March 8, 2006	Wednesday	Safar 7, 1427

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ISLAMABAD, March 7: Mercy Corps, an international humanitarian organization has called for adopting a targeted strategy to avert the outbreak of the air-borne bacilli of tuberculosis in the earthquake hit areas.

The Mercy Corps said: “If an urgent and targeted strategy is not applied to contain the air-borne bacilli of tuberculosis, indications are that the cases of tuberculosis in the earthquake areas will multiply to alarming proportions making otherwise curable and preventable TB, a living nightmare.”

It said in the earthquake-hit areas, official preventive programmes for TB, HIV and malaria had been seriously disrupted. TB was potentially breeding on populations ravaged by poverty and malnourishment, a rampant phenomenon in earthquake affected areas of NWFP and AJK.

Already, the number of TB patients was on the increase in NWFP from 18,500 in 2004 to 24,500 in 2005. The situation in the quake-hit districts of the province would only increase the number, it said.

Mercy Corps country director, Faiza Janmohammad said that TB control was a big challenge for the public health managers in the earthquake hit areas as traditionally in these areas, the public health sector - consisting of a network of four-tier health care facilities and community based health workers - provided almost exclusively preventive health services while the private health sector largely providing the curative health services.

She said public-private partnership was key to reviving the disrupted health care system in quake-hit areas.

She stressed the need of implementing the TB control programme in the whole of the country with equal coverage of World Health Organization (WHO) recommended Directly Observed Treatment Strategy (DOTS) instead of a sporadic interventions made by the health department in the past.

Referring to the official figures that approximately 40 per cent of the TB patients were lost at the follow-up treatment in the affected areas, she warned that sporadic interventions in the aftermath of the quake could develop into Multi-Drug Resistant (MDR-TB) in which a TB patient develops resistance to different TB medicines.

A recent health situation report of the quake-hit areas by the health ministry noted that the number of acute respiratory infection cases was still the highest among reported diseases.

Out of 36 primary health care centres providing TB care in AJK 30 are in tents. Twenty-eight diagnostic centres for TB and 70 out of 96 treatment centres were functional in NWFP, the report added.

It said Mercy Corps along with the National TB Control Programme and the WHO, was engaged in critical TB control activities in Battal in the Mansehra district. “Additional work needs to be done to restore diagnostic and treatment centres in these areas,” it said.

DOTS could only be successful if there was a sustained political commitment, access to quality assured TB sputum microscopy, standardised short-course chemotherapy to all cases of TB under proper case management conditions, uninterrupted supply of quality assured drugs and recording and reporting system enabling outcome assessment.

If any one of the DOTS elements is missed during implementation, TB control is rendered ineffective resulting in MDR-TB and if around Rs600 is needed to cure one TB patient then more than Rs100,000 is required to treat one MDR case.

There are no drug resistance data available for Pakistan, although WHO estimates a prevalence of MDR in new TB patients of 10 per cent. Patients in whom MDR-TB is diagnosed are not treated under the National TB Programme.

It is a daunting task to implement DOTS in around 250 union councils in the catastrophe stricken areas.