Tuberculosis is caused by a bacterium called Koch bacillus after the scientist who discovered it.
Most individuals become infected when they breathe in droplets containing the tuberculosis bacterium. When untreated, a patient with infectious pulmonary tuberculosis will expel these droplets.
Infection does not necessarily lead to illness. In many cases, an individual’s own immunity will hold the infection in check all through life. In 10% of cases, the infection becomes an active disease. Individuals infected with HIV will have more than one chance in two to develop active tuberculosis in the course of their lives.
Infection and illness
Tuberculosis may affect any part of the body. Most sufferers develop pulmonary tuberculosis.
The consequences of tuberculosis
A diagnosis can only be confirmed with certainty after a bacterium has been detected. Many ill individuals expel the bacteria in his sputum. When that happens, examining the sputum under a microscope will confirm whether the disease is there. A chest X-ray examination may reveal a suspicious picture, but no picture will provide a sure diagnosis.
Once the diagnosis has been confirmed, treatment must be applied. The WHO recommends the Directly Observed Treatment Strategy short course, or directly supervised monthly ambulatory treatment. The patient follows a treatment scheme proven for its efficiency in the presence of an individual trained to this effect. This individual may be a health worker, a responsible member of the community or maybe a member of the family. Treatment consists of an intensive phase lasting 2-3 months with three to five drugs, followed by a continuation phase lasting 4-6 months with 2-3 drugs.
The Directly Observed Treatment Strategy
In order to be cured, a tuberculosis patient has to take 2-3 drugs a day for 6-9 months. This is not easy. Many patients feel like ending their treatment no sooner they feel better, after a few months that is. However, breaking off treatment half-way is the worst thing one can do because the disease will very likely recur. Some patients develop drug resistance as a result.
The WHO recommends the Directly Observed Treatment Strategy
In order to guarantee complete and adequate treatment, the WHO recommends DOTS. According to recent figures, 77% of tuberculosis patients currently live in areas where DOTS is applied. The Damien Foundation has helped 15 countries to apply the strategy.
The basic Directly Observed Treatment Strategy involves five factors :
- The local authorities’ political commitment towards tuberculosis control.
- Confirming diagnosis by detecting the Koch bacillus contained in sputum.
- Full standard treatment with directly supervised drug administration for at least the infectious cases.
- A constant supply of high quality drugs.
- Standard recording and reporting.
1. Local authorities’ political commitment towards tuberculosis control
Without the local authorities’ cooperation, we cannot combat tuberculosis effectively.
2. A diagnosis based on examining sputum
Clinical symptoms and X-rays are insufficient evidence to prove the presence of tuberculosis. Only the presence of the Koch bacillus in sputum proves that tuberculosis is the cause of signs and symptoms that were observed. Any diagnosis based only on X-rays bears the risk of “over-diagnosing” and treating individuals who are not affected by tuberculosis
3. A complete treatment
All cases of tuberculosis require full treatment. However, direct observation of drug administration is more important in infectious cases. These patients run a greater risk of dying than of developing drug resistance if they do not take the full course of treatment or if they break off their treatment prematurely.
4. Available drugs
There are very efficient anti-tuberculosis drugs. However, in order to be efficient, all drugs have to be available for all patients undergoing treatment, unfailingly and without delay.
5. Standardised recording and retrieval
All patients have to be recorded. Treatment results must also be set on record each time and reported in standardised way. This will enable us to monitor a programme, detect problem areas and, if necessary, modify our support.