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.