The UN World Health organization (WHO) rates Tuberculosis (TB) as top priority for global health emergency action. In the S.E Asia region it is considered to be the leading cause of adult deaths. Bangladesh has the world’s sixth highest TB burden. 50% of adults in Bangladesh have been infected. This however does not mean that they have active TB or are infecting other people.
TB is spread by infected respiratory droplets from active sputum positive patients. Each such person infects ten other people every year, mostly children ( but only 10% of these contacts actually develop TB). Every year one per thousand of Bangladesh’s 145 million population becomes sputum positive.
Although BCG immunization prevents life-threatening forms of childhood TB, it does not influence development of TB later on (post-primary) or affect the TB epidemic.
The two great community dangers are multi-drug resistant TB and TB associated with AIDS immune deficiency. HIV-AIDS prevalence in Bangladesh is still low but increasing amongst drug addicts.
The five year outcome of sputum positive patients is of enormous importance. Without treatment 50% die, 25% cure spontaneously and 25% go on to chronic TB. The difficulty in treatment is the long duration of multi-drug therapy and hence difficulty with patient compliance.
The WHO sponsored six months’ DOTS treatment programme manages this by direct observation of drug consumption in a closely monitored national programme package. Results are spectacular: 95% five year cure rate with only 2% death rate and 2% going on to chronicity.
New patients get four drugs under direct observation for the first two months. Re-treatment cases get five drugs initially and direct observation for eight months. Even with modern drugs patients treated outside the DOTS programme do very much worse (because of high costs, poor motivation and lack of monitoring).
The aim of the national TB programme is 85% cure rate and 70% case detection rate thus reducing disease prevalence to the level of no longer being a major health problem and eliminating TB by the year 2050.
In 2007 the Kailakuri TB programme detected about 73% of estimated new cases with a 95% treatment success rate! Tangail District however is below the national average.
All patients with cough for over three weeks or coughing up blood have to be screened by three sputum examinations. Positives are treated and negatives have to be followed up. Campaigning must be done to bring in more suspects.
Kailakuri Health Centre TB Statistics
Success rate: Of 43 sputum positive patients starting between March 2006 and February 2007 40 successfully completed treatment. This is a 93% success rate!
Statistics for 2007
Total number of patients treated 61
Number continuing form 2006 17
Started in 2007 +44
Transferred 3 - 47
Continuing into 2008 14
(Child contacts receiving preventive treatment= 2)
Total Patient Analysis
Category 1 (new sputum positive patients) 57
Category 2 (re-treatment patients) 4
Category 3 (non-pulmonary or sputum negative) 2
98% followed treatment regularly
5% had diabetes
52% lived within five miles (14% within two miles)
34% were under 30 years’ age
Male 52%, Female 48%
Muslim 85%, Christian 10%, Hindu 5%
Number of patients hospitalized 22 (12 at Kailakuri, 10 at Jalchatra)
The present challenge for the programme is to increase publicity and bring all TB patients to diagnosis and treatment.