Social awareness is key in tackling stigma associated with tuberculosis
Pinky Akter : Rukhsana Siddiqui, a resident of Dhaka, had a prolonged cough, along with a few other common tuberculosis (TB) symptoms. She suspected that she had TB, yet she still delayed going to the doctor for a confirmed diagnosis. Despite her deteriorating physical state, Rukhsana was aware about the equally heavy social burden the disease carried and knew that her husband may leave her, if she tested positive. Fear of being shunned by her husband, isolated by family and ostracized by society, Rukhsana hid her ailments from everyone. She continued living in denial and concealing her condition, until the situation got dire and she finally sought medical help at the last stage, at the cost of a negative effect on her marital and family life. Rukhsanais currently on TB treatment and her physical condition is gradually improving. As a TB survivor, she now advocates to raise awareness about the disease and remove stigma associated with it.
Lack of awareness about TB (ranging from information about TB, signs and symptoms, preventive measures, where and how to test and seek treatment) play a key role towards this high disease incidence. Moreover, TB remains a highly stigmatized disease in our society, and the fear of stigma compels people to hide their TB status, which further increases disease transmission. Experts believe that this very factor, stigma – is one of the main obstacles in ending TB from the country.
Bangladesh is one of the 30 high tuberculosisburden countries in the world where one person succumbs to death due to TB every twelve minutes. Despite the age-old belief that there is no cure for TB, the disease is, in fact, preventable, treatable and curable. In Bangladesh, TB diagnostic tests and treatment are provided free of cost by the government to all citizens. Yet, the disease incidence rate is very high with one person falling ill with TB every single minute. In 2021, 375,000 individuals were infected with TB in Bangladesh and 42,000 deaths were attributed to the disease. TB is an airborne disease and is usually transmitted from one person to another when the bacteria is passed through the air when a person with TB disease someone who is sick with TB disease of the lungs or throat coughs, speaks, laughs, sings, or sneezes. Anyone near the sick person with TB disease can breathe TB germs into their lungs.
Though TB can affect anyone, studies have shown that those living in overcrowded households, having poor nutritional status; having other co-morbidities are at higher risk of being infected. Due to these risk factors, the prevalence of disease is higher among people from low socio-economic backgrounds.
Dr. MahfuzaRifat, country representative of Damien Foundation, confirmed that many TB patients in Bangladesh do not start TB treatment for fear of stigma within their families and society. She also said that a large proportion of TB-affected individuals come from poor households, who live in slum/slum-like areas. Latent TB infection, or LTBI, is another serious concern in the country. People with LTBI have the TB bacteria in their body in the latent stage, which may become active and progress to disease later in life. In addition, environmental pollution, drug addiction, diabetes and other co-morbidities can increase the chance of having TB disease.
Mass awareness campaigns, counseling for the disease, and sensitization campaigns at community level using society gatekeepers should be conducted to increase people’s knowledge about the disease, identify signs and symptoms, where to seek healthcare is symptomatic, and destigmatizing the disease. Doctors say that in a year, 10 individuals can be affected by TB disease from only one individual with TB disease, if that person is not under TB treatment. Therefore, it is of utmost importance to ensure early diagnosis and treatment of TB affected individuals. On top of that, to reduce transmission at household and community level, contact tracing and investigation of close contacts of a TB-affected person should be prioritized.
Even a few decades ago, we all knew that there is no cure for TB. But times have changed and TB experts now say “There is no fear of TB”. With advancements in medical research and technology and through the relentless efforts of the Bangladesh government and NGOs, the country now offers advanced testing options and treatment regimens. While as a country, we still have a long way to go to earn the goal of ending TB from Bangladesh, if everyone joins hand and pledges to contribute towards this goal, and help in raising awareness about the disease from their own sector, a TB free Bangladesh could be very near the horizon.