World TB (Tuberculosis) Day held annually on March 24th is intended to promote awareness and knowledge of the seriousness of the disease and to motivate action to be taken in order to cure TB worldwide
135 years after the discovery of the kochs bacillus, TB still remains an epidemic in much of the world today despite the effective cures which have been made available for decades. This lethal killer of human beings still prevails despite many scientific breakthroughs.
Tuberculosis has re-emerged with a vengeance and has become the deadliest infectious disease in the world and has become the number one killer causing three (3) million deaths per year. These deaths also create serious implications on the world economy, as it kills or disables mainly young people who form the productive sector of the economy. The World Health Organization (WHO) declared Tuberculosis ‘a global emergency’ in 1993. This illness could affect around 90 million people worldwide within the next decade.
The emergence of multi drug resistant tuberculosis can be controlled if the treatment of tuberculosis patients is completely supervised. Tuberculosis patients (or for that matter any patient) have the bad habit of forgetting to take their drugs when, they feel better, or throwing their drugs away when they feel better
A study was undertaken in collaboration with the medical personnel of the Respiratory Disease Control Programme of the Ministry of Health, the Centre for Social Survey and the University of Sri Jayewardenepura
Tuberculosis appears in forms resistant to multiple drugs (MDR TB) and cannot be cured by a single medicine. Together with its deadly ally, the human immunodeficiency virus (HIV), TB has emerged as one of the most potent threats to the existence of mankind.
Can tuberculosis be eliminated? Low priority has been assigned to tuberculosis by health policy makers. In many low to middle income countries, less than 1% of the annual health budget is allocated for tuberculosis prevention. Why is this? Is it because Tuberculosis is something to be swept under the carpet?
The inadequate funding and inefficient tuberculosis control programmes have led to a worsening of the global situation regarding tuberculosis.
This is because of inadequate treatment that does not cure patients nor cause fatalities, leaving a pool of inadequately or improperly treated patients disseminating multi - drug resistant tuberculosis in the community. In other words, in a poor tuberculosis control programme, many patients will die of the disease, but there will also be half treated half dead patients disseminating the disease to healthy people. Also, if there were no tuberculosis drugs at all in a country, there would be no multi - drug resistant tuberculosis for it is the improper use of anti - tuberculosis drugs that creates multi-drug resistant tuberculosis.
This is also compounded by patients who are forced to purchase drugs as cases have emerged of patients seeking private treatment having to purchase the drugs cutting costs by self reduction of the dosage or discontinuing the treatment due to lack of funds while in other instances cheaper drugs with less efficacy also causing great harm.
However, all is not that gloomy. It has been shown conclusively in countries poorer than Sri Lanka, such as Nepal and Bangladesh. (with per GNP of around US$200, compared to a per capita GNP of US$ 840 for Sri Lanka).
More than 90% of Tuberculosis patients can be cured. The emergence of multi drug resistant tuberculosis can be controlled if the treatment of tuberculosis patients is completely supervised.
Tuberculosis patients (or for that matter any patient) have the bad habit of forgetting to take their drugs when, they feel better, or throwing their drugs away when they feel better.
As Tuberculosis has been declared a global emergency many efforts are being made to find new effective solutions and strategies in service, design and delivery to eliminate this global menace which is appearing in various forms.
New tools, drugs and strategies are being researched and tried out bringing effective results.Lets take a closer look at them.
The DOTS Strategy (Directly Observed Treatment Short cause)
Represents a major breakthrough in controlling tuberculosis. No other TB control strategy comes close to being as effective and is affordable as DOTS.
The advantages to the community by using the DOTS strategy are numerous.
A. Cures the patients
Dots produces cure rates as high as 95 percent, even in the poorest of countries.
B. Prevents New Infections
DOTS makes it virtually impossible to cause a patient to develop incurable forms of TB that are becoming more common.
MDRTB
DOTS Makes it virtually impossible to cause a patient to develop the incurable forms of TB that are becoming more common.
Cost effective
A six-month supply of medicines for DOTS cost only $ 11 per patient in some parts of the world. This can be less than the price of a few bottles of aspirin. The World Bank has ranked the DOTS strategy as one of the most cost effective of all health interventions.
Community based
DOTS have been demonstrated to add as many years of life as currently available protease inhibitors to HIV positive people.
Protects the workforce
Nearly 80 percents of those ill with TB are in their most economically productive years of life. These youthful TB patients represent a workforce nearly as large as the number of people employed by the world’s 20 biggest international corporations.
Protects International Travelers
The only safeguard against TB is to use DOTS more widely.
