National Tuberculosis Control Programme faces challenges

Despite provision of free of cost treatment facilities at around 1,056 Tuberculosis (TB) diagnosing and treatment centres operating across the country, desired results to check spread of TB could not be achieved due to increase in poverty level and failure of the patients to continue treatment.
National TB Control Programme (NTCP) still faces challenges because TB planning shifts from the national to the district level, technical and managerial capacities at the provincial and district levels require strengthening.
Pakistan accounts for around 57-percent of the MDR-TB burden within WHO's Eastern Mediterranean Region. Although TB is curable, the treatment requires taking a combination of drugs for at least six months. Laboratories are still using a century-old diagnostic method that involves searching for TB bacteria derived from a person's sputum under a microscope. And there is still no vaccine able to prevent pulmonary TB, the most common form of the disease, experts said.
Health professionals told Business Recorder that the rising incidence of tuberculosis has economic repercussions not only for the patient's family but also for the country. "About 80 percent of people afflicted with tuberculosis are in the most economically productive years of their lives, and the disease sends many self-sustaining families into poverty. The unavailability of anti-TB drugs, insufficient laboratory networking, poor health infrastructure, including a lack of trained health personnel, have also contributed to the rise in the incidence of the diseases," they said.
According to them, TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to "wall off" the bacteria. The symptoms of active TB of the lungs are: coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats.
With an estimated 300,000 TB patients, Pakistan ranks eighth on the list of 22 high-burden tuberculosis (TB) countries in the world and the emergence of multi-drug-resistant (MDR) TB and TB-HIV co-infection is a growing concern in the country, experts believe.
According to them, DOTS, the internationally recommended strategy for TB control was started in 1995, with Balochistan selected as a pilot province. Much progress has been made over the past few years, as DOTS coverage increased in Pakistan from 44 to 99 percent. But still a lot more is to be done. The DOTS treatment success rate has improved, while steep rise in case detection and the number of TB cases reported each year.
They said DOTS strategy depends on five elements for its success ie microscope, medicines, monitoring, directly observed treatment and political commitment. If any of these elements are missing, our ability to consistently cure TB patients slips through our fingers
It may be recalled that 22 countries, including South Africa, bear 80 percent of the burden of TB world-wide. Some 9 million people become ill with active TB and nearly 2 million die each year. Half a million people die each year from HIV-associated TB.
The Global Plan calls for $37 billion for implementation of TB care between 2011 and 2015. A funding gap of about $14 billion - approximately $2.8 billion per year - will remain and needs to be filled by international donors. WHO is engaged in a five-year project to strengthen TB laboratories with rapid tests in nearly 30 countries. This will ensure more people benefit early from life-saving treatments. It is also working closely with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the international community on increasing access to treatment.