World TB Day falls on March 24th, and this year's theme aims at putting an end to
the global epidemic and bring TB-related deaths to zero. Of the 9 million people who
get sick with TB every year 3 million are missed i.e. they fail to get the care they
need. The World TB Day 2014 targets to 'reach the 3 million; find, treat and cure TB
March 24 is observed globally every year as World TB Day; it was on the same date in
1882 that Dr Robert Koch astounded the world with his discovery that TB bacillus
is the cause of
tuberculosis. The announcement came at a time when TB was rampant in Europe and the
Americas killing one out of every seven people affected.
TB is a curable disease. It is a bacterial infection
that can spread to
any organ in the body though the lungs are most commonly affected. A six-month
course of drugs can completely cure most people with TB. An incomplete treatment is
more dangerous, it harbingers
the return of TB in a more
resistant form. In 2012, 8.6 million people fell ill with TB, around 1.3 million
The global war against TB has saved nearly 22 million lives since 1995; a 45 %
decrease in TB has been registered since 1990. Despite these reassuring statistics
the rash truth that 3 million people are "missed" each year serve as a pointer to
the inefficiency of our health systems
. The proportion of missed
cases has remained the same for the past seven years. Nearly two-third of the missed
cases reside in South Asia and Africa.
Why are 3 million missed?
* People with TB may not access care at all- Awareness of TB appear to be limited.
Those with TB continue to suffer discrimination, stigma
, rejection and social isolation.
The very poor who cannot afford user fees or transport may keep away from health
* Those who access health services may not get diagnosed- Overburdened and
staff may fail to identify the
symptoms; inaccurate and inappropriate tests can prevent a proper diagnosis.
Children with TB are the ones often missed or overlooked. Children are estimated to
account for half a million new TB cases every year and nearly 74000 deaths.
* Despite a diagnosis, people with TB may not be documented-Lack of documentation of
reported cases is a major problem. Gross weaknesses in recording and reporting exist
within our public systems. There also exist poor coordination between the government
sector and the private sector. It is not uncommon to find private practitioners and
hospitals who fail to adhere to the standard protocols of diagnosis and management.
Reaching three million is an arduous task. We need an aggressive campaign to ensure
access and coverage for all; TB 'hotspots
' need to be recognised. The
underserved and vulnerable communities need to be identified. Attempts must be made
to reduce the stigma associated with TB. We need more investment in basic research.
Fast diagnosis, treatment and prevention require the development of better tools-
efficient screening tests, newer drugs and vaccines. We need to strengthen specimen
transport and patient referral systems. Healthcare providers should be trained
Strategies That Worked
The participation of female Health Extension Workers (HEWs) in Ethiopia, an area of
over 3 million people, doubled TB case notification in years' time. HEWs are lay
workers with a small government salary who provide basic services to their
community. They were trained to identify the symptoms of TB, collect sputum and
Better screening of people attending health facilities did wonders in Afghanistan.
It trained staff across 47 health facilities in screening and sample collection;
within a year, over 70 % more cases were identified than the year before.
Myanmar developed an evidence based national response planning to identify its heavy
burden of missed TB patients
. A national survey found out
a higher burden in urban areas, in men, and among the elderly.
New molecular tests that can better identify cases of TB than smear microscopy
have been developed.
Xpert MTB/ RIF is such a rapid diagnostic test; countries such as Moldova and South
Africa are working hard to improve access to this test.
Countries like India, Pakistan and the Philippines are trying hard to engage the
private providers in their national programmes. China improved her surveillance
systems by setting up a national web-based for mandatory reporting of infectious
diseases. The use of a low cost system that involved the use of electronic score
cards on mobile phones allowed health workers in Karachi, Pakistan to better
identify childhood TB
; the number of identified
cases was six times more than what was done in previous years.
Examples of successful interventions do not end here; the cost of inaction is heavy.
A case of TB can infect up to 10 people a year. Well, keeping all this in mind, let
us all be part of the Stop TB Partnership, and play our roles in eliminating this