Tuberculosis (TB) continues to thrive in the 21st century, decades after the first successful antibiotic treatments were developed.

It continues to be one of the leading causes of death in the Philippines.

The World Health Organization (WHO) has said that the Philippines still “has a long way to go” in eliminating TB among its citizens.

Based on WHO’s Global TB Report, the Philippines remains vulnerable to this communicable disease and ranks ninth among the 22 countries highly burdened by TB around the world.

As many as 75 Filipinos die of the disease every day, making TB the 6th leading cause of death among Filipinos.

This common and deadly infectious disease is caused by the airborne Mycobacterium tuberculosis.

“TB most commonly attacks the lungs as pulmonary TB. the disease is transmitted from person to person via droplets from the throat and lungs as an infected person coughs, sneezes or otherwise transmits their saliva through the air,” explained Dr. Eduardo C. Janairo, director of the Department of Health (DoH) National Center for Disease Prevention and Control.

Left untreated, Mr. Janairo said each person with active TB will be able to infect an average of 15 people every year.

Based on WHO statistics, about a third of the world’s population is currently infected with TB. the global body estimates that the largest number of new TB cases in 2008 occurred in the Southeast Asian region, which accounted for 35% of the TB incident cases globally.

In the case of the Philippines, the WHO Global TB Report said TB incidence is 290 cases per every 100,000 people as of 2009.

Some success

But Mr. Janairo said the country has taken significant strides in controlling the spread of the disease after the government adopted in 1996 the Directly Observed Treatment Short course (DOTS) strategy.

DOTS consists of improved case detection through strengthened laboratory testing and drug resistance surveillance, which is key in fighting the disease.

Because of the success of DOTS (which is offered free in government health centers nationwide), Mr. Janairo said the Philippines is one of the first four among the 22 “high burden” countries to have met the WHO’s targets.

He said that in 2004, the country achieved a TB case detection rate of 72%, exceeding the WHO’s target of 70%. Since 2007, the detection rate has been 75%.

The treatment success rate reached WHO’s target of 85% in 1999 and has remained at that level since then.

While the national performance levels are already high, Mr. Janairo noted that a great number of provinces are still below target detection and treatment levels due to various systemic and social factors including the difficulty of breaking down the stigma of TB, which keeps many of those infected from seeking care.

“For example, there are still those who think that TB is only a disease of the poor, so sometimes people get all sorts of medication for their incessant coughs, not considering that what they have might be TB,” he said.

Resistant TB

Elizabeth Atienza, campaign coordinator of the Philippine Tuberculosis Society inc. (PTSI) said under the DOTS scheme, patients are required to take the prescribed medicines in the presence of a health worker to ensure proper compliance with the entire treatment program.

Before DOTS, Ms. Atienza said some patients sold their free medication to other people once they started to feel better. “Because of this poor compliance, patients develop Multi-Drug Resistant TB (MDR TB),” Ms. Atienza told BusinessWorld in a telephone interview.

WHO medical officer of the Stop TB program Dr. Woo-Jin Lew said that there are a great number of TB patients in the Philippines with the more complex and dangerous MDR TB.

In a statement, the WHO official explained that a first-time TB patient who undergoes poor treatment is most likely to develop MDR TB, which requires costlier treatments.

About 4% of all detected TB cases in the Philippines — about 12,000 people — are MDR TB, said the WHO.

These patients must be treated for 18 to 24 months, with medical expenses estimated to reach more than P200,000 per patient said Ms Atienza.

(She said regular TB cases detected early enough require only up to six months of continuous treatment, which could cost P5,000 to P6,500 per patient.)

“Much worse, there are many MDR TB patients who are required to take regular doses of extra-strength anti-TB medication for life,” she explained.

According to Ms. Atienza, based on PTSI’s experiences in its hospital arm, the Quezon Institute along E. Rodriguez Ave. in Quezon City, the availability of over-the-counter TB drugs and the propensity of Filipino patients to self-medicate continue to contribute to the emergence of drug resistant TB, and its growing prevalence.

