Rashida lives in Nagarpara village under Gazipur Sadar Upazilla. She is a garment’s worker and her husband works in a local restaurant. They were passing their days struggling with poverty. But it was a bolt from the blue, when Rashida was detected with TB infection. Rashida stopped going to her workplace. Though she started drug therapy through a BRAC worker at the beginning but within few days her husband sent her to Mymensingh at her father’s residence.

Even though the cost for treatment was low Rashida’s husband scared of the costs of her supplementary nutritious food and to afford transportation cost of her going to the Health Centre. On the other hand as Rashida stopped working their family income also reduced. This is not only for Rashida, but also to most of the TB affected poor people who have to stop continuing their treatment because of lack of money. Thus, poverty increases vulnerability to TB infection. Information of the government of Bangladesh reveals that 30 percent of the TB affected people who aren’t extreme poor go under poverty levels as an economic consequence of TB and its management/treatment strategy. Experts working on TB state that malnutrition, overcrowds, insufficient ventilation and unhygienic sanitation facilities of the poor community increase possibilities /(risks) of TB infection. A recent study reveals that 70 percent of the patients that goes to DOTS Centers live under poverty level. The indirect cost of TB diagnosis and treatment affect poor people more adversely and as a result they show less interest to go to TB care centers. High incidences of deaths adversely reflected on the socio-economic condition where poor and the underprivileged people are affected most.

As per experts’ opinion, most of the people are found carrying TB virus on examination. Longevity of TB outbreaks and its danger should be realized on its greater socio economic perspectives. During the recent decades significant success has been achieved in this country in the areas of poverty alleviation, extended life expectancy, reducing maternal and child mortality rates and malnutrition. Therefore the experts on TB have identified poverty as a root cause of this infection.

`A publication (book), `Bangladesh TB Policy: A Civil Society Perspectives’ described that the poor people are getting infected by TB in one way and on other hand infection of TB can also bring the patients in to poverty. Treatment and other relevant costs become comparatively high for them. As TB destroys the physical and mental abilities of an affected person it also burdens the patient by cost of treatment simultaneously. As a result level and impact of poverty multiplies by many times. 90 percent of the TB affected people represents the most productive age groups, as such, they becomes economic and social burdens to their families.

Poverty is the major cause of TB not only in Bangladesh but the fact is similarly true also in other underdeveloped countries including Tanzania and Nigeria. A patient from Tanzania mentions, “though the treatment and diagnosis is freely available but sufficient food intake is required by the patients as the drug is applied in high intensity /(doses). Where there are most of the patients belong to poor families and they have to strive hard for their livelihood only, many a times TB patients of such families are compelled to keep themselves away from taking drugs.”

It appears to be a challenge to those patients who are malnourished, taking
anti-retroviral drugs, having other physical illness or poor to follow health care practices for long six months. Proper and a complete course of treatment deserve long time, physical strength and investment of familial resources of the patient. “Though the treatment is provided free but the other relevant/indirect costs have to be borne by the patients and their families”, mentioned in a report prepared on Bangladesh, Brazil, Nigeria, Tanzania and Thailand.

Indirect cost includes the costs of diagnostic tests, cost of transportation for going to the health centers, cost of nutritional supplements i.e. patients have to take sufficient amount of food during the course of treatment. At the same time income of the patients fall during this period as their working hour is reduced. On the other hand it is found in Nigeria that the patients avoid DOTS services because of the lack of their awareness about free treatment, lack of facilities or aspiration for getting better services at clinics. There, individual affordability gets more importance than the government policies. Non-governmental service providers go for chest X-ray of those patients who have their affordability rather than depending only on sputum test for diagnosis.

A statistics reveals that 70 percent of the poor TB patients in Bangladesh go for traditional healers, homeopath or quacks first for their treatment. As they provide their services by money, patients go for treatment if they can afford, if they can’t, they just keep themselves away from any treatment. Besides, often there remains the risk for MDR TB infection due to wrong treatment.

The Daily Janakantha
25 August 2007
Translated by: Md. Mahbubul Ashraf