World TB Day marked

Afghanistan marked World Tuberculosis (TB) Day on Monday with a ceremony in the capital, Kabul. The country has one of the highest incidences of the disease in the world. "As a result of two decades of war, TB cases have been rapidly increasing in Afghanistan," Dr Abdul Wudood Haidari, the deputy manager of the Afghan health ministry's national TB programme, told IRIN. "There are 70,000 TB cases in Afghanistan annually and only 15 percent of them are reported and treated," he said, noting that 23,000 people die of the disease each year. According to the official, the destruction of health centres, displacement and migration were the root causes of the increased incidence. "The majority of TB cases are in areas where there was war and displacement of people from one area to the other," he said, adding that there remained large areas of the country where people had no access to clinics to be properly diagnosed. Afghanistan is one of 22 countries accounting for 80 percent of TB cases worldwide. "As far as the incidence rate and the proportion of the cases are concerned, Afghanistan has one of the highest TB rates in the world," Dr Giampaolo Mezzabotta, a TB medical officer for the World Health Organisation (WHO), told IRIN in Kabul. "The number of cases notified are still a minority of the actual number occurring in Afghanistan," the WHO official said. The country has about 300 cases per every 100,000 people, with women accounting for 65 percent of all deaths. An estimated 150,000 people suffer from the disease. "We have found out around the country that women find it more difficult than men to go to a clinic," Mezzabotta said. Traditionally, in many rural areas of the country women need to be accompanied by a male relative, a custom which often serves to render receiving treatment problematic and difficult - particularly given that TB patients require eight months of regular treatment before a cure can be effected. The recommended strategy for the detection and cure of TB is the Directly Observed Treatment of Tuberculosis (DOTS) recommended by the WHO. This year's theme for World TB Day was: "DOTS cured me. It will cure you too." Currently, WHO, in collaboration with the health ministry, is planning to increase the number of TB centres in the country from 32 to 183. "Our main effort is to expand DOTS in such a way as to bring treatment as close as possible," Mezzabotta said, noting that the WHO's objective was to detect 70 percent of all cases by 2005.

Many people have to travel for days for treatment

But the road leading to the defeat of the disease remains a long one, requiring close cooperation and partnership between NGOs, the government and the UN. "There is a great need for public awareness," Mezzabotta said, in the context of the stigma attached to the disease. Many people were reluctant to attend TB centres, where they had to talk about their condition, he explained. He stressed that the stigma attached to TB remained the greatest remaining obstacle to overcoming the disease itself. In addition to a lack of sufficient TB centres, inaccessibility and lack of awareness among the public, staffing is a major problem needing to be addressed if the disease is to be effectively tackled. "There is not enough manpower in terms of quality and quantity," Haidari said, explaining that the last decade of war had isolated his ministry from all means of training and updating methods and techniques. "In addition many of our experts and good doctors have left the country," he said, thanking Japan's official development agency, the Japan International Cooperation Agency, for undertaking the reconstruction of the National Tuberculosis Institute in Kabul, thereby enabling it to train many people for the anti-TB effort. In Afghanistan, the disease is mainly the result of poverty and malnutrition. To deal with this problem, the World Food Programme (WFP), has undertaken an initiative to supply food aid to 27,400 TB patients estimated to be infected in 2003. "WFP has agreed to provide a monthly ration of food for TB patients and their families," Mezzabotta said, noting that food support was critical in the WHO's efforts to fight the disease. "If you are well nourished, you will not get sick, and it will help the patient recover," he said, calling on other UN agencies, donors and NGOs to make joint efforts in the fight against TB. "It is a huge task to tackle TB in a country like Afghanistan," he concluded. For more information on TB see the IRIN report: Focus on TB