The battle gets tougher to fight drug resistant TB

The scenario at the National Institute of Diseases of the Chest and Hospital (NIDCH) is slightly different from that in other hospitals in the capital. It is difficult to identify anybody on the ground floor of the hospital because everyone has to wear a mask in and around the wards where multidrug-resistant (MDR) tuberculosis patients are treated.

This type of tuberculosis (TB) is highly infectious and requires lengthy treatment. It develops when a normal tuberculosis patient stops taking medication in the middle of treatment. But recently many MDR tuberculosis patients have emerged who had no history of tuberculosis ever.

This is a matter of great concern because Bangladesh is trying to eradicate tuberculosis by 2035. Eradicating MDR tuberculosis, latent tuberculosis, and diagnosing all infected people to give them treatment are the biggest challenge Bangladesh is facing to end the spread of this deadly disease.

Mohammad Mohibullah, 40, a madrasa teacher, was diagnosed with MDR tuberculosis at Mitford Hospital three months ago, but nobody knows how he got infected with it.

Mohibullah said, "I just could not accept the fact that I am infected with MDR tuberculosis. Initially it seemed like a simple cold and cough."

Mohibullah lost his job after he was diagnosed with tuberculosis, although the madrasa assured him that he will be reappointed after he completely recovers from the fatal disease.

"I have been taking medicines regularly as I want to survive for my little daughter," he added.

Another patient at the hospital, Masud Rana, 24, also shared a similar story. He worked as a salesperson in Gazipur and had a chance of going abroad for his excellent performance at work.  He was diagnosed with MDR tuberculosis when he was going through a medical checkup for the trip. He could not believe it at first. He then went to three hospitals in Gazipur and in Dhaka for diagnosis. Later, he got admitted to the NIDCH where he has been under treatment in the MDR tuberculosis ward for the last one month.

Mohammad Abdur Rashid, an official at the NIDCH's MDR TB control room, said, "People who are infected with MDR tuberculosis are spreading this disease to others." 

A person who has tuberculosis can easily infect 10-20 other people in a year. There were 450 tuberculosis patients in the hospital in 2017, but that number increased to 600 in 2019.

It is not just the number of MDR tuberculosis patients, the number of general TB patients is also increasing in the country.  

The World Health Organization's Global Tuberculosis Report 2019 revealed that about 357,000 people were diagnosed with tuberculosis in Bangladesh in 2018, which is 4 percent of the total global tuberculosis patients.

The report also revealed that 221 out of one lakh people here are infected with tuberculosis.  Bangladesh is among eight countries which accounted for two thirds of new tuberculosis cases.

A global total of 186,772 cases of MDR tuberculosis were detected in 2018.

There were an estimated 47,000 TB deaths in Bangladesh in 2018.  Of them, 190 people were HIV infected and 5,900 were MDR tuberculosis patients.

The WHO End TB Strategy

All World Health Organization (WHO) member states adopted "The End TB Strategy" in 2014.

In this plan these countries aim to reduce tuberculosis deaths by 95 percent from 2015 to 2035. It also set a goal of 90 percent reduction in the number of tuberculosis patients in the same period.

Tuberculosis patients and their families have to bear huge treatment costs. Providing treatment for these patients is a good indicator of progress towards the Universal Health Coverage (UHC) as well as social protection.

But specialists think that reducing the number of tuberculosis patients in Bangladesh in the stipulated time will be very challenging. 

Factors that facilitate the spread of the disease include increased population, increase in average life expectancy, rapid urbanisation, malnutrition, poverty, diabetics, AIDS and multi-drug resistance. It will be very tough to control the disease in this country within the stipulated time, because of these reasons.  

An official of the National Tuberculosis Control Program said there is no term like "End TB."

"Tuberculosis will not go away; it has to be kept under control. While working at the field level, we found that the number of tuberculosis patients are increasing at such a rate that it is very difficult to fulfil the targets set for 2035," he added.

Dr Asif Mujtaba Mahmud, who has been working with tuberculosis patients for 34 years both at the government and the private levels, told The Business Standard that 27 percent of tuberculosis patients are not being treated because they are not aware that they have the infection.

"Those undiagnosed tuberculosis patients may infect others. Moreover, some infected people stop taking treatment in the middle because of social misconception, fear about the disease and side effects of its treatment. They later become infected with MDR tuberculosis," said Dr Asif.

The risk of tuberculosis infection is two to three times higher in diabetic patients than in normal people, because the immunity of malnourished and diabetic patients is very low.

Since 2013, Birdem Hospital has been implementing a project called "BADAS-USAID Challenge TB Project" to identify diabetic patients with tuberculosis. Project Manager Professor Dr M Delwar Hossain said there are 35,000 diabetic patients who also have tuberculosis in the country.

Medical Officer of the project Dr Ferdousi Begum said, "With the increase of diabetic patients in our country, the number of tuberculosis patients is also increasing. On an average, 45 diabetic patients, including children, are diagnosed with tuberculosis every month".

Dr Shamiul Islam, line director of the National Tuberculosis Control Program, expressed confidence in successfully eradicating tuberculosis in Bangladesh by 2035.

He said, "We can achieve all the goals within the stipulated time. Our coverage increasing by ten percent last year. Currently, around 95 percent of patients complete the full treatment.

"The government has identified all types of tuberculosis, including drug resistant tuberculosis with the use of GeneXpert machines of which it has 218. Additionally, programs including coordination, monitoring and evaluation adopted by the government and non-government organisations are being implemented successfully," he added.

However, Dr Asif Mujtaba Mahmud, respiratory medicine consultant at Asgar Ali Hospital, said that along with active TB, there are also latent tuberculosis infections, which is expensive to diagnose and cure. Currently Bangladesh does not have the facilities to treat latent tuberculosis.

"We are putting priority on controlling active tuberculosis. Eradicating all types of tuberculosis including MDR and latent tuberculosis, and identifying undiagnosed patients is a challenging task. For that we have to take measures to identify latent tuberculosis and its treatment".

He said, "The private sector also has to become involved in this initiative.  Additionally, we have to put emphasis on poverty reduction and prevention of smoking. We need a national level campaign for this".