KARACHI, March 29: Tuberculosis-induced mortality rate in local women appeared higher than all other causes and as such the situation requires an integrated approach to combat the ailment.
Experts discussing ‘TB and required control programme’ at the Saturday’s scientific session of the ongoing International Congress on Infectious Diseases reminded that women in their productive years appeared more vulnerable to the disease than men of the same age group.
The congress has been organized under the aegis of Infectious Diseases Society, Pakistan.
It was suggested that various departments, including women development, social welfare, family planning and health, must initiate close and coordinated efforts to address the scenario as TB in women severely affect family life and the children.
It was also observed with great concern that TB, though not generally considered to be a child disease, was increasingly noticed among local children. The situation is all the more serious as diagnosis of the disease in children is quite difficult and so is its management.
Dr Amanullah Ansari, speaking on the occasion, mentioned that the National TB Control Programme was currently in process of developing a separate TB guideline for children in coordination with Pakistan Paediatric Association and Pakistan Chest Society. These guidelines are likely to be finalized by the end of this year.
He acknowledged that TB could affect the rich as well as the poor and observed that people in impoverished and drought-affected districts of Sindh had reported more cases than other areas. He was of the view that there was a definite correlation between TB and poverty.
Referring to the statistics, he said that in Tharparkar an estimated 1,841 cases were detected in a population of 1.04 million and 1,824 (99 per cent) cases were detected in 2002 alone. In Umerkot and Dadu 1,161 and 3,275 cases were estimated. The figures showed that 2001 cases were detected in Umerkot and 3,668 in Dadu showing the detection percentage at 172 and 112 respectively.
In Karachi, he pointed out 4,149 TB cases were detected as against the estimate of 21,045. He, however, adding that many more cases might not have been reported. He opined that Karachi posed a real challenge to the disease and could be a role model for urban DOTS.
Discussing the DOTS Expansion for TB Control in Sindh, he said proper DOTS was started in Sindh in 2000 in the most difficult district of Tharparkar. It had been practised at the Ojha Institute of Chest Diseases and some other pilot sites since 1996.
An ADP scheme of Rs95 million has been approved for three years (July 2000-June 2003). The PC-I is currently under revision and the scheme will be continued till June 2006 paving the way for integrating TB services with PHC.
Admitting that the case detection process appeared to be usually slow in new districts and proportion of smear positive cases needed to be increased, Dr Ansari said that success rate was likely to improve as DOTS is being expanded and no room was being kept for complacency.
Multi Drug Resistance (MDR) incidence, he stressed, might not be a major problem as generally assumed.
He claimed that Sindh would attain universal DOTS coverage by August this year and complete 70 per cent of case detection process by the year 2005.
The current case detection rate is 36 per cent which is expected to increase to 45 per cent by Dec 2003, 60 per cent by Dec 2004 and 70 per cent by Dec 2005, he said.
To maintain the pace, he said laboratory network was being streamlined to create greater confidence in the programme and the district managers. Moreover, he added, 1,095 doctors, 910 paramedics, 197 lab technicians and 3,884 LHWs had specifically been trained under TB Control Programme till Dec 2002.
To a question, the speaker replied that reporting delays and errors were indicative of low-motivation of District TB Coordinators. To address the situation, meaningful partnerships are being built, he said.—APP
