Tuberculosis Programs In The Philippines
Out of 196 countries, the Philippines has the distinction of being included in the top 22 high-burden tuberculosis countries in the world. This report is according to the World Health Organizations (WHO), which ranks the Philippines at number nine worldwide. 2013 Revised Manual of Procedures for the National Tuberculosis Control Program (NTP) of the Department of Health, Philippines by mduavis in Types > Instruction.
Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and sneezing. Even the accidental spread of saliva through laughing, singing, and spitting can pass on the TB bacteria. In the Philippines, TB is the number six leading cause of death, with 73 Filipinos dying every day of TB. Let us look at 10 facts about TB: 1. An estimated 200,000 to 600,000 Filipinos have active TB. This condition makes the person sick and contagious to others.
Active TB can occur in the first few weeks after infection with the bacteria, or it can occur a few years later. Signs and symptoms of active TB include cough, phlegm (sometimes with blood), unexplained weight loss, fatigue, afternoon fever, night sweats, chills, and loss of appetite. See your doctor if you have these symptoms. The danger of TB is real. Out of 196 countries, the Philippines has the distinction of being included in the top 22 high-burden tuberculosis countries in the world. This report is according to the World Health Organizations (WHO), which ranks the Philippines at number nine worldwide.
Together, these 22 countries (including the Philippines) contribute 80 percent of the global TB burden. TB is a disease of poverty and the high TB burden is a reflection of our economic status.
On the other hand, some people consider being number nine as “good news” since we came from number seven worldwide! In fact, after China, the Philippines had the second highest number of TB cases in the WHO Western Pacific Region in 2007. Each person with active TB can spread the disease to 10 other Filipinos each year! This is alarming since there are between 200,000 and 600,000 Filipinos with active TB. Multiply this by 10, and just imagine how much TB is being spread yearly.
Hence, if someone in the household has been diagnosed with TB, all the other members of the household should get tested (like a chest x-ray) for TB, too. The usual treatment course for TB is between six and nine months of continuous medicines. The good news, however, is that once active TB is treated with the appropriate drugs, the person is no longer contagious after three weeks.
That is why those who are being treated for TB are advised to rest during the first month. Another alarming fact: An estimated 80 percent of Filipinos have latent TB. Because of the huge TB burden in the country, most of us already have the so-called “latent TB.” Yes, that in all likelihood means you and me. In this condition, we already have the TB infection in our bodies, but the TB is still in the inactive state. Hence, we feel no symptoms and we are not contagious to other people. Some countries, like the US, will treat those with latent TB with medicines.
But we can’t help it because we are born in the Philippines. We just need to observe a healthy lifestyle, or else the TB infection might get reactivated. Tuberculosis can affect other organs of the body, such as the kidneys, spine or brain. Symptoms depend on the organ affected. TB of the spine causes severe back pain, while TB of the kidneys can cause bloody urine. Hence, TB should be checked and treated as early as possible.
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Treatment of TB may not change your chest x-ray results back to normal. Thus, many Filipinos cannot pass job tests for abroad because of past or present TB infection. Studies show that once treatment for TB is completed, a repeat chest x-ray may show the following results: 30 percent of chest x-rays will revert to normal (good news), 30 percent of chest x-rays will improve but will still show a scar (still can’t pass job test), 30 percent of chest x-rays will remain the same. This just goes to show that the TB burden in the country is also affecting the employment of our people. The BCG vaccine against TB is not 100-percent effective. Although the WHO recommends that BCG be given to all infants and young children in countries with high TB burden, the vaccine does not always protect people from TB. In addition, the protection given by the BCG does not seem to be effective as the person becomes an adult.
Still, the BCG appears to protect the person from a more serious TB disease and should be a part of the immunization program. Beware of multiple drug-resistant tuberculosis (MDR-TB). Another challenge is the emergence of a new drug-resistant strain of TB called MDR-TB. This new “superbug” probably arose because TB patients did not adhere to their drug regimen, which means that they didn’t take their medicines religiously for the usual six months. Because of this, the TB bacteria developed a resistance to the first-line drugs like Isoniazid and Rifampicin. MDR-TB is difficult and expensive to treat.
Worldwide, in 2008, there were an estimated 440,000 new cases of MDR-TB and 150,000 deaths from MDR-TB. Estimates show that 3.3 percent of new TB cases are really MDR-TB. Have you heard of XDR-TB? If having the multi-drug-resistant TB is bad enough, scientists have discovered a third more terrible strain of TB. These nasty bacteria are called “extensively drug-resistant TB” or XDR-TB. This means that XDR-TB is resistant even to the special drugs developed for MDR-TB.
