LEVELS OF PREVENTION & CONTROL OF TUBERCULOSIS:
Preventing and controlling tuberculosis is firstly aimed at early diagnosis and treatment with TB. Primary, secondary and tertiary prevention levels of TB are as follows:
TB stigma is highly prevailing in Pakistan and is very common. Because of this, patient suffers from discrimination, rejection and social isolation (1). TB stigma is one of the most common barrier to TB control (2). Even after TB is cured the label of having “TB”. This stigma is related to TB affect negatively the life of a TB patient in different following ways (2):
Patient does not reveal his ailment.
People develop feeling of hatred towards the TB patient.
It gives rise to gossip and speculations.
Marriage prospects reduce.
Family tensions and divorce rate may increase.
Patient may lose his job
Patient and his family members are financially burdened
Patient worries about fulfillment of his responsibilities in the society
Guilt and blame of TB infection
This stigma has public health implications. It may lead to delayed diagnosis and thus delayed treatment for TB. On the other hand, once the treatment is started, it may also lead to treatment default.
How this stigma can be addressed? Here is where health education comes into play. Focused health education about TB not only to patients but their family members may allay fears and overcome this stigma (15). Once the patient knows that he has support in society from his family, friends and the healthcare workers, TB will be diagnosed and treated early which is one of the effective strategies for TB control.
1- Early diagnosis: TB is an insidious disease and may not produce violent symptoms. By the time typical symptoms of TB like cough, fever, weight loss and night sweats develop, the person has infected many others. Therefore it is necessary to find a case of TB early for effective control of the infection. On finding the case of TB early, treatment can be started early and thus he can be prevented from becoming infectious and spreading the disease to others. Following investigations are performed to detect a case of TB:
Sputum microscopy for AFB is regarded as the most effective method for diagnosis of infective case of TB (5). By sputum examination, a patient of TB can be distinguished in the following categories: i. Sputum smear positive ii. Sputum smear negative
Tuberculin test: It is easy to perform and tells whether the patient has had tubercular infection. In this test tuberculin reaction is elicited, universal method of which is by Mantoux test. This test consists of injecting 0.1 ml (5 i.u). of Purified Protein Derivative (PPD) solution intra-dermally on the outer surface of the forearm four finger breadths below the elbow. The reaction is measured after 72 hours. If the reaction is positive, a wheal is raised measuring 5 mm or more surrounded by the zone of erythema. Only induration has to be measured (5). The specificity of Mantoux test for pulmonary as well as extra-pulmonary TB increases as the size of induration increases reaching 86% at induration of more than 15 mm (21).
X-Ray examination: By X-ray examination of the chest, tuberculin positive cases can be divided into those who have healed TB requiring no treatment or are suffering from active tuberculosis.
2- Prompt treatment: It is the most important preventive measure against TB. In order to control TB, it is important to control the reservoir (the infected TB patient). The only quick way for it is to treat the infectious patient to render him non-infectious.
It consists of disability limitation and rehabilitation of the TB patient. Tuberculosis patient due to his disease may develop disability in respiratory functions such as chest wall deformity and decreased exercise endurance due to which his daily activities may be restricted. These disabilities can be limited by adequate treatment and rehabilitation can be provided in the form of physical therapy as well as social support.