She said that due to the bacteria’s adaptive mechanism, the irregular or non-continuous treatment of infected patients has resulted in its resistance to drugs like isoniazid and rifampicin, which are used to treat regular TB infections.

Expensive disease

The Quezon Institute operates a 50-bed ward for infection control for drug resistant TB cases, and a separate 30-bed ward for indigent TB patients who cannot afford to pay for their treatments.

Ms. Atienza said the Quezon Institute offers free medicines and medical treatment to patients. But patients must pay for the other antibiotics and vitamins that may be prescribed.

Among the hospital’s patients, the stories are similar — family finances drained because of the costly drugs, and lives temporarily put on hold because of the ravaging disease.

With as many as 270,000 new cases of TB detected daily in the Philippines, it is inevitable that the disease leads to mounting financial losses.

In a study by the Tropical Disease Foundation presented by Caltex Philippines, inc. during the launch of the oil company’s anti-TB campaign on Aug. 16, the total economic loss in wages alone due to TB in the Philippines comes to P7.9 billion annually — much more than the P200 million per year budget needed for TB drugs for patients in the country.

Because of this, it has been an imperative for the Department of Health (DoH) to provide free treatments and medicines to TB patients, under the government National TB Control Program (NTP).

“For decades, tuberculosis has been causing enormous economic losses to our country. Hence controlling it to a level where there is no longer a public health problem is a priority,” the department said in a statement.

“the National TB Program is the government’s commitment to address the TB problem in the country. the NTP is being implemented nationwide in all government health centers and government hospitals,” it added.

The DoH urged those who have TB symptoms to go to the nearest health center to be evaluated. “Physicians should assure that patients take their medications regularly and completely,” it added.

The department admitted that the NTP’s implementation had been affected by several constraints, including an inadequate budget for drugs, the poor quality of diagnostic tests done in public health centers and government-operated hospitals, the different approaches in diagnosis and treatment of patients by doctors, and poor treatment compliance.

Through the help of various agencies like WHO, international aid agencies, nongovernment organizations, and the private sector, the government has since been able to implement the NTP and provide free medical assistance to patients.

Budget Secretary Florencio B. Abad assured that the government is working to keep health programs accessible to the poor.

He noted that the expected additional revenues from the Aquino administration’s proposal to adjust the taxes levied on cigarettes, alcohol and other so-called “sin” products will be used to finance various health programs.

Approval of higher “sin” taxes could bring in P58.54 billion in revenues next year, rising to P72.43 billion in 2013, based on the data of the Ways and Means committee of the House of Representatives.

Under the proposed National Budget next year, Mr. Abad pointed out that the government has earmarked P1.02 billion for TB control to ensure treatment of patients under the DOTS scheme. he said this proposed allocation will benefit 293,643 adults, and 65,000 children.

“the Aquino administration considers the advancement and protection of public health as key measure of good governance,” Mr. Abad said in a briefing for BusinessWorld on Aug. 12 “After all, a healthy citizenry means a vibrant country.”

ACCORDING TO the Mayo Clinic Web site (mayoclinic.com), a patient may have either latent TB or active TB.

Latent TB is when the person has a TB infection, but the bacteria remain in an inactive state and cause no symptoms. the person with Latent TB is not contagious.

Active TB makes the infected person sick and the disease can spread to others. It can occur in the first few weeks after infection or it might occur years later.

Signs and symptoms of active TB include: cough, unexplained weight loss, fatigue, fever, night sweats, chills, and loss of appetite.

Tuberculosis usually attacks the lungs. Symptoms of TB of the lungs include: coughing that lasts three or more weeks; coughing up blood; and chest pain, or pain with breathing or coughing.

Tuberculosis can also affect other parts of the body, including the kidneys, spine or brain. Symptoms may vary according to the organs involved. For example, tuberculosis of the spine may present as back pain, and tuberculosis in the kidneys might cause blood in the urine.