Shiraj Mian died two years ago after suffering multi-drug resistance-Tuberculosis (MDR-TB) for years.
He had lost ability to work and survived 10 years after the diagnosis of the disease. Shiraj had to sell all his ancestral land as the very last resort to bear the treatment expenses.
He left behind his wife and seven daughters, three of them were married off.
“When it was the time for him to earn livelihood for the family, he fell sick. This made us to feel down,” said Sajeda, wife of late Shiraj, standing at a corner of her only small and stuffy room at a city slum. She and her four children live there.
“We faced social stigma, as many did not want to marry us because of TB,” said 22-year Mukta, the second daughter of Sajeda. She later married one of her cousins.
The situation got worse after few days when Sajeda’s last four children were also infected with TB. Currently, they are now under treatment in a TB care centre run by a non-government organisation.
Sajeda and her four children depend on the earnings of her married daughters.
Doctors say Sajeda’s four daughters are very compliant patient, but neither she nor her family have the means to provide the necessary nutrition for their health.
Her story discovers that TB still poses a serious threat to Bangladesh economy in the wake of emergence of MDR-TB, pushing hundreds of thousands of families into wrenching poverty and the country to lose productivity.
It is one such disease that many do not perceive as a public health threat, when in fact it is among the leading causes of death in Bangladesh.
Like Shiraj, millions of people of Bangladesh are suffering from TB. Annually, the country witnesses 80,000 TB deaths and 350,000 new cases, according to the World Health Organisation. TB accounts for 9% of the deaths in Bangladesh every year. Hence, every hour nine people die of TB despite an effective treatment.
Bangladesh having a high MDR-TB burden with around 4,700 cases notified every year ranks 7th globally in terms of the burden of TB on the population, according to World Health Organisation (WHO) Report, 2014. As many as 29% of old patients turned into MDR-TB patients in Bangladesh.
If a TB patient fails to take drugs regularly, or does not complete full course or if the drugs are below quality, then TB germs become drug-resistance, which is called MDR-TB, said Shayla Islam, programme manager of TB control Programme, BRAC.
She said despite various efforts made by the government and some non-government organisations, factors including poverty, malnutrition, overcrowding, low education, poor access to TB treatment, negligence of patients and still lack of awareness are some of main causes behind the TB infection in Bangladesh.
“It is taking a toll on Bangladesh. Almost half of all cases of active TB go unrecognised,” she said.
“Most tuberculosis patients are unable to work and dependent on others for financial support during the treatment period. To address the challenges we need to make tuberculosis a national priority.”
The death and new case figure indicates that Bangladesh is robbing of billions of taka due to losing productivity of people getting into contact with TB like Shiraj, thus slowing down economic growth.
Officially TB treatment is provided for free, but studies in Bangladesh consistently show that having TB can be catastrophic to poor households, said Anna Vassal, professor of London School of Hygiene & Tropical Medicine in her paper on TB in the post-2015 and development agenda.
To reach the global TB target by 2030, around 315,000 persons need to be treated currently in Bangladesh per year. So it is estimated that the current total cost of the TB programme required to reach the target to be an additional Tk680 crore per year, although this estimate falls over time as TB incidence reduces. This is over and above the current TB programme of around Tk450 crore, the paper said.
This investment will give anyone in Bangladesh who develops TB around 19 additional years of life on average, based on the fact that the average to contract TB in Bangladesh is around 45 years, and the life expectancy in Bangladesh is currently around 70 years—and including an adjustment for the fact that some with TB will self-cure.
MDR-TB is assured of having lower rate of return given that treatment is less effective, at around 13.5 years of life gained.
In total, if scaled up to levels to achieve the TB targets the TB programme in Bangladesh will produce around 2.8m additional years of life for the annual investment.
The life of years saved the recommended methods of using an economic value of Tk78,000 or Tk390,000. Applying this value to life years saved describe above, it is found that the economic return per taka spent ranges from Tk29 to over Tk162, making this a sound investment in post-2015.
The average cost of first line treatment to be found Tk10,140 per person treated, with around Tk1560 of this cost being spent on drugs, said the paper.
There are no studies examining the costs of MDR-TB treatment in Bangladesh, but there have been studies recently conducted in Nepal that estimate that the treatment of those with MDR-TB can cost around Tk335,400 per person.
Despite the economic progress over the years and a 92% cure rate in Bangladesh, it still remains a very poor country, with some 20% of people live in extreme poverty.
According to a survey of National TB Control Programme (NTP) in 2011, among the new TB patients diagnosed, about 1.4% was new MDR-TB cases and about 28.5% MDR patients were identified from previously treated TB cases.
NTP line director Ahmed Hossain Khan said lack of awareness, taking drug irregularly and fear of social stigma is the prime cause for the deaths in Bangladesh. “And MDR case is not only problem in our country but allover the world,” he said.
The government has adopted directly observed treatment short-course (DOTS) programme with strong monitoring to control the infection, which improved the situation to a great extent, he said.
Of the new cases, 20% has always been retreated due to drug resistance, said Khan. “However, combined efforts can help eradicate the disease.”
In Bangladesh, every year approximately 1.4m people on average seek care for TB and from 2004 to 2013, more than 1.5m TB patients have been treated, according to the NTP.
NTP has installed new diagnostic tool gene expert machines, which is helping to detect more TB patients including drug resistant TB in a short time.
