Kris Thomas
The World Health Organisation (WHO) recognises tuberculosis as the eighth deadliest disease in the world. Although Sri Lanka is a low-prevalence country, recent statistics show an increase in the number of TB reports, particularly in Colombo.
Due to our country’s high BCG vaccination coverage, the odds may seem to be in our favour. However, according to recent reports and the Health Ministry of Sri Lanka, tuberculosis seems to be on the rise.
Although many consider tuberculosis to be just another mycobacterial disease similar to the common cough, if left untreated, this infectious disease can develop to epic proportions, even resulting in death.
Mycobacterium tuberculosis bacteria that causes the deadly disease. Image credits: National Institute of Allergy and Infectious Diseases
Surpassing 2015
According to the Colombo Municipal Council’s (CMC) Health Department statistics, over 600 cases of tuberculosis have been recorded in Colombo over the last eight months ‒ a significant increase in comparison to previous years.
Reported Tuberculosis cases in Colombo, as per CMC statistics.
In 2013 there were 560 cases of TB reported in Colombo city limits, followed by 570 cases in 2014. Last year there were 667 cases in total. By September this year, the CMC had recorded 589 tuberculosis cases. These included 65 new cases from Modara and Mattakkuliya, as well as three deaths, during the first eight months of the year. In Maligawatte, there were 40 cases recorded, including 28 from the Maligawatte flats.
According to the National Programme for Tuberculosis Control and Chest Diseases (NPTCCD), last year Colombo recorded the highest number of new cases, as well as relapse cases, in comparison to other districts.
Roar spoke to the CMC’s Chief Medical Officer of Health, Dr. Ruwan Wijayamuni, to understand what has caused the sudden surge of tuberculosis cases in Colombo.
Tuberculosis Linked To Poverty?
According to Dr. Wijayamuni, most TB cases have been reported from densely populated and low-income parts of the city. “Most of the cases were reported from Colombo North and Colombo Central, specifically Modara, Mattakkuliya, Grandpass, and Maligawatte. These locations are very densely populated with income-deprived factions of the society. They are considered to be among the poorest of areas in Colombo,” he said.
His statement is supported by findings of the Health Ministry’s NPTCCD, which in 2010 noted that 95% of patients in the world are from economically underdeveloped countries, and often belong to disadvantaged social groups.
Dr. Wijayamuni meanwhile also noted that there have been several issues that have made treating new cases very difficult. One such issue is that patients fail to provide accurate personal information, such as their addresses.
“When they give false information like a wrong home address, we cannot trace them back,” said Dr. Wijayamuni, adding, “Then we don’t know where they are and collecting information becomes hard.” This, in turn, hinders authorities from keeping a tab on the patients to prevent the disease from spreading.
Another problem arises when patients stop their treatment halfway, something that doctors discourage.
Patients who are diagnosed with tuberculosis are generally prescribed a multi-drug treatment which has to be continuously taken over a course of six months or more. This treatment creates a resistance in the patient’s body and prevents the disease from evolving further.
Thus, when patients fail to complete the course of medication, they could contribute to the spread of disease.
The multi-drug treatment prescribed to the patients. Image credits: doctorswithoutborders.org
“The tuberculosis mycobacteria develops according to the conditions it is in. So if it has been contracted by an individual, the mycobacteria would constantly mature and attack the individual’s systems. This is why a multi-drug treatment is recommended. The treatment bombards the patient’s system with drugs and doesn’t allow the mycobacteria to develop. This is how the disease is cured,” explained Dr. Wijayamuni.
What this means is that if the treatment is stopped half-way through, the patient has the potential to spread a developed form of the tuberculosis mycobacteria to their environment. This developed mycobacteria will be resistant to treatments and eventually make curing the disease much harder.
CMC Battle Plans
The CMC has already drafted a strategy to diagnose the increasing number of new cases, to improve detectability of the disease in urban areas.
Individuals and families are advised to bring others who have been suffering from a cough for over two weeks, to immediate medical attention. This would increase the detection rate at hospitals and medical centres.
Once it is diagnosed, the patients will undergo a Direct Observed Treatment (DOT) schedule. This is where the patient takes the prescribed drugs under the supervision of a practitioner, which allows no room to avoid treatment. According to Dr. Wijayamuni, the Ministry of Health has provided a strict control programme for hospitals to conduct this schedule.
Thus, the number of defaulters is expected to decrease in Colombo. Practitioners are also advised to pay attention to others who come into contact with patients (such as family members), who will be then investigated and examined.
Dr. Wijayamuni says that if this strict strategy is followed for at least a period of one year, the increase in tuberculosis can be curbed, to a certain extent.
Staying Informed
Tuberculosis is by and large an urban disease. According to Health Ministry and CMC statistics, patients with low immunity, diabetic patients, severe drug addicts with compromised immunity systems, smokers, individuals with immunocompromising cases, malnourished people, and the elderly are most prone to this mycobacteria.
National TB Awareness Day organised in Vavuniya this year. Image credits: nptccd.health.gov.lk
And according to Dr. Wijayamuni, we all might have contracted this disease during our lifetime.
“At some point in our lives, we might have contracted this disease. However, our immune system, depending on how strong it is, was able to fight it off. So it never developed into anything other than a simple, irritating cough,” he explained.
Prevention is most certainly better than cure. However, in order to prevent a disease, one has to be aware of it. Many of us think tuberculosis has been eradicated from society due to the immediate vaccination procedure that takes place after one’s birth. But the reality is otherwise.
Although authorities are yet to determine exact reasons behind the rise in tuberculosis, the Ministry of Health and the CMC have commenced education camps to strengthen public awareness on TB. Doctors and practitioners have been advised to inform the public on the sudden rise in TB cases.
Furthermore, the CMC has also initiated a special ambulance service as well, specialising in aiding tuberculosis patients, which can be reached via the usual emergency service, 110. The CMC also advises the public to advocate a destigmatisation procedure.
So if you see a family member, a friend, or a co-worker who has been suffering from a cough for over two weeks, prompt them to seek out immediate medical attention and do not let them avoid treatment; every effort counts in fighting this disease.
Featured image courtesy: cqmsjt.com
