KARACHI, Sept 13: A panel of health experts, registering its serious concern over high incidence of multi-drug resistance (MDR) among the local TB patients, besides a surge in the disease prevalence , has urged a cautious approach towards management of TB through drug therapy.
The panel comprised Dr Mohammad Hussain, Dr Shaheena Qayyum, Dr Jawaid A Khan, Dr Nisar Rao, Dr Shakil Ahmed Siddiqui, Dr Tajammul Baig, Dr Zafaryab and Dr Ghazala Ansari, who expressed these views at a symposium held by the Pakistan Chest Society on Monday.
The event was arranged to observe the death anniversary of Quaid-i-Azam Mohammad Ali Jinah, who died of the disease in 1948, while the ailment continues to afflict thousands of people in the country.
The speakers attributed the rampant trend of "Non Compliance" on part of local patients to the poor realization among local medical community as how to counter adverse side-effects of the first-line anti-TB drugs through efficient and constant monitoring of the impact of the drugs on patients.
It was strongly recommended that all local general physicians urgently required to develop adequate skills to comprehend results of smear sputum tests, the basic source of a proper diagnosis, besides being capable of making proper prescription for the disease, equally affecting children and adults.
"A mere five to 10 per cent of local doctors were able to write proper prescription for TB," the participants of the moot were reminded by the speakers. People were also urged to see that cough continuing for three consecutive weeks or more must not be ignored, and the patient be immediately referred to some qualified professional, who, on the basis of smear sputum test, could make proper diagnosis.
Dr Shakil Siddiqui, who is consultant chest physician, Sindh Government Hospital, Korangi, reiterated the fact that TB could be cured through adequate and regular treatment and people must be educated on the importance of early treatment.
This was said to be particularly important for the patients with chest symptoms, especially cough persisting for three weeks or more, shortness of breath, chest pain, blood stained sputum, fever and weight loss.
The prevalence of TB was much more likely when someone in family was fond smear positive, he said. Dr Jawaid A Khan, head of the Pulmonary department, Aga Khan University, mentioned that Pakistan ranked sixth with highest TB burden under a situation when it was globally registered to be one of the biggest killer infection.
Every year, according to the World Health Organization, approximately 10 million people develop TB, and two to three million of them, he said, referring to a survey, jointly conducted by the PCS and the International Union Against TB and Lung Diseases, showing only five per cent of doctors well versed in making proper prescription on case to case basis.
He said strong recommendation was also made at a recent meeting to modify the curriculum of local medical institutions in accordance with local needs. Dr Mohammad Hussain, Consultant Pulmonologist, Liaquat National Hospital, in his presentation mentioned that management of MDR-TB, because of being time consuming and with long-term involvement of staff and financial resources, was difficult even in the developed countries.
An efficient TB control programme was the only solution to the preventable MDR, he said. Dr Nisar Ahmed Rao of the Ojha Institute of Chest Diseases explicitly discussed the minor as well as major side-effects of each of the first and second-line drug regimes, prescribed for TB treatment.
He strongly recommended frequent blood-level assessment, as well as physical examination, of the patients administered the drugs, to prevent the conditions, including those of serious nature, feared to turn irreversible if not dealt in time.
Dr Zafaryab Hussein of the Kulsoom Bai Valika Hospital, SITE, said the key factor in management of TB was correct prescription and adequate patient compliance. According to him, in a condition where people were denied proper treatment for the disease, there was a possibility of high prevalence of TB carriers, who might infect the otherwise healthy individuals.
The risk of disease could be high under the conditions, where people feel inclined towards discontinuing medication and might develop MDR, he added. Dr Tajammul Baig Mughal from the Civil Hospital Karachi, discussing "Diagnosis of Tuberculosis", said the diagnosis of Pulmonary TB was possible through sputum examination under microscope, adding that Smear Positive was highly infectious, and might infect approximately 10 persons every year for bout two years.
Chest X-ray and clinical condition might be the supplementary tools to diagnose TB, he said, adding that mass-scale sputum AFB was still the gold standard. -APP