TB: Back with a vengeance

TB: Back with a vengeance

International Tuberculosis Day, which fell on March 24, passed
without much media coverage in Indonesia, despite the fact that
tuberculosis (TB) is the third-deadliest disease in the country,
after cardiovascular and respiratory diseases. This is somewhat
surprising, considering that TB is not a new illness, and
medication is therefore readily available to all.

The latest report received from the World Health Organization
(WHO) is alarming: Every year, Indonesia records more than
583,000 new TB cases, which means it is the country with the
third-largest number of TB cases in the world, after densely
populated India and China. Shocking though this may be, the
government has yet to do more field research to follow up the WHO
findings.

According to the Ministry of Health, 83,410 TB cases were
detected in Indonesia in 2000, of which almost 52,500 were
communicable. In 2001, 97,124 TB cases were detected and more
than 56,700 were communicable, while during the first three
quarters of 2002, 107,234 cases were recorded, of which almost
62,000 were communicable. Unfortunately, there has yet to be a
reliable explanation for this recent, steady increase.

Given this situation, it is imperative that the government
find out which parts of this archipelagic nation experience the
most TB cases. Also, the ministry should tell the public whether
the patients were mostly men, women, office workers, drivers,
farmers or workers in other jobs liable to infection by TB.

The answers to these questions are crucial for the government
to determine what further moves are necessary to treat patients
or to stop the spread of the lethal disease. In the absence of an
official explanation, several factors arise that may promote the
spread of TB, which is linked mainly to poverty and malnutrition.

It is often argued that in Indonesia, the fourth-most populous
country in the world, overcrowding in many places is difficult to
avoid, which creates ideal conditions for the TB bacillus to
replicate. However, a doctor working for the Jakarta-based
Organization for the Eradication of Tuberculosis (PPTI) has said
that TB no longer claims its victims from among rural citizens
alone. Smoking and a nocturnal lifestyle are also latent causes
of its spread. Among PPTI patients, for example, are a member of
a band that plays in pubs and women working in a variety of
nightspots -- people who are passive smokers virtually all night
long. Increased air pollution in big cities like Jakarta is also
a dominant factor in the spread of the disease.

A global program for TB, introduced by WHO in 1994 and known
as the Directly Observed Treatment Short Course (DOTS), seems not
to have been very successful in Indonesia, judging from the
increasing incidence of TB from 2000. Indonesia applied DOTS in
1995. The scheme, which aims to help eradicate the disease in
member countries, enables local health officials or relatives to
ensure that patients take their medication regularly, every day.

A Jakarta-based doctor, who has entrepreneurs among his
patients, said that most TB patients quit taking their pills
after about two months. A complete cure usually takes six months
to eight months. Obviously, discipline and lifestyle are key
factors in dealing with TB -- a disease that was almost totally
eradicated here in the not-so-distant past.

The conclusion that can be drawn from all this is that
campaigns to eradicate TB are still relevant, despite the fact
that it is an "old" disease, the medication for which is readily
available to patients. People should be continuously warned of
the danger of TB and adequate information on how to stop its
spread should be made available to the public, especially those
living in slum areas.

A detailed TB database should be established and a provincial-
level, integrated information system be made available to the
public so as to encourage those from all levels of society,
including businesspeople, to participate in the fight against
this potentially deadly disease. In this way, regular BCG
immunizations could be administered to school students and
residents living in areas suspected or proven to be vulnerable to
TB, to prevent its spread.