Strengthening of Tuberculosis Care and Prevention with a Focus on Case Finding Activities in Bangladesh.
AMIC, Dhaka Ahsania Mission (DAM) – GFATM (Global Fund to Fight AIDS, Tuberculosis and Malaria) TB Control Program started on 1 January, 2013 at the Ward 1 and Ward 17 in Dhaka North City Corporation. DAM has been providing free TB management services among the population, conducting different types of advocacy & social mobilization programs to raise knowledge & awareness on TB in the project area. TB diagnosis ND treatment through DOTS service are provided to the patients as project activities.
The project has been running with a goal to reducing the incidence of TB of all forms by 50% by 2025 and 90 % by 2035 (from 2015 baseline figures).
Ward 1 and Ward 17 of Dhaka North City Corporation.
Everyone residing in the project area has access to the TB management program if necessary. DAM’s target population is 249,382 people living in the project areas.
The project has started its functions from January 2018 and it will continue its services until December 2020.
DAM has been operating one DOTS & ZN Microscopy center in Uttara (Ward 01) and one DOTS & ZN Microscopy center in Khilket (Ward 17). These centers have been testing the sputum for AFB to diagnose the TB patients. In the centers, 1,304 presumptive TB cases have been tested during the period of July 2017 – June 2018. Two cases have been diagnosed from microscopic evidence and 85 cases have been bacteriologically diagnosed from the presumptive cases. In the period of July 2016 – June 2017, 365 TB cases have been notified and among them one was multi drug resistant (MDR) TB and the rests were drug sensitive (DS) TB. All the cases have been provided with the DOTS therapy. The treatment success rate of DS-TB from the program is over 97% and DR-TB/MDR success rate is 100% during this period. For detecting the Pulmonary Smear Negative TB, EPTB, child TB and DR/MDR TB, the project ensures both therapeutic and financial support of Taka 65,270/= among 60 presumptive TB cases during the period of July 2017 – June 2018. Among these cases, 23 TB patients have been receiving treatment from the DOTS centers.
The project has been running microscope laboratory for testing sputum for AFB and DOTS center for providing TB treatment against all notified TB cases.
Among the target population, the project has notified 191 Pulmonary Smear Positive TB cases, 16 Pulmonary Smear Positive Relapse cases, 65 Pulmonary Smear Negative New cases, 183 Extra-pulmonary New cases, 14 previously cases and one case that failed to follow up the treatment. During the time period of July 2017 – June 2018, a total of 470 TB cases have been identified and 25 of them were incidents of child TB cases.
Success Story: Hira Miah
Hira Miah is 18 years old adolescent. He is working in a Hotel and living in Farid Market area of Dokkhinkhan under Dhaka North City Corporation. One of the family members of Hira Miah was a TB patient. But unfortunately his parents were not aware of TB and they did not consult with any TB service centers.
When Hira Miah became severely sick, his parents took him to a pharmacy holder who provided some conventional treatment. Hira’s physical condition was worsening each day. At this situation his mother took him to DAM’s Uttara DOTS center as a TB Presumptive on 16 August, 2017. The respective staff checked his sputum for AFB through ZN Microscope and found AFB positive (Acid Fast Bacilli) 2+. This observation along with the signs and symptoms of TB such as low grade fever, cough, weight loss, loss of appetite, chest pain and physical weakness; diagnosed his condition as bacteriologically confirmed TB Case. He had no previous history of getting Anti-TB treatment. According to the advice of the physician, the project staff started his Anti-TB treatment as Category-1 on 17 August, 2017 as a new smear positive TB patient. DAM provided Anti-TB medicines with health education. His body weight was 43 kg at the time when the treatment began. Regular follow up was made according to NTP guideline and respective staff checked his sputum after completion of two months.
On 15 October, 2017, project staff found seven AFB in every 100 fields of ZN microscopic picture. Then Hira Miah was sent to NIDCH (National Institute of Chest Diseases and Hospital) for testing the Xpert MTB/RIF (Drug resistance TB detection) on 15 October, 2017. But the report of that test was M (MTB detected, but Refampicine not detected). Then DAM continued his treatment according to the NTP guideline. His physical condition was improving gradually and his body weight was increased at 49 kg. The follow up sputum test results were negative from five months to the end of treatment course. Hira Miah was declared as a cured patient from Tuberculosis on 12 February, 2018.
Now Hira Miah is well, leading a healthy life and is doing his job regularly. It has become possible only because his uninterrupted full course treatment. His family was supportive in following the counseling and acknowledging the importance of the treatment. His family is now very happy and satisfied with the treatment procedure.
Hira Miah’s story reminds us about the importance of proper TB Treatment and about the importance of emphasizing on knowledge sharing, facilitating the diagnosis and early treatment of TB.