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Tuberculosis

TB is contagious and potentially a fatal disease that is present since mankind evolved. Talking about current scenario there are huge number of deaths due to increasing TB cases. This has gained much attraction at global level , WHO has put all its efforts and has visioned to end TB epidemic by 2035. Each country individually, especially like India which has highest number of TB cases has put forward many programs like NTEP and RNTCP to control its increasing TB cases . Despite of all these striving attempts there is lack of knowledge in rural India and there is prevailing stigma around. Also many factors like financial, social, lack of awareness, poor habits, pill burden and low socioeconomic level , TB conqueres and haunts the world and is difficult to eliminate . As medical undergraduates we can give our small efforts to make big differences in fighting against disease.

Mother Teresa correctly aforesaid “the biggest disease today is not leprosy or tuberculosis but rather the feeling of being unwanted” and it has lead to tremendous agony . World TB day is marked on 24 March each year, the anniversary of koch’s original scientific announcement .

Tuberculosis has existed since time immemorial. The archaic evidence of disease comes from remains of bison in Wyoming dated to around 17,000 years ago. Researchers have found tubercular decay in spines of Egyptian mummies and with more such evidence today also TB threatens the whole world .

Despite advancements in science and technology in medical field and with enormous research from past many years , TB still has not been eliminated from the world, because of many reasons like people just focus on managing people who are sick rather than trying to prevent cases of the disease. There is no planned population screening of citizens at higher risk and immigrants from TB prone countries and contact tracing. Other reasons like most pathogens require hundreds and even thousands of organism for the disease to start growing inside human body but TB requires ten or fewer bacteria and it is a slow growing disease and can be inside a person for several months or even a year or two before symptoms such as coughing weight loss etc. arise and in this latency a person can transmit disease . Talking about the pill burden a patient being treated for drug resistant TB will swallow around thousands of pills over a period of two years , this is an exceptionally long course of treatment compared with other bacterial infectious disease which makes a challenging task to ensure patient adherence, manage side effects, monitor for toxicity of drugs. For these reasons patients do not complete drug regimen which leads to emergence of more drug resistanct bacilli . In developing countries like India patients do not remain in touch with health care workers , sometimes it takes nearly two hours to reach clinic if they even have funds for transport in first place. The bus fare with loss of income from missed work is financially crippling and the patient procrastinates regular hospital visits. And on the other hand BCG vaccines are effective only for children and not for adults. Furthermore it prevents disseminated disease in children including TB meningitis and miliary TB not the pulmonary TB. Various other factors like overcrowding, poor hygiene, smoking, alcoholism, poor nutrition, political interference, poor medical public-private coordination also plays a crucial role that prevents TB eradication.

Even though it has a great prevalence in the society, TB is one of the most misunderstood disease with many misconceptions surrounding it, therefore “Tomorrow is going to be too late, let’s take steps today and burst myth related to disease.” Although it has a prevalence in low socio- economic strata but TB is not always a poor

man’s disease, no person is immune to tuberculosis infection. TB also occurs in patients like HIV, diabetes mellitus or malnutrition contrary to the belief that TB is a disease of smokers. TB not only affects lungs but it also affects kidney, spine, brain, etc. TB is spread to others through coughing but in case if the person has not any symptoms of coughing then it is not risk of infection, so every patient of TB need not to be isolated. In last TB is fatal disease for those who are at higher risk but it can be cured with timely diagnosis and treatment and therefore life with TB is anguished but the good news is that we can get rid of the disease !

“Too many falsely believe TB is a disease of past but to truly relegate this disease to the pages of our history books, we must identify better ways to detect and treat TB and we must stop the emergence of further drug resistance.” by Dr. Jonathan mermin . During recent times of COVID pandemic the cases of tuberculosis has reduced indirectly because of preventive measures like mask , isolation and lockdown practices but morbidity and mortality due to it is still significant and therefore both governmental and non- governmental organization are now joining hands together to decrease the burden of disease as much as possible .

Various non-governmental organization plays a pivotal role by working dedicatedly towards the elimination of TB . In a country like India the corporate TB pledge program is a joint initiative of the Government of India and USAID in collaboration with the International Union against tuberculosis and lung disease with the objective to develop a shared TB vision in alignment with PM Narendra modi’s vision of eliminating TB in India by 2025. This corporate TB pledge program was launched in April 2019 and offered a tiered approach for corporate to use their resources to combat TB, raise awareness of TB as a curable disease and ultimately improve TB health outcomes .

“Every breathe of yours is worth million dollars smile of your loved ones , keep TB away and live healthy”. I think keeping this in mind at a global level WHO has put forward end TB strategy. It has a vision of world free of TB with zero death, it has set various targets to be fulfilled by 2035 like 95% reduction of TB death compared with 2015 and therefore various country government can follow guidelines like integrated patient centered care and prevention like early diagnosis and treatment of TB, collaborative TB-HIV activities and preventive treatment of person at high risk. Government should make bold policies in supportive system with strong political commitment, engagement of communities, public and private health care providers, universal health coverage policy, regulatory framework for case notification, vital registration, quality and rational use for medicine, developing drug regimens to decrease pill burden, social protection, poverty alleviation, and action on other determinants of TB. Political leaders should encourage discovery, development and rapid uptake of new tools , interventions and strategies and research to optimize implementation and impact and promote innovation. In a country like India which has highest number of TB cases, the Government of India developed National Tuberculosis Elimination Program and it has a vision of achieving TB free India which provides various free of cost quality tuberculosis diagnosis and treatment service across the country through government health system.

Inspite of this much endeavours by government it feels somber that some people in community still perceives disease that it is spread through contaminated food, sharing meals, sharing utensils and by having sexual intercourse with a TB patient. In addition females unemployed and persons having less than six years of education were also more likely to associate stigma with TB and we can find that there is an association between lack of knowledge about TB and perceived stigma .

As a medical student, I can at my undergraduate level, participate in various awareness program at PHC, CHC , district level and educate and communicate with people about prevention, risk factor, disease related misinformation. I can go for various bicycle awareness rallies in villages where people has less knowledge about the disease. I can participate in poster-making, wall painting and various other activities to spread awareness. So let’s join hands and kick that disease out of the block. All we need is determination to fight it off with grit .

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