While countries across the globe are battling with the TB epidemic, Pakistan also shares a fair portion of the burden. Unfortunately, the growing crisis has increased the number of cases to an alarmingly high level. As per global stats, the number of affected individuals was 10.6 million in 2022. Pakistan accounts for 5.8% of new TB cases worldwide, standing at number 5 in high TB-burden countries.

But why is Pakistan unable to control the growing crisis of the deadly infection? Which effective measures can ensure maximal reduction, and what difficulties exist with tuberculosis treatment in Pakistan? Let us briefly highlight these aspects in this month’s article:

Factors Contributing to High TB Prevalence

Understanding the root causes behind the deadly infection is imperative. Its infection is airborne,  and spreads from one person to another. Symptoms of tuberculosis include coughing, sneezing, or spitting. Although many people get infected with TB, only a few successfully battle it.

Your risk of getting sick with the TB germ is just 10%. Nevertheless, a considerable part of the population gets sick due to compromised immunity. Poor immunity results in highlighting the TB infection, leading from  latent to an active TB.

Smoking, which is common in Pakistan, intensifies the risk of TB. Likewise, regular use of alcohol weakens the immune system, increasing the risk of catching infectious diseases. Diabetes, another highly prevalent disease in Pakistan, is also linked to tuberculosis. Likewise, HIV weakens immunity and raises the probability of catching TB.

Pakistan's Challenge in Tuberculosis Management

Pakistan established a National TB Control Program to address the growing spread of the infection. This program, which works under the Ministry of Health, has initiated several strategies for detection and treatment.

WHO recommends DOTS (Directly Observed Treatment, Short Course) for effectively treating the epidemic. The NTP in Pakistan incorporated this strategy in 1995. However, further improvements were made in 2001 after the disease was declared a public health emergency.

Consequently, improvements were observed for detection and positive treatment outcomes. But despite such initiatives, many challenges persist, such as:

Lack of Education

 Due to low levels of education, the rural population of Pakistan is less aware of the cause and consequences of TB. It is the reason why they fail to make informed decisions regarding its treatment. Unfortunately, a large number of people are not even aware of the common TB symptoms, which include:

●       Persistent cough 

●       Sudden weight loss 

●       Tiredness and fatigue 

●       Night sweats or high-temperature

Moreover, tuberculosis is considered as a social stigma. Since people are unaware, they show reluctance towards vaccines and early treatment. On the flip side, illiteracy also gives birth to poverty. People hardly meet their daily bread and butter,  leaving no resources for treatment. Treatment delays then result in complications and spread of the disease.

Malnutrition

Besides illiteracy, another problem with TB treatment is malnutrition. Be it an adult, child, or a teenager, the rate of malnutrition in Pakistan is alarmingly high. Thousands of malnourished children face growth difficulties due to weak immune systems. Tuberculosis already opens the door to multiple health challenges. Therefore, in this context, addressing the root cause of malnutrition poses various complexities.

Even if treatment for tuberculosis is accessible, eradicating this underlying factor of poor immunity is imperative. It is due to malnutrition that the probability of survival in severe tuberculosis cases becomes a big question.

Humanitarian Crises

 Natural disasters leave a poor impact on the healthcare system. Especially in rural areas, moving from one place to another becomes even more challenging.  One such example is the flood in Sindh in 2010. After the devastating flood, TB cases in Sindh were reportedly higher compared to the previous year. This shows how natural disasters make it even more troublesome for the rural population to seek TB treatment.

Overcrowding and Dense Living Conditions

 One more concern discussed very rarely is dense living conditions. Crammed houses with minimal to no ventilation are home to infections and germs. TB transfers from an infected person's cough, sneeze, or spit within a short radius. In case of no ventilation, the probability of this transfer intensifies.

Lack of Vaccines and Shortage of Testing Facilities

Pakistan has a laboratory network for TB diagnosis. However, the rural population suffers due to the lack of testing facilities in nearby locations. Poor healthcare infrastructure, limited resources, and a shortage of skilled workers are the core reasons behind it.

BCG, a neonatal vaccine for protection against TB, is essential for every newborn. However, Pakistan faced a severe country-wide shortage in 2015. Millions of newborns missed the vaccine, even in urban areas. The shortage of medical facilities and vaccines makes Pakistan more vulnerable to growing health crises.

Spread Awareness, Save Lives: Let's Make Pakistan a TB-Free Country

 Many of the socioeconomic challenges hamper the early TB diagnosis. To address the growing issue, effective planning and strategies are imperative. Most importantly, awareness should be the prime focus. Educating people regarding TB symptoms, impacts, and outcomes can eradicate the stigmatization. Besides this, steps should be taken for patient counseling.. Having an understanding of how the treatment can protect them and their loved ones can motivate individuals to seek treatment.

Furthermore, Pakistan should also include additional strategies in its NTP. Countries like India, China, South Africa, Brazil, and many others are also adopting effective measures to curb the spread of TB. India is offering free TB screening and treatment besides incorporating it with other healthcare plans. They also provide free treatment for MDR and XDR TB.

Likewise, China has stepped up to train healthcare workers specifically for TB treatment. They also adopted preventive therapies to safeguard the high-risk group.  Isoniazid preventive therapy is one such example. Isoniazid is a medicine that reduces the risk of converting latent TB into an active TB.

Measures for effective case detection and treatment are also taken by several other nations. Pakistan along with other countries should stand together to globally eradicate the devastating virus. Recently, World TB Day was celebrated in Pakistan on 24th March 2024 as in other countries. Various events were held across Pakistan in which different speakers highlighted the need for TB eradication.

Federal Secretary of the Ministry of National Health Services, Ali Shallwani reaffirmed a TB-free nation. Likewise,   Dr. Razia Kaniz Fatima and Dr. Muhammad Ahmed Kazi emphasized collective action for TB management. The Prime Minister, Shahbaz Sharif also appealed for collaboration to tackle the growing TB crises.

SHINE Humanity's Initiatives for Tuberculosis

Shine Humanity acknowledges the severity of TB crisis in Pakistan. We have taken a few steps for this cause and aim at developing more preventive strategies. Should state that we are in the early stages of launching our very own TB program. It will be the newest edition to our ecosystem, and like any other SHINE Program, will offer free and specialized care to our beneficiaries.

In our already-established clinic at Gharo, we are training two doctors specifically for TB. With six modules left in their training, by mid-April, our doctors will be equipped to offer diagnosis and counseling for TB, based on sputum analysis and coughing. We will offer a six-month treatment plan and counsel the patients so that the disease spread can be curtailed.

Besides this, we are running a telemedicine clinic in Tando Hyder. The clinic serves as a platform for underserved individuals, where they get screened by a physician and connect with a qualified doctor. This initiative helps in the early detection of various diseases, including TB.

Likewise, our satellite clinics provide healthcare access to remote communities. Our team visits communities like Var Town, Gul Hassan Samo, and Peer Daryabad for weekly consultations.  We have also taken numerous steps to address malnutrition, which is another reason behind TB prevalence.

Help  Shine Humanity in this journey towards TB eradication. Donate now to tackle this health crisis in a holistic and preventative manner. Together, we can save millions of lives. All we need is a collective effort towards awareness and treatment strategies.