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Tuberculosis (TB) is the second deadliest infectious disease after COVID-19. In the cramped Rohingya camps where one million people live in southern Bangladesh, the disease can spread fast. A new initiative is trying to keep up with its speed – by bringing access to TB diagnosis on wheels.
Since August 2017, the influx of one million forcibly displaced Rohingya population has severely strained existing health facilities in Cox’s Bazar, making it challenging to combat infectious diseases.
The mortality rate from tuberculosis has reduced by more than 50% over the past few decades, resulting from the expansion of community-based testing facilities, identifying people with symptoms, and ensuring treatment adherence. Despite that, Bangladesh still remains one of the 30 countries with the highest tuberculosis burden.
Tuberculosis in the Rohingya camps
Tuberculosis is a global public health concern which caused 1.5 million deaths in 2020. In Bangladesh, it is responsible for over 100 daily deaths, while more than 980 people are diagnosed with it each day. These figures could become even more deadly in the Rohingya camps for two reasons.
First, the prevalence of TB amongst Myanmar nationals is three times the global average. This raises the possibility that many Rohingya families could have had the disease when they arrived in Bangladesh, without being aware of their condition.
Second, the disease can spread quickly in the densely-packed camps of Ukhiya and Teknaf in southern Bangladesh, and spill over across the 1.2 million people in the host communities.
Tuberculosis is typically transmitted when an infected person coughs, sneezes, or speaks. Lungs are the first site of infection. Research indicates that the incidence of tuberculosis in the Rohingya community is relatively high, owing to malnutrition, poor living conditions, and a general lack of knowledge about the disease.
“If a person gets diagnosed with tuberculosis or is suspected of having the disease, immediate diagnosis and treatment under DOTS (directly observed treatment, short course) is the most effective strategy to prevent further transmission. The first priority is the completion of proper treatment”, says Sarower Hossain, who is managing BRAC’s tuberculosis interventions in the Rohingya camps.
The DOTS course is a six-month course where a community volunteer monitors and observes a tuberculosis patient’s intake of prescribed medication. Pioneered by BRAC in the mid-90s to combat tuberculosis, and scaled up along with the Government’s National Tuberculosis Control Programme, this approach ensures that the patient takes the correct dosage and reduces the risk of drug resistance resulting from erratic or incomplete treatment.
“Our staff members are working across 33 Rohingya camps to support efforts under the National Tuberculosis Control Programme (NTP), by raising awareness of the disease through community mobilisation”, Sarower added. Community mobilisation activities include door-to-door syndromic surveillance to find tuberculosis patients, along with raising awareness about its symptoms within the Rohingya community. Currently there are 10 tuberculosis testing labs within the 33 Rogingya camps.
Selina Akhter, a BRAC field staff, joined the fight to stop tuberculosis in the camps 16 months ago. Every morning, she sets off to help people understand its hazards and ways to prevent its transmission.
“If I find anyone in the community who has been suffering from sudden weight loss or has been coughing constantly for two weeks, I provide them with a small pot to collect their sputum”, says Selina. Later, the collected samples are sent to the nearest laboratory in the camp for diagnosis.
Treatment starts immediately if the test indicates signs of tuberculosis. Prescribed medication is provided free of cost from the Government of Bangladesh, and the patient is monitored through the DOTS course.
Diagnosis on wheels
The National Tuberculosis Control Programme (NTP) and BRAC, with support from The Global Fund, has been working to provide large-scale tuberculosis detection through latest mobile vans equipped with Digital X-ray and GeneXpert machines since October 2020. These mobile vans are making tuberculosis diagnosis easily accessible to the one million Rohingya people across the camps.
Two mobile vans are currently in operation, covering the camps on a rolling basis. Aside from the mobility, what makes them unique is their capacity to conduct both X-ray and GeneXpert tests. Through the GeneXpert tests, traces of tuberculosis bacteria can be confirmed from a patient’s cough sample.
“Any person showing symptoms of tuberculosis can come to the van on the designated days to do their X-ray” says Bablur Rahman, a field staff member of BRAC. “These X-ray reports are reviewed online by designated doctors. If the report shows any abnormality, the patient is counselled to submit their cough sample in a pot the very next day to be analysed in the GeneXpert machine within the mobile van”, he added.
On average, 30 X-ray reports are reviewed and 16 cough samples are tested in the GeneXpert machines daily in each van. Once the GeneXpert test report is positive, a community volunteer begins the DOTS treatment, with prior approval from a medical doctor at the Upazila (sub-district) Health Complex.
BRAC’s mobile van tuberculosis team under NTP are acting as a driving force to end tuberculosis within the displaced Rohingya community living in one of the world’s largest refugee camps.
World Tuberculosis Day is observed on 24 March each year. As the world emerges from the initial two years of the COVID-19 pandemic, continuing to invest resources, effort and time in combating tuberculosis is more critical than ever, to ensure we win the battle against tuberculosis.
BRAC initiated the tuberculosis control programme in 1984 in one district as a pilot. In 1994, BRAC became the first NGO in the country to sign a memorandum of understanding with the Government of Bangladesh to expand directly observed treatment short course (DOTS) services across the country. BRAC’s approach towards the diagnosis and treatment of tuberculosis focuses on community level education and engagement.
Find more blogs on what BRAC is doing through health interventions on The Good Feed.
MD Yazdani is a Communications Specialist at BRAC Communications.