TUBERCULOSIS: BANGLADESH: TB rates plummet, but still high among poor and uneducated

DHAKA, 2 August 2010 (IRIN) - The tuberculosis (TB) prevalence rate in Bangladesh has plummeted to 79 per 100,000 people from 800 in the 1990s, with the majority of cases among the rural, poor and uneducated, according to the Nationwide Tuberculosis Disease-cum-Infection Prevalence Survey 2007-09 [http://www.whoban.org/Full_report_TB-10.html]."The association between poverty and TB is well recognized, and the highest rates of TB are found in the poorest section of the community," said K Zaman, an epidemiologist with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICCDR, B) [http://www.icddrb.org/], who led the survey with the National Tuberculosis Control Programme (NTP) [http://ntpban.org/]."TB occurs more frequently among low-income group people living in overcrowded areas and persons with little schooling."Zaman said government and NGO activities since 1993 to implement the Directly-Observed Treatment, Short Course programme (DOTS) [http://www.who.int/tb/dots/en/] throughout the country led to vast improvements in detection and treatment.In 2009, 109,311 new smear-positive cases - when TB bacteria is found in a patient's sample of mucus or phlegm - were detected, compared with 38,457 in 2000, indicating a high detection rate.Populations most affectedBangladesh ranks sixth among countries with the highest burden TB in the world [http://www.whoban.org/communicable_dis_tb.html], with 300,000 new cases and 70,000 deaths each year, according to the World Health Organization (WHO).Most affected are the poor and uneducated: in rural areas, 86 adults in every 100,000 suffer from TB, against 51 in urban areas; 159.7 per 100,000 are among those who earn less than US$43 a month, against 45.7 among those who earn more than $143 a month; and 138.6 per 100,000 among those with no education, compared with 39.3 among people with a secondary education."Poverty may result in poor nutrition, which may be associated with alterations in immune function. On the other hand, poverty results in overcrowded living conditions, poor ventilation, and poor hygiene habits, which are likely to increase the risk of transmission," said Zaman of ICCDR,B.Comparatively poor treatment facilities in remote areas may contribute to the higher prevalence rates in rural areas, Zaman said, compounded by lack of awareness. Health Minister AFM Ruhal Haque pointed out that very few people in rural areas knew about the disease and its treatment.However, the government has expanded care across the country, with 1,050 DOTS centres at the sub-district level where TB treatment is free, said Nazrul Islam, NTP programme manager.Bangladesh has achieved the Millennium Development Goal for 70 percent case detection and an 85 percent cure rate.