Drug resistant TB cases on the rise

… despite the overall number of TB cases dropping annually

Despite making good progress in detecting tuberculosis (TB) cases and achieving a treatment success rate of 90 percent in the last few years the number of multi drug resistant (MDR) TB cases in Bhutan is on rise.

MDR-TB cases in the country increased to 55 in 2016 from just six in 2005, while TB cases has decreased to 1,145 in 2016 from 1,328 in 2010, according to the health ministry’s deputy chief programme officer of the national TB control programme, Chewang Rinzin.

Presenting the situation of TB in Bhutan at the world TB day celebration at Bajo yesterday, Chewang Rinzin said that globally, MDR-TB is an emerging public health problem and the WHO has declared it a crisis. This, he said, is because only one in four MDR-TB cases are detected and only one in two cases are cured.

However, he said the treatment outcome of MDR-TB is only 48 percent globally, and treatment outcome of MDR-TB in Bhutan is 92 percent, as per 2014 records.

MDR-TB is caused due to partial or irregular TB treatment, non-completion of the full course of TB treatment, no direct observed treatment, side effects of the medicines and social or economic barriers. It is also caused if the person is HIV infected, has diabetes, is under-nourished, those abusing substances  and psychiatric conditions.

The increase in treatment failure for MDR-TB, close contact tracing and delay in seeking health care are some of the challenges being faced, Chewang Rinzin said. Treatment failure is attributed to incomplete and irregular treatment and inadequate directly observed treatment implementation.

Health officials said that someone close to the patient should ensure the patient completes the full course of treatment.

This year the day was celebrated with the theme, “Unite to End TB”. The post-2015 End TB strategy envisions a world free of TB, with the eventual goal of ending the global pandemic by 2035.

According to global TB report 2016, about 10.4 million (M) TB cases were reported globally in 2015 of which about 45.6 percent of the cases were from the Southeast Asian region. Of the 0.58M cases of MDR-TB reported globally, about 34.5 percent were from Southeast Asian region. Similarly, of 1.4M deaths globally, about 0.71M deaths are due to TB in the Southeast Asian region and of the 1.2M people who were co-infected with TB and HIV, 0.39M died from HIV associated TB worldwide.

Health Minister Tandin Wangchuk said although Bhutan is considered a low TB burdened country in the region, TB is still a priority public health problem mostly affecting the productive age groups of 15-44 years.

Lyonpo said considering the burden of TB and MDR-TB in the country, the government had joined the global and regional community in taking forward the agenda of TB through the sustainable development goals, 2016-2030 and the End-TB strategy, 2015-2035.

Lyonpo said the set strategy is ambitious and required concerted efforts from all individuals and every stakeholder. The ministry commits to reach 90 percent of the people who need treatment and treat them successfully.

“I call upon all individuals to help identify and encourage those with cough for more than two weeks to visit the nearest health facility to be screened for TB so that we leave no one behind in terms of access to services, diagnosis and treatment,” said Lyonpo Tandin Wangchuk.

Every individual, Lyonpo said, could take part by identifying potential TB hosts and referring them to hospital, encouraging close contacts of TB patients to get screened, assist in educating and disseminating the message and help in ensuring sputum follow up examinations for TB patients at two, four and six months.

Some of the major challenges the health sector is facing are suboptimal implementation of directly observed treatment, delays in diagnosis and treatment and sample shipment due to rugged terrain and inadequate infection control measures in the health facilities, Lyonpo said.

Meanwhile, records with health ministry stated that in 2010 around 48 people died of TB, which decreased to 40 in 2012, but increased to 44 in 2014 and again reduced to 24 deaths in 2015.

Dawa Gyelmo | Wangdue  

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