Drug-resistant TB poses new health challenge

The government-run National Tuberculosis Control Programme (NTBCP) has reported 340 new TB cases among the displaced from conflict-hit areas in Pakistan's North West Frontier Province (NWFP).



This is in addition to the 944 TB cases among internally displaced people (IDPs) diagnosed before they moved to camps.



NTBCP officials told a seminar in Peshawar, the provincial capital, that the closure of TB control centres in parts of the province affected by fighting between the army and insurgents in May this year raised the risk of TB resurgence in the area.



Cases of Multi-Drug Resistant TB (MDR TB) are also said to be on the rise. According to the World Health Organization (WHO), this strain is resistant to Isoniazid and Rifampicin, the two most powerful anti-TB drugs.



The WHO's Global Tuberculosis Control Report 2009 states that 3.2 percent (about 9,500 patients) of all new cases and about 35 percent of all existing TB cases in Pakistan are MDR. According to official figures, about 300,000 new TB cases are detected in the country each year and Pakistan ranks eighth on the list of countries with the highest TB burden.



"MDR TB presents a particular threat because it is harder to treat and does not respond to first-line drugs," Owais Khan, a Peshawar-based physician, told IRIN.



It often develops because patients "left off treatment half-way through, either due to ignorance or financial constraints". The bacterial infection then returns with a vengeance, he said.



Failure to comply with the treatment is common, according to NTBCP.



Rizwan Khan, 50, an IDP from Buner district, whose wife has TB, said: "My wife left off treatment after four months, when she felt better. Doctors had told her to take the medicines for eight months. The coughing and chest pain came back.



"The cost of the treatment, about Rs2,000 [about US$25] also made things difficult for us," he said. Rizwan earns about $50 a month as a shop assistant.



Such issues contribute to more cases of MDR TB, say specialists. Health officials fear an increase in conflict-hit areas.



An official with the NWFP Health Department, who did not want to be named, said the militants' campaign against NGOs and health workers, who helped spread awareness among communities, meant they no longer operated in areas affected by the recent fighting. "This raises the risk of diseases such as TB spreading," the official said.



kh/at/mw