Dr Shyam Lohani

Around 4,000 people die of tuberculosis (TB) every day around the world. TB is a disease, caused by Mycobacterium tuberculosis, making it the world’s leading infectious disease killer, by far. The bacteria usually infect the lungs, but other parts of the body can also be damaged. The bacteria that cause tuberculosis spread through the air droplets when someone with the active form of untreated tuberculosis coughs, speaks, sneezes, spits, laughs or even sings.

Burden
Tuberculosis is one of the easily preventable as well as curable diseases. It infects about 10 million people every year around the world, killing about 1.5 million. Worldwide, TB is one of the top 10 causes of death and the leading cause of a single infectious disease which accounts for more deaths than HIV/AIDS.
In 2019, 5.6 million men, 3.2 million women, and 1.2 million children contracted TB, totaling an estimated 10 million people worldwide (WHO, 2020). People from all countries and ages are susceptible to contract TB. Every day, about 15 people succumb to TB in Nepal, and over 180 people are infected with it. A recent survey revealed that around 117,000 people are currently living with TB in Nepal. Similarly, in 2018, 69,000 people developed active TB. It has been shown that the case incidence was higher than previously speculated.
In 2019, 87 per cent of new TB cases were found in 30 high TB burden countries. Among the eight high burden countries that account for two-thirds of the total cases, India leading the case count followed by Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. In 2019, 1.2 million children were infected with TB globally. Often overlooked by health providers, child and adolescent TB is difficult to diagnose and treat.
Multidrug-resistant TB (MDR-TB) remains a public health threat especially in high burden countries. In 2019 alone, a global total of around two hundred thousand were diagnosed with multidrug- or rifampicin-resistant TB (MDR/RR-TB), a 10 per cent increase from 2018. However, globally, TB incidence is falling at about 2 per cent per year and the cumulative reduction was only 9 per cent between 2015 and 2019. Moreover, this was less than halfway of the End TB Strategy milestone of 20 per cent reduction from 2015 to 2020. It has been estimated that around 60 million lives were saved through TB diagnosis and treatment between 2000 and 2019.
A bad cough lasting 3 weeks or longer, weight loss, loss of appetite, coughing up blood or mucus, weakness or fatigue, fever, and night sweats are symptoms associated with TB lungs. There are mainly two types of TB. In latent TB, we have a TB infection, but the bacteria remain in our body in an inactive state and cause no symptoms. Latent TB, which is also known as inactive TB, is not contagious. However, it can turn into active TB if left untreated; therefore, treatment is important for the person with latent TB and to help contain its spread. Two billion people worldwide have latent TB. Active TB makes infected people sick and in most cases can spread to others. It can develop into an active form in the first few weeks after infection with the TB bacteria, or it might occur years later.
Although tuberculosis is contagious, we will not easily catch the infection and much more likely to get tuberculosis from someone we live with or work with than from a stranger. Most people with active TB undergoing TB drug treatment for at least two weeks are no longer contagious.
United Nations Sustainable Development Goals (SDGs) aim to eliminate the TB epidemics by 2030. The End TB Strategy has set milestones (for 2020 and 2025) and targets (for 2030 and 2035) for reductions in TB cases and deaths. Comparing with 2015, SDGs targets for 2030 are a 90 per cent reduction in the number of TB deaths and an 80 per cent reduction in the TB incidence rate (new cases per 100,000 populations per year). Similarly, the milestones for 2020 are a 35 per cent reduction in the number of TB deaths and a 20 per cent reduction in the TB incidence rate. A 2020 milestone that TB patients and their households should face no catastrophic costs as a result of TB disease is also the strategy of SDGs.

Targets
It is also estimated that every dollar invested to eradicate TB in Nepal, returns 43 US dollars, besides the multiple benefits of a healthy society that contributes to the economy substantially. Nepal has set targets to stamp out the tuberculosis epidemic by 2050 with the intermediate target of reducing TB incidence by 20 per cent within the year 2021 in comparison to 2015. From 2016 to 2021, Nepal also aims to achieve case notifications by a cumulative total of 20,000.
The National Tuberculosis Programme has been entrusted with dispensing and managing treatment of tuberculosis free of cost through health posts, primary health care centres, and hospitals. Along with the treatment and management of Multi-Drug Resistance TB (MDRTB) cases, the programme aims to focus on new challenges of TB/ HIV co-infection, childhood TB management, and TB among diabetics.
The national target can only be achieved with the commitment of all the stakeholders. The government’s initiatives require cooperation and coordination from both public and private health sectors including private medical colleges, clinics, pharmacies as well as patients, their family, community, and religious and community leaders.

(Professor Lohani is the founder and academic director of Nobel College. lohanis@gmail.com)