National Tuberculosis Control Program (NTP) is under question due to statistical error though the detection program of tuberculosis has recently crossed its development goal in Bangladesh. TB control program started in Bangladesh since 1965. The government of Bangladesh has started a countrywide consolidated TB control program with different non-governmental organizations in 1998. Based on the prevalence survey conducted by World Health Program in 1988, the present programs of situation analysis and NTP has been started. According to the ARTI (Annual risk of TB infection) set by World Health Organization, at least three hundred thousand people are getting newly infected with and about seventy thousand people are deceased by tuberculosis in every year. World Health Organization has set a target for Bangladesh to detect 70% of the TB patients by the year 2005. Annual Report 2006, National TB Program (under print) says, though the NTP could not reach its target by 2005, but 71% of the TB patients were detected within 2006.  This rate was 61% in the year 2005. It was 46% and 41% by 2004 and 2003 respectively. According to the views of experts, if the rate of detection continues to be 70% the death toll from tuberculosis in this country can be reduced to 50% by 2015.

But in every year there are 3 hundred thousand people getting newly infected with TB which adds more 1 hundred thousand patients of the previous year. That is, though 70% patients are detected with tuberculosis infection in every year, but the rest 30% patients are kept apart from NTP coverage. The NTP has no record of this 30% TB patients, where they use to go for their treatment, what types of drugs are they taking and whether they become cured at all or not. As a result, it is not possible to take those patients under its coverage who do not get treatment offered by government. According to the NTP information, it was not possible to detect 59% patient in 2003, 54% in 2004, 39% in 2005 and the latest 29% in 2006. NTP does not also know whether this large number of unknown patients gets any treatment or not.

The main issue of the treatment of tuberculosis is to continue medication for six month without any break. But there is no mechanism of knowing the fact that those who take treatment from pharmacies or private practitioners, whether they take full course of treatment or even after full treatment to what extent are they get cured or not. As a result there creates two types of risks in our society. The unidentified patients contaminate TB among their fellow beings; on the other hand those detected patients who do not complete their courses of treatment become Multi-Drug Resistant (MDR)-TB patients.  These MDR-TB patients also contaminate MDR bacteria. According to the views of experts, the treatment of MDR-TB is expensive and long-term. Most of the patients do not have their ability to take this treatment. Besides, the rate of success of this treatment is also low. As a result hundred thousands of previous TB patients get out of trace in the bulk of newly infected 3 hundred thousand patients. They always kept out of NTP coverage. The traditional belief of the community is also a major obstacle to combat against TB. The incidences of isolation from society are not even unusual if a person is known to be infected with tuberculosis. As such, many people still hide their tuberculosis infection that hinders their treatment. In this situation it is necessary to take steps for detecting these unknown patients. The national tuberculosis control program cannot be successful keeping this large number of unidentified patients apart.
Dr. Pravat Chandra Barua, the line director of TB & Leprosy mentioned that National Tuberculosis Program is not a solitary organization while he was speaking on the activities of government to bring them under NTP coverage. This program has been implementing in 64 districts of the country in collaborations with of government and non-government organizations. The government has arranged sputum test facilities and provides TB treatment free of cost at every up-zila all over the country. Even then people use to go or compelled to go other place for their treatment. He opined that the main barrier of the control of tuberculosis is social restrains. People abstain from going to physicians due to poverty and lack of education and health awareness. As a result the diseases grow further among them. Awareness should be raised among them. He mentioned, NTP is doing its best to take TB treatment facilities at doorsteps of the people. Moreover, people from all levels should come forward to make further awareness among all people of society. Everyone should play their roles from their respective places. It is not a responsibility of the government alone, but also a responsibility of all. On this context, Dr. Asif Muztaba Mahmud, Associate Professor, Respiratory Medicine Department of National Institute of Chest-diseases and Hospital mentioned that, the whole population of the country must be brought under the coverage of NTP. Mass media should also come forward to control tuberculosis through raising awareness of this mass people. Dr. Saifuddin Bennur, Assistant Professor, Respiratory Medicine Department of National Institute of Chest-diseases and Hospital suggested resetting the development goal of World Health Organization. He mentioned new research activities are needed to make the ongoing program successful which was initiated on the basis of a very back dated statistics and information of World Health Organization.

Mr. Afsan Choudhury, Director of BRAC Advocacy and Human Rights Unit said that the present and real scenario of tuberculosis cannot be revealed clearly from the current program based on very back dated information and data. He added that the findings of the survey of World Health Organization conducted in 1988 were not
well-established. Correct information should be provided to the civil society if we want them to integrate into TB control program. Mass integration couldn’t be achieved if correct information is not disseminated.  

Dr. K. Zaman, Epidemiologist of ICDDRB informed that national TB prevalence survey has been started recently in Bangladesh. WHO, ICDDRB & NTP have been jointly conducting this survey by the funding support of USAID. The principal researcher of this survey in Bangladesh Dr. K. Zaman informed that the prevalence survey is going on in 40 upzilas of the country at this stage. In this program the present situation of tuberculosis in the country will be determined by testing TB bacteria among 50 thousand people. He added this survey will take about one year to be completed.

The Daily Samokal
18 August 2007
Translated by: Md. Mahbubul Ashraf