Tuberculosis is one the leading causes of mortality in the infectious diseases category after COVID-19. In this essay describes the reasons for difficulty in eradication of Tuberculosis from the world.
Tuberculosis (TB) is the menace that has plagued the world from times innumerable. About 10 million [1] people worldwide have fallen victim to its ill effects, just in the year 2020. Furthermore, in spite of Coronavirus (COVID-19) pandemic claiming hundreds of precious human lives, TB has still managed to hold its position at the top of the list as the second leading cause of death amongst infectious diseases after COVID-19[1].
As per the geographical distribution of the disease according to The World health organisation (WHO), south east Asian countries account for more than 43% new cases of TB. Most of these countries, being developing countries, with India topping the list [2]. Maharashtra and Uttar Pradesh are the two states with maximum number of TB cases in India [3] while also being the most populous states in the country [4]. Majority of the population of these areas live in the slums [5] and belong to the lower socioeconomic strata. Low socioeconomic status owing to poor living conditions, overcrowding, poor ventilation and sanitation and improper healthcare benefits account for the raging mini-TB pandemics in these areas. The poor living conditions aggravate the transmissibility of the infection calling forth an uncontrolled disease spread.
TB being an ancient disease it is, has accounted for many lives, creating a growing fear in the hearts of many more. Many people diagnosed with TB don’t even want to believe their diagnosis and go to quacks to exorcise this “evil spirit”. Severely stunted public knowledge on such infectious diseases is also one of the causes for delayed diagnosis and furthermore delayed patient management. The stigma of Tb runs so deep in the human mind that people fear the diagnosis. When diagnosed individuals are faced with emotional and mental turmoil as they would be down casted in the society and fall victim to mental trauma. Public ignorance and nonsensical beliefs need to be put to an end; the general population need to be educated.
Fifty percent children [6] living with TB are asymptomatic and only diagnosed after being screened as a close contact. Sometimes due to difficulty in obtaining body fluid specimens for diagnosing, many physicians will overlook the possibility of tuberculosis and the child remains undiagnosed for months, spreading the infection to hundreds of other children. This calls for an urgent need to train all healthcare workers in identifying the symptoms and also producing a fixed set of diagnostic guidelines for managing TB.
As many of us are aware, the treatment of TB is a rigorous course of antibiotics for a period of 6 months or sometimes extending up to a year or two depending on the response to antibiotics. Along with the cocktail of antibiotics come disturbing side effects such as vomiting, nausea, jaundice, peripheral neuropathy and many more. Now battling these complications for a prolonged period is what keeps patients from completing the course as the treatment is more tedious than the disease itself. Thus, individuals prefer alternative medication, they skip doses or simply discontinue the treatment. This is where antibiotic resistance comes into the picture. Repeated drug defaulters end up with multidrug resistant or extremely drug resistant TB. Furthermore, a new variant has been discovered i.e. totally drug resistant which doesn’t respond to any treatment, though this name hasn’t been approved by the WHO, a few cases have been reported in many countries [7]. According to WHO total drug resistance has shown up on Drug sensitivity testing because of faulty apparatus and improper diagnostic protocols.
It has been well established by the emergence of new strains that if not controlled TB will wreak havoc in the lives of millions. This problem needs to be tackled from the root staring with the people, they must be educated and the social stigma needs to busted.
References: [1] https://www.who.int/news-room/fact-sheets/detail/tuberculosis [2] https://tbfacts.org/tb-statistics/ [3] https://www.statista.com/statistics/1187232/india-states-with- highest-tb- notifications/#:~:text=In%202020%2C%20Uttar%20Pradesh%20had,eight%20and% 20seven%20percent%2C%20respectively. [4] https://www.census2011.co.in/states.php [5] https://www.census2011.co.in/slums.php
[6] Marais, B., Gie, R., Hesseling, A., Schaaf, H., Lombard, C., Enarson, D., & Beyers, N. (2006). A Refined Symptom-Based Approach to Diagnose Pulmonary Tuberculosis in Children. Pediatrics, 118(5), e1350-e1359. doi: 10.1542/peds.2006-0519 [7] https://www.who.int/news- room/questions-and-answers/item/tuberculosis-totally-drug-resistant-tb