Stimulates Economies
The DOTS strategy offers relatively quick payoffs to the economies of developing countries.
Proven effective
DOTS has been successfully implemented in a wide variety of conditions, including Sri Lanka, India, Tanzania, Guinea, China,
1. The implementation of the ‘Stop TB Strategy’
This strategy has greatly expanded the Tuberculosis diagnosis and treatment services and has saved millions of lives.
The development of new tools is a major component of the revised global efforts to stop TB Progress made in this area. They are now in the evaluation process and will be incorporated in to the TB control programme in the near future.
Systematic Strategy for screening and monitoring high risk zones
Where the population is concentrated such as,
a) Garment Industries
b) Factories
c) Prison Institutions
d) Rehabilitation Camps
e) Elderly Peoples Institutions
f) Orphanages
g) Mental Asylums
h) Low income communities residing in congested areas.
04. Changing of the campaign terminology strategy
In the campaign such terms as TB suspects, defaulters, control, Campaign tend to criminalize and use terminology that is patient unfriendly, Therefore in the control of Tuberculosis consideration is being given to the use of terms which are more humane and patient friendly which will make the patient more co-operative.
05Greater involvement of NGO’S/ CNAPT
In recruiting and mobilizing volunteers for treatment and supervision which will make Tuberculosis programmes efficient.
Compared to other South Asian Countries, Sri Lanka is far ahead in terms of quality of life, life expectancy, literacy and maternal mortality. This is a constant source of amazement to developed countries, who wonder how we can maintain such indices comparable to developed countries.
Ceylon National Association for the Prevention of Tuberculosis (CNAPT) Initiatives in Sri Lanka
It has been recorded that in countries poorer than Sri Lanka, such as Nepal and Bangladesh, (with per capita GNP of around $ 200, compared to a per capita GNP of US $840 for Sri Lanka) have managed more than 90% of controlled Tuberculosis treatment.
However, compared to other South Asian countries, Sri Lanka is far ahead in terms of life expectancy, literacy, and maternal and infant mortality. This is a consistent source of amazement to developed countries like Japan. It would be tragic if the TB situation in Sri Lanka was allowed to deteriorate, in spite of possessing such a record of healthcare.
This is where the CNAPT steps in educating the public in one of the areas most important in TB eradication. The CNAPT has been at the forefront of the campaign for the education of Sri Lankans. Over the past 70 years, the CNAPT has worked in partnership with the Ministry of Health.
In 1948 when tuberculosis (TB) was prevalent in Sri Lanka, the Ceylon National Association for the Prevention of Tuberculosis (CNAPT) was formed as a Government approved non government organization (NGO), aimed at launching a nationwide TB programme which had support and international cooperation. 70 years ago when medical treatment was at its infancy and TB was rampant with no definitive cure, Dr. J.H.F.Jayasuriya, Chairman of the Rotary Club, Colombo, sponsored a voluntary organization to combat TB through the auspices of the club. An inaugural meeting was held on 17th June 1948, thus heralding the beginning of the CNAPT.
A study was undertaken in collaboration with the medical personnel of the Respiratory Disease Control Programme of the Ministry of Health, the Centre for Social Survey and the University of Sri Jayewardenepura.
With the intention of spreading knowledge regarding TB, its spread, prevention and management as well as to inform the public on how and where to get the help and information required, the CNAPT, with the assistance of the Global Fund, also started a Health Education Programme.
The international community, WHO NGOs and the Sri Lankan Government have done a great deal for the prevention, treatment and management of the disease while also educating the public. Help is available, but people need to be informed where assistance and information can be found.
The CNAPT aims at promoting the concept of extending a helping hand by seeking community, public and volunteer assistance. Tomorrow will be better only through our efforts.
TB in children
Special hospital facilities were non-existent for children afflicted by TB The CNAPT remedied this by constructing three children’s wards: Welisara Children’s Ward (1952) Hawake Memorial Ward, Kandana (1955) and Clarence Nathnielz Memorial Ward, Welisara (1960) which provided a total of 165 beds exclusively for children. The total cost of Rs. 900,000 was raised through the efforts of the CNAPT.
Health Education
Since its inception the association has concentrated heavily on health education. The objective of the programme was to convey to the public that TB could be cured, patients must take prescribed treatment and those with suggestive symptoms be screened for they must take prescribed treatment and those with suggestive symptoms be screened for the disease. The programme also included lectures to specifically targeted groups, talks via electronic media, participation at public exhibitions and the distribution of TB related literature.
The proximity of the Health Education Centre to the Colombo Museum makes it accessible to any visitors to the Museum visit the CNAPT’s Health Education Centre.
