Lack of awareness about tuberculosis in coastal villages
Pinky Akter : Sukhjan Bibi lives in Kaikhali village of Satkhira upazila with her two sons and husband, Abdur Rahim. Sukhjan’s third pregnancy was short-lived and she miscarried after about 6 weeks. She needed a surgery after complications arising from her miscarriage, which caused an infection in her uterus and led to two more operations. It took 3 surgeries, many other follow-ups and tests, and over one and half lac taka, till Sukhjan was finally diagnosed with tuberculosis. Her husband, Rahim is a fisherman and the sole bread-earner in the family and Sukhjan’s illness puts a tremendous financial and mental burden on the family. Even though TB treatment is provided free by the government, Rahim has to travel a long distance to avail the medicine which adds to his costs. Moreover, Sukhjan and Rahim were completely unaware that TB can affect the uterus (extrapulmonary TB – that is, TB, that affects any part of the body other than the lungs). Their lack of awareness also added to the delay in diagnosis. They spend a substantial portion of their monthly household income on other medicines, but their income is less compared to that which hampers their ability to afford basic nutrition. Interestingly, malnutrition is a risk factor for TB. On top of lack of awareness and delayed diagnosis, in such communities, frequent natural calamities also hamper TB management. As TB treatment is generally a long one, and requires taking medicine from DOTS centers, natural disasters can obstruct the TB affected people from accessing the health facility and may thus cause temporary disruption in the treatment course.
Mizanur Rahman, Senior Coordinator of Coastal Foundation said due to natural disasters on the coast, people affected by TB often cannot complete their courses, and in many cases, many of them become displaced/homeless after this disaster, which also affects their treatment. To avoid health complications arising from non-adherence to treatment and further transmission in community, he thinks that a special system should be in place in this regard.
Dr. Hena Khatun, Assistant Professor, Respiratory Medicine Department, Dhaka Medical College Hospital opines that awareness and knowledge about the disease can be increased through health education. For successful TB control, she believes that a multisectoral approach is needed. Reducing malnutrition, ensuring proper family planning practices, can help in reducing the incidence and burden of TB in the society. However, she also agrees that detecting TB in remote areas such as these coastal villages is challenging and more resources should be allocated in this regard.
According to the World Health Organisation’s Global Tuberculosis Report 2022, in 2021, about 375,000 people had TB in Bangladesh, that is, 1 person being infected by TB every minute. An estimated 42,000 people died in the same year from TB, which exceeds the number of total deaths due to COVID-19 in the last 2 years. On top of that, Bangladesh also has a high burden for drug-resistant TB which can be caused by delayed diagnosis and incomplete treatment of TB. Physicians say this is the biggest challenge in TB control in Bangladesh and believe that more resources need to be allocated towards ensuring early detection and completion of appropriate TB treatment.