March 24, 2011
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Tuberculosis is a disease we have known for centuries and it is completely preventable. Yet millions today suffer from it and we still see the faces of misery and pain. Even today, tuberculosis (TB) is the cause of many deaths. Prevalent myths that TB is not curable and death is inevitable still exist. In Afghanistan, the situation has been grave. Decades of human conflict and displacement has had a severe impact on the health sector of Afghanistan. High vulnerability to natural disaster, limited safe water supply, poor standards of hygiene and sanitation and restricted access to health care for women have become important features of the health situation in Afghanistan, exacerbated by difficulties of geographic access.

Tuberculosis is a disease we have known for centuries and it is completely preventable. Yet millions today suffer from it and we still see the faces of misery and pain. Even today, tuberculosis (TB) is the cause of many deaths. Prevalent myths that TB is not curable and death is inevitable still exist. In Afghanistan, the situation has been grave. Decades of human conflict and displacement has had a severe impact on the health sector of Afghanistan. High vulnerability to natural disaster, limited safe water supply, poor standards of hygiene and sanitation and restricted access to health care for women have become important features of the health situation in Afghanistan, exacerbated by difficulties of geographic access.

I was reading about a story of a 14 year old Afghan girl called Fazilla. She had started complaining about pain in her legs. The doctors said it was rheumatoid arthritis. They gave her medicine but it didn’t help her pain. There were more tests and more prescriptions. X rays revealed a serious scoliosis of the spine. After a point she was unable to sit properly. In 2006, she was finally diagnosed with a very rare form of tuberculosis, known as tubercular spondylitis. She was put on standard treatment for tuberculosis. After nine months of treatment she was tested again, this time results were negative for tuberculosis. Unfortunately, her spine was permanently damaged. But she is still alive. On the downside, she has lost three years of schooling and her good health. It is sad as we know if she was diagnosed on time, all of this was preventable.

Afghanistan is one of the 22 high TB burden countries, and TB is a major public health problem. As per the World Health Organization (WHO) estimates, each year 37,313 to 42,593 new cases of TB occur in Afghanistan, with more than 10,000 people dying from TB each year. Furthermore, over 32,500 TB cases are women, a highly vulnerable group, which accounts for 65% of all cases of TB presenting to public clinics.

To fight tuberculosis BRAC piloted community based Directly Observed Treatment Short Course (DOTS) in Jabul Siraj district of Parwan province in Afghanistan in 2004. The pilot provided us with the inspiration. The case detection rate in the district improved from 18% to 69%. We scaled up our intervention to five provinces in 2006 and 9 provinces in 2007, with the technical and financial support of The Union (International Union of Tuberculosis and Control programme).

Today the detection trend in Afghanistan has greatly improved. Our advocacy and social mobilisation through awareness campaigns in television, radio, and billboards has raised social awareness on TB. We trained 6,700 community health promoters to implement TB DOTS. Training for service providers and private practitioners proved a success. BRAC has also ensured procurement and regular supply of Anti-TB drugs through Global Drug Facility (GDF). We have worked closely and organised meetings with BPHS implementers and NTP personnel at the provincial, national and regional level to strengthen our stance against TB.

Today we have renewed hope as TB is being defeated. The World Health Organisation introduced DOTS to treat TB in 1993. In 2001 there were only 36 health facilities applying DOTS and now in 2011, there are 582.

We saw Fazilla suffer because she was not detected in time. Today, we can talk about a better, brighter situation. The latest statistics by WHO published in 2011 are encouraging. In 2001, the detection rate of TB was only 26%. After the hard work of many, today 66% of TB cases are detected, and more than 85% of the cases are treated successfully. The graph below shows the progress in the last ten years. Only 34% TB cases remain undetected now compared to 74% in 2010.

We can draw inspiration over the results of the last ten years and move forward to successfully detect and treat all tuberculosis patients in the future. We can hope for a world free of the misery and pain caused by tuberculosis to the countless Fazillas and see healthy smiles on their faces in the near future.

(Story of Fazilla: From the book Tuberculosis: Voices of the Unheard by the WHO in 2008)

– Faisal Rezwan, BRAC Communications

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taintedeclipse
12 years ago

Rather insightful. There are enough TB cases that needs to be dealt with around the world; especially in the third world nations. Here’s to hoping that it can soon be entirely defeated.

hernia surgery Los Angeles

Good information.There is a lot of research on the types of tuberculosis and remedies that should be discussed for the benefit of patients around the world.There are advanced medications for the same.Good to see the advancement here.