Co-Infection in Pakistan
Tuberculosis or TB, a common and fatal infectious disease, has been a serious problem for mankind for centuries. According to the WHO, TB comes in second against the human immunodeficiency virus (HIV) related to infectious micro-organisms that cause death. Pakistan is also included in the five countries which experience largest number of reported TB cases in the world. The country ranks at number 5 amongst a list of 22 countries with highest TB burden. It also ranks at number 4 amongst a total of 27 countries with highest Drug resistant TB burden. The DM and TB co-morbidity is re-emerging due to the progressive epidemiology of both diseases all over the world, especially in developing countries like Pakistan. The adverse effects of both diseases may result in poor glycemic control in DM and poor response to anti-TB drug treatment. The relative risk (RR) of developing pulmonary TB is 3.47 to 5.15 times higher in diabetics as compared to non-diabetics. In Pakistan, the prevalence of tuberculosis in diabetic patients is almost 10 times than in non-diabetics.
In this connection a study by researchers from University of Veterinary and animal sciences Lahore has found strong link between TB and diabetes co infection in Pakistan. Above mentioned study was conducted at Department of Epidemiology & Public Health, University of Veterinary & Animal Sciences, Lahore by myself under supervision of Professor Dr Mansur ud Din Ahmed. The prevalence of Diabetes among TB patients was found 14.8% while in general public it was found 7.9%. Worldwide, 70% of diabetic patients live in TB endemic countries. In the 22 countries with the highest burden of TB, the prevalence of Diabetes Mellitus (DM) in the general population ranges from 2% to 9%, and eight of the ten countries with the highest incidence of DM are also classified as high burden countries for TB by the World Health Organisation (WHO). Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues. A bidirectional association between them has been demonstrated by many researchers. The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of diabetes mellitus is increasing. The association between diabetes and tuberculosis may be the next challenge for global tuberculosis control worldwide. Proper planning and collaboration are necessary to reduce the dual burden of diabetes and TB. Study describing a total of 500 patients who were diagnosed with pulmonary tuberculosis were scrutinised for this study. It was found that prevalence rate of TB-DM is higher (62.16%) among male as compared to the female (47.84%). The maximum number of patients with co-existent TB-DM were laid in the age group of >57 years (35.13%), unemployed (48%) and illiterate (72.97%). Moreover, among the total patients positive for TB-DM co-incidence, 27% exhibited smoking history. The study revealed high mortality and morbidity among patients of TB-DM co-infection which are influenced by several socio-demographic factors, including age, unemployment, literacy rate and polluted environment. Thus, poor and unhealthy lifestyle was found main reason that impacts the ailments by leading to the development of DM among immunologically compromised individuals due to TB.
Other than DM and TB co-morbidity, researchers also found that bovine TB is another problem being faced in Pakistan. Bovine TB is a chronic bacterial disease of cattle that has zoonotic significance. M. bovis infection in humans can occur through the consumption of contaminated unpasteurised milk, raw or undercooked dairy or meat products. Occupational infection may occur due to exposure through airborne infection among farmers, veterinarians, and slaughterhouse workers. It is still common in less developed countries, such as Pakistan, and gives rise to severe economic loss due to death of livestock, chronic disease and trade restrictions. It is estimated that if diabetes could be reduced by 35% globally, 1.5 million TB deaths and 7.8 million infections could be prevented, making this an important area where further local research is warranted.
