Every hour, nine people die from tuberculosis in Bangladesh. High rates of poverty, overcrowding and a lack of information about the disease combine to make treating tuberculosis in Bangladesh particularly difficult.
As of 2017, 244,201 Bangladeshis were suffering from tuberculosis. Nearly 6,000 of these patients were infected with drug-resistant tuberculosis.
The Problem of Drug-resistant Tuberculosis
Improper tuberculosis treatment has led to the occurrence of drug-resistant tuberculosis. When physicians prescribe the wrong drug or dose, or when patients do not finish their entire course of treatment, the tuberculosis bacteria evolve to become resistant to that treatment. Multidrug-resistant tuberculosis (MDR-TB) poses a unique challenge in Bangladesh.
While regular tuberculosis is entirely curable with proper treatment, the cure rate for MDR-TB is only 50 percent. Treatment for regular tuberculosis takes as little as six months, while the treatment for MDR-TB takes up to two years. The extra treatment time hits poor families the hardest since more time in the hospital bed means less time at work. Tuberculosis, especially MDR-TB, can deepen the cycle of poverty.
Bangladesh Innovates Treatment Plans
Bangladesh doctors have pioneered a new treatment course that uses a combination of drugs at different doses and they have been able to reduce the MDR-TB treatment time to nine months. This new treatment lowers the cost of treatment from $4,000 down to below $1,000. Since health care resources are scarce, this improvement means that more lives can be saved. New community-based approaches have also been successful in treating tuberculosis in Bangladesh.
The new community-based approach has also been successful in treating tuberculosis in the country. In Bangladesh, treatment of MDR-TB was generally confined to a few national hospitals. But in 2012, the Ministry of Health, with support from the National Tuberculosis Program, launched a new approach: community-based programmatic management of drug-resistant tuberculosis (CPMDT). Although it has a long name, this approach has a very simple goal: to shift the focus of treatment away from national hospitals and toward a decentralized, community-based approach. Treatment is now supervised by Upazila-level health centers. An Upazila is a type of administrative region or sub-district.
Instead of staying in a hospital for the entire course of treatment, patients will only spend brief stints there before moving either home or to outpatient Upazila health centers.
DOT Providers Play a Crucial Role
Directly-observed therapy (DOT) means that a health care worker regularly observes the tuberculosis patient, prescribes the proper dosage and actually watches the patient take the proper dose. In the CPMDT intervention, DOT providers visit patients daily, taking the opportunity to screen family members for tuberculosis as well.
The new model also places more emphasis on psychosocial support. DOT providers counsel the patients, focusing on providing nutritional support and even vocational training. The Bangladeshi government even provides patients with a monthly nutrition stipend.
Overall, the intervention has increased the proportion of MDR-TB patients enrolled in treatment, reduced treatment delay and improved outcomes. Following this intervention in Bangladesh, researchers measured a 76 percent cure rate which is much higher than the global average of 56 percent.
Thanks to a dedicated government and devoted community health care workers, treating tuberculosis in Bangladesh has become a more manageable feat. The success of these decentralizing government interventions has promising implications and other governments can learn a lot from Bangladesh to improve their own health care outcomes.
– Ivana Bozic