Tuberculosis Prevention - Many Challenges

(Baonghean) - Implementing the National Tuberculosis Prevention and Control Project, in recent years, with the attention and strong investment of all levels and sectors, tuberculosis has tended to decrease nationwide and in our province, the tuberculosis prevention program, especially the detection and treatment, has achieved certain results. However, there are still many cases of severe tuberculosis, and raising awareness as well as strengthening human resource training for tuberculosis prevention and control work is still limited.

Tuberculosis is still a global health problem, it affects millions of people every year and is the second leading cause of death in the group of causes of death from infectious diseases, after HIV. According to the World Health Organization: Vietnam currently ranks 12th out of 22 countries with a high number of tuberculosis patients worldwide and ranks 14th out of 27 countries with a high burden of multidrug-resistant tuberculosis worldwide. Every year, our country has about 200,000 people with tuberculosis of all types and 18,000 people die from tuberculosis (of which 5% are HIV-positive), which is twice as high as traffic accidents, the number of multidrug-resistant patients is about 3,500 people (3.3% of new tuberculosis patients and 17% of re-treated patients).

Up to 76% of people with TB are farmers, due to the low living standards of many households, polluted environment, limited primary health care; in particular, the number of TB patients detected and treated accounts for only about 60% of TB patients in the community. The reason is that doctors are "aging", there is no one to replace them; the TB prevention network is lacking and often changes jobs, so they cannot devote themselves to their work. In addition, the epidemic of TB, TB/HIV and multidrug-resistant TB in Vietnam is still high, the number of undetected patients is too large, which is a source of exponential infection in the community. Meanwhile, the stigma and prejudice against TB among the people still makes TB patients hide their illness, self-treat, the more severe the disease, the greater the possibility of spreading it to others; there is still a large number of people who do not have enough knowledge about TB, the attention of society to TB prevention is not much, and communication work is not extensive.

Tuberculosis screening in Nghi Lam commune (Nghi Loc). Photo: Thanh Son

In the past 3 years, along with the National Tuberculosis Control Program, our provincial Tuberculosis Control Program has achieved certain achievements, demonstrated in all 3 criteria: In 2011, the number of tuberculosis patients with all types was 2,431, the cure rate was 85.8%, the death rate due to tuberculosis was 2.8%; then in 2012, the number of tuberculosis patients with all types was 2,388, the cure rate was 87.8%, the death rate due to tuberculosis was 2.1%; and in 2013, the number of tuberculosis patients with all types was 2,381, the cure rate was 90.1%, the death rate due to tuberculosis was 1.7%...

Basically, the increase of tuberculosis in Nghe An has been controlled. The above results were achieved thanks to the close direction of the National Tuberculosis Prevention Project as well as the attention to investment in facilities and equipment of the Provincial People's Committee and the Department of Health; The organization of the grassroots health network has been strengthened. Public and non-public health units have coordinated in detecting, managing and treating tuberculosis patients; the strong participation of socio-political organizations: Women's Union, Farmers' Association, Youth Union, so the province's tuberculosis prevention work has been increasingly consolidated and improved, patients feel less self-conscious when coming to examine and treat tuberculosis; treatment at home, at the grassroots and at the provincial hospital has achieved good results; The treatment process for tuberculosis patients at all levels has been carried out in accordance with regulations: emergency and severe treatment is carried out at the provincial hospital, after they improve, they are transferred to the district and commune, their families and medical staff have examined them daily, dispensed medicine and conducted control tests.

However, it must be said that TB prevention in our province still faces many difficulties and challenges: First of all, Nghe An is a large province, with many difficulties in transportation, and the human resources and facilities for TB prevention from the provincial level to the grassroots level are still lacking and weak. The number of doctors at the provincial level is only 23 people, but they have to do treatment and direction for 20 urban districts and 2 prisons of the Ministry of Public Security. At the district level, the staff in charge of the program often changes, so they lack experience, only 20-30% of the staff working on TB prevention are doctors, and there are no doctors at the commune level; equipment for early detection of TB and multidrug-resistant TB is still lacking; health education and communication work on TB is not extensive, only focusing on some residential areas in cities, towns and the delta. Besides, it must be said that: the severity and complexity of the disease is increasing. These are huge challenges for the province's tuberculosis prevention work, because the costs and facilities to treat these patients are huge and take a long time, while the province's investment resources are limited.

To achieve the goal of reducing the number of people with tuberculosis by 50% compared to 2000 by 2015 and eliminating tuberculosis by 2030, in the coming time, the Nghe An Tuberculosis Control Program will continue to strengthen propaganda activities so that people have more knowledge about tuberculosis and join hands to remove barriers, reduce stigma, not hide their illness, voluntarily go to the doctor for free treatment; improve the capacity of laboratories in districts; strengthen the reporting and feedback regime from communes and wards to the province and central levels; coordinate early detection of tuberculosis in prisons and reformatories; strengthen coordination of tuberculosis control programs and HIV/AIDS prevention programs; expand public-private health coordination activities, encourage private health facilities to participate in detecting and treating tuberculosis; combine the activities of specialized health facilities, general health facilities, and public health with private health facilities in tuberculosis prevention and control activities; implementing TB Program activities in crowded areas...

To effectively prevent tuberculosis, it is necessary to change the thinking about tuberculosis of patients, sectors, social organizations, as well as strengthen coordination with health agencies. Curing one tuberculosis patient means preventing 10 others from getting tuberculosis. Therefore, the province and the health sector need to have appropriate incentive policies to attract doctors working on tuberculosis and grassroots tuberculosis prevention personnel; there needs to be policy changes so that patients can proactively seek out medical facilities, persistently treat tuberculosis according to the correct regimen in order to completely eliminate tuberculosis from the community.

Doctor CKIThai Dinh Lam

(Deputy Director of Nghe An Tuberculosis and Lung Hospital)