Be forewarned: The WHO has reported that XDR-TB cases have been confirmed in 58 countries, including the Philippines. Finally, some good news. Despite the high TB incidence, significant developments have been made in increasing case detection and treatment in the country. In 2007, the Philippines achieved a TB case detection rate of 75 percent, exceeding the WHO target of 70 percent. The Directly Observed Therapy Short Course or DOTS is the internationally recommended strategy for TB control. DOTS simply means asking a relative or a health worker to directly observe the patient taking the anti-TB medicines daily.
The Philippines’ DOTS treatment success is at around 88 percent, which is higher than the WHO target of 85 percent. Fortunately, international agencies, like the Global Fund and USAID, are helping the country combat TB. Despite these accomplishments, many factors still need to be addressed such as reducing the stigma of TB patients, and increasing the public’s awareness of the disease, especially the need for treatment. Some infected TB patients still refuse treatment and continue to pose a danger to people around them.
I appeal to our policy makers, health workers, and media to further strengthen our campaign against this terrible scourge.
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Getting sick, though, and taking time off work was not an option. When Jose developed a wet cough, he tried a series over-the-counter medicine. Finally, Jose’s wife convinced him to go for a doctor’s appointment.There, the family-man learned he was one of the 290,000 Filipinos newly infected with tuberculosis (TB). This airborne disease has plagued humanity for thousands of years. The characteristics of the disease: fever, colorless urine, cough resulting in a thick sputa, and loss of thirst and appetite have haunted millions. In the 19th century, one in every four deaths in Europe was attributed to this disease.
Now, TB has nearly been wiped away from countries with high-income economies. But in places where poverty persists, TB continues to strike. According to the World Health Organization(WHO), TB is still one of the world's top health challenges with 9 million new TB cases and the deaths of nearly 1.5 million people each year. In Jose’s low-income, high-density housing neighbourhood in Cagayan de Oro City, TB was not uncommon. It’s in conditions like these that infectious diseases best spreads – overcrowded places with poor ventilation. When one person coughs, the virus can be spread to many.
With today’s rapid urbanization and easier migration from one place to another, Tubercolosis continues to plague many neighbourhoods. The WHO report that people ill with TB can infect up to 10 to 15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with Tubercolosis will die.
Jose tells us that several of his neighbours were infected with TB, too. Others were stigmatized and shunned. When Jose learned he was infected, he too refused to take treatment, even though it was free from the government. His family needed him to earn money.
His children needed to eat. To fully treat TB, discipline is required. People infected with the disease must complete a full 6-month course of treatment. If the full treatment is not completed, people can be re-infected and develop a more extreme type of the disease – multi-drug resistant TB. The WHO estimates that about 450,000 people contracted Multiple Drug Resistant (MDR)-TB in 2012, and some studies have shown that drug-resistant tubercolosis are far above what authorities originally believed. There are several reasons for surging of drug resistant TB. According to the WHO, the following are the two main causes of drug resistant TB: (a) Mis-management of TB treatment which includes inappropriate or incorrect use of TB medicines, poor quality medicines, and stopping treatment before finishing the full course; (b) person-to-person transmission of drug resistant in crowded setting such as prisons and hospitals.
Tuberculosis In Children
Luckily, for Jose, one of his adult daughters agreed to go to work to provide him, his wife and other children with food to eat. World Vision also had a social mobilization project dedicated to stopping the spread of tubercolosis. A network of local volunteers dedicated themselves to supporting those affected by the disease through engaging communities in TB detection, supportive care and management. “We were advised to go to the health centre for the treatment. I had to take six months of medication,” Jose says. “The process was really hard for the entire family.
Philippine Tuberculosis Society
I isolated myself for my children and grandparents for some time because I do not want them to be infected.” Task Force members of the social mobilization project checked in on patients and made sure they adhere to the treatment regime. Eventually, Jose was cured. “I don’t think I am still alive today and take care of my children and grandchildren if I wasn’t treated and if I wasn’t able to avail the free medication of the government,” he says. While the outcome was positive for Jose, for Filipinos the situation is not bright. The WHO still ranks the Philippines as one of the global top 10 in TB prevalence. The rate of new infections, despite a push from the Millennium Development Goals has not fallen in the country in the last 15 years – stubbornly sitting at 290,000 new infections each year. In order to better combat this disease, a wider range of stakeholders needs to be engaged to reduce the tubercolosis burden.
Doh Programs In The Philippines
These should include civil society organizations, non-governmental organizations, community based organizations, private and corporate sectors as well as academe. The battle against TB in the Philippines can be won – the way it has been in high-income countries - with integrated efforts and commitment.