Pakistan ranks fourth among countries with high incidence cases of multidrug-resistant Tuberculosis (TB). Pakistan has the dubious distinction of being the country with the fifth highest burden of TB in the world, following India, China, Indonesia, and the Philippines – all resulting from poverty, overcrowding, and malnutrition. Pakistan has 95 million people living below the poverty line of $3.65 per day. According to WHO Pakistan, with an estimated 510,000 new TB cases emerging each year and approximately 15,000 developing drug-resistant TB cases every year, it is ranked fifth among high-burden countries worldwide, and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. The country is also estimated to have the fourth-highest prevalence of multidrug-resistant TB (MDR-TB) globally. Key reasons for the emergence of drug-resistant forms of TB include: delays in diagnosis, unsupervised, inappropriate, and inadequate drug regimens, poor follow-up, and lack of a social support programme for high-risk populations.
In most countries, more men have TB, but in Pakistan, more women of childbearing age are affected, often with severe and advanced disease as a result of multiple pregnancies, poor nutrition, and restricted access to healthcare. TB disproportionately affects the poor, pushing vulnerable families into financial hardship while exacerbating existing social disparities. While a nationwide TB cost survey is still underway, there is compelling evidence to suggest that a significant proportion of TB-affected households face catastrophic healthcare costs (over 10 per cent of the household income), lost wages, and the inability to meet nutritional requirements during TB treatment.
Symptoms include a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody, weight loss, night sweats, fever, loss of appetite, swelling in the neck, tiredness, and fatigue. Doctors claim that while it is a serious condition, it can be cured if treated properly with antibiotics. Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever, and night sweats. Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Pakistan has a few available options for integrating social support models for persons with TB. The BISP Nashonuma scheme provides conditional cash transfers to children under two and pregnant and lactating women to improve health-seeking behaviour and nutritional intake. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. Microscopy detects only half the number of TB cases and cannot detect drug resistance.
People with active TB can infect 5–15 other people through close contact over a year.
Diagnosis can be made within 2 hours, and the test is now recommended by WHO as the initial diagnostic test in all persons with signs and symptoms of TB. Poor living conditions – for example, overcrowding, lack of ventilation, inadequate or low-quality food – play a big role in determining who gets to acquire TB. Rightfully, they argue that it can only stop TB if we deal with its social determinants. While acknowledging that “practical ideas for action are scarce”, these voices nonetheless underscore the need to provide social and economic support to urban poor communities in the region, amid the continuing rapid pace of urban migration and rising inequity. Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable. TB is spread from person to person through the air. When people with lung TB cough, sneeze, or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
People infected with TB bacteria have a 5–15% lifetime risk of falling ill with TB. People with compromised immune systems, such as people living with HIV, malnutrition, or diabetes, or people who use tobacco, have a higher risk of falling ill. When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking care and result in transmission of the bacteria to others. People with active TB can infect 5–15 other people through close contact over a year. Control of any disease is best achieved through awareness-building to erase myths and stigmas. Information flows at the grassroots about disease source, transmission, early diagnosis, treatment, and outcome are essential for a cure. Patients should be counselled about healthy nutrition and completion of the prescribed course of treatment. Coupled with professional counselling and liaison with the treating doctor, this will achieve a complete cure in the majority of patients. Prevention of spread to others will ultimately lead to TB control.
Tuberculosis is a disease of poverty and poor, malnourished, diabetic patients using corticosteroid drugs, drug addicts, smokers, the elderly, HIV-infected patients, alcoholics, and people living in overcrowded institutions like prisons. A large number of people infected with the tuberculosis bacilli are not diagnosed either because of poverty or because of a lack of awareness about the seriousness of the disease. The delay in diagnosis, along with unsupervised, inappropriate, and inadequate drug regimens, poor follow-up, and lack of social support programmes for high-risk populations, are some of the reasons for not reaching the target rates and emergence of a drug-resistant form of tuberculosis. Despite having social protection programmes such as the Benazir Income Support Programme (BISP) and the Sehat Sahulat Programme (SSP), TB-affected individuals remain largely excluded from these vital safety nets in Pakistan.
Tuberculosis is a treatable disease with a six-month course of antibiotics. However, prevention is better than a cure. It can be prevented by BCG vaccination and by awareness-raising campaigns on a mass scale. If somebody has the symptoms of tuberculosis, they should report to the nearest healthcare centres to get their sputum tested free of cost. Tuberculosis patients should not be stigmatised and must receive full support from family and community. To reduce the burden of the disease in Pakistan, there is a dire need to increase awareness among the public and especially among the youth through mass media.