‘Increase in MDR TB cases due to over-the-counter availability of drugs

The steady increase in the incidence of multi-drug resistant (MDR) tuberculosis is due to the over-the-counter availability of first and second line of anti- tuberculosis drugs and their irrational prescription by general physicians, experts observed during a media conference on Tuesday.
They warned that severe consequences of misuse, including over- or under-use or even unnecessary administration, of TB drugs is also turning into a major contributory to extra-drug resistance as well as total drug resistant tuberculosis among the local population.
The speakers also said the Sindh government needs to make it mandatory for family physicians and other private medical practitioners to report tuberculosis cases to the provincial TB Control Programme.
Dr Ismat Ara, director of the Sindh TB Control Programme, Dr Amanullah Ansari, technical advisor to the provincial TB Control Programme and Dr Saleem Hasan Kazmi, national program officer, Global Fund, TB Control Programme were responding to media queries at the event.
“Four hundred MDR patients were enrolled with the Sindh TB Control Programme in 2011 against an estimated number 3,000 such patients in the province,” said Ara.
She also noted that between 13,000 and 15,000 new cases of MDR TB are believed to be added to the population of such patients in the country every year.
The provincial TB control manager said the declaration of TB as a notifiable disease will ease the process of proper documentation and efficient strategies for timely diagnosis and strict compliance of drug therapy for the disease that is otherwise 100 percent curable.
She pointed out that the PC-I of the Sindh TB Control Programme has no provision for MDR diagnosis and treatment.
“However, under the joint efforts of the National TB Control and the Sindh TB Control programmes, we are running a program with our private sector partners, through the support of Global Fund, for screening, diagnosis and treatment of all categories and types of TB,” she elaborated.
Replying to a question, she said 54,170 TB cases were detected in the province during 2011, in a period when attempts were made to involve private sector in the TB prevention and control strategy.
“Collective drug resistance was identified among 58 percent of these people and 15222 deaths were reportedly caused due to TB, that may not have been necessarily diagnosed in 2011 or 2010 only,” she added.
The program director said more than 80 percent of TB patients in the province pertain to productive age groups with 28 percent aged between 15 and 24 years and another 23 percent between 25 and 34 years.
Answering another question, she said the cure rate for the disease has been found to be 87 percent against a default rate of seven percent.
“Around 418,000 new cases of TB surface in the country every year including 92,800 in Sindh alone,” she added.
Ara said the provincial programme is focused on “interrupting the bacterium transmission through timely detection and 100 percent drug compliance”.
For this purpose, she said, the Directly Observed Treatment Strategy (DOTS) programme is being implemented at every level, with hospitals and rural health centres working as basic management unit for TB care.
Dr Amanullah Ansari said in view of the fact that public sector facilities have reached their optimum potential, private sector hospitals and NGOs are needed to be efficiently involved.
“The country in its endeavor to achieve the millennium development goals needs to acquire a 90 percent reduction rate in the disease prevalence,” he added.
“According to a recent WHO report, we have managed to bring down the 500 per 100,000 cases in 1990 to 364 per 100,000 in 2011, with a death rate of 78 per 100,000 in 1990 to 34 per 100,000 in 2011.”
Earlier, the partners of the National and Sindh TB Control programmes including representatives from Indus Hospital, Dr Salman; Regional Coordinator, Assistance for Social Development, Dr Abdul Qadir Shaikh; Dr Srichand from the Marie Adelaide Leprosy Centre; Dr Muntazir Jafferi from the TB Reach Programme; Dr Mubashir from the Aga Khan Community Health Sciences Department; Dr Rafiq Manghi, Bridge Consultants Foundation and M Yasir, Coordinator, GOOD Life Programme of Greenstar shared their experience of diagnosing and treating the patients.