeness of a person to an infectious TB case, play a vital role in accelerating the course from exposure to infection. Endogenous variables can have a role in the development of infection to active tuberculosis illness. Emerging variables such as diabetes, indoor air pollution, alcohol, immunosuppressive medication use, and cigarette smoke, in addition to well-established risk factors (such as HIV, malnutrition, and young age), have a substantial effect at both the individual and community level. In addition, socioeconomic and behavioral variables have been demonstrated to influence infection susceptibility. Specific populations, such as health care professionals and indigenous peoples, are at a higher risk of contracting tuberculosis.
Children are also vulnerable for TB progression. Children who had smear-negative pulmonary TB or were unable to produce adequate sputum or children who had extra-pulmonary tuberculosis are more vulnerable. Risk factors such aspoverty, a lack of education, inadequate housing, urban surroundings, and overcrowding etc. are found to be associated with childhood TB which need more attention. Another area of concern are instances in which TB medicine is given to those who are not actually infected, as they have been tested without adequately trained personnel. This is problematic because if they get infected later, these medicines no longer work on them. Drug resistance can also result when TB patients do not complete their full doses of their medications. Eighty percent of drug-resistant patients are appeared to be out of the TB diagnosis according to a report that are conducted by Government of Bangladesh in association with an NGO called BRAC. Researchers say that the number of multiple-drug resistance TB patient is now at least ten thousand in the country. Bangladesh has set a target of bringing 90 percent of patients under complete treatment by 2030. It is expected to get 80 percent under control in 2021. In this case, the big challenge will be the patients who have become drug resistant, unexamined TB patients, or those who do not complete treatment. They are called Multi-Drug Resistant TB or MDR-TB. According to the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB’s) officials in Dhaka, modern gene expert tests are now being conducted in Bangladesh and can be used to diagnose the disease in two hours. However, they say the country needs at least 1200 modern gene expert devices at this moment, but only 221 are in operation, so tests are being hampered in the early detection of TB with that shortage of modern devices. Therefore, the government should aid in the country-wide distribution of gene expert devices, even in all tertiary health care centers.
Despite the claim that the treatment of TB is entirely free in Bangladesh, only medicine and cough test are included. Apart from this, X-rays, CT scans, and other tests or treatments are not free, including beds in the thoracic hospital. This is one of the reasons why economically indigent patients hide their diseases in many cases. Treatments are especially expensive when a patient becomes TB drug resistant. In general, the cost of treating a TB drug-resistant patient is at least thirty times higher than that of an average tuberculosis patient. Otherwise, the disease could take a more serious shape. So, the phenomena of rapid TB-progression aspect needs special attention for creating a congenial environment for TB patients on sympathetic consideration.
Recently, the ongoing Covid-19 pandemic has profoundly impacted the fight against TB at the national level. Although the Covid-19 has been the focus of attention worldwide, TB remains the leading cause of death in the world’s single infectious disease and the leading cause of death in Bangladesh. Those who have been severely infected with the coronavirus may cause fear that a large portion of their lungs may be severely damaged, termed Pulmonary Fibrosis. There is no cure for this lung damage, and the symptoms are severe shortness of breath, cough, and fatigue. With these symptoms, TB patients may be susceptible to severe lung infection during an ongoing pandemic. This may be an inevitable reason that all-out efforts of Bangladesh in controlling TB may be delayed for a more extended period than what was planned.
About the Author
Mst Marium Begum is a 1st year graduate student in the Physiology and Pharmacology discipline of the Integrated Biomedical Sciences (IBMS) Program. She worked as a faculty member and multi-disciplinary researcher in three different universities of Bangladesh for the last seven years. She served East-West University, Bangladesh as a senior lecturer in the Department of Pharmacy for five years. Before choosing her faculty career, as a pharmacy graduate, she also worked as a product development executive in a renowned pharmaceutical company in Bangladesh. She has published more than 25 research and review articles and worked as a peer reviewer of Clinical Phytoscience and BMC Complementary Medicine and Therapies journal. She has been awarded two research grants from SSRC, Planning Ministry, Peoples Republic of Bangladesh to contribute to public health-related research. Recently she has been listed as a researcher-scientist in the “World Scientist and University Rankings 2021” ranked by “AD Scientific Index.
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