In the cold winter of Punjab, Pakistan, we see families spending their weekends with their families and loved ones. However, this was a different day for Adnan Saeed and Rizwan Saeed. Traveling around an hour to Faisalabad Pakistan, they spent their day waiting in line for a promise: a tuberculosis screening and test. Amongst tens of other women, men, and children, they waited patiently in line to get an opportunity for clarity. Adnan’s brother had unfortunately passed away which made this personal; getting clarity for a test about his symptoms will help him improve his outcomes.
His story is one of many. Camps, hosted by Mercy Corps or other humanitarian organizations, help mobilize care to people living in the most underrepresented areas of Pakistan. As a way to provide community-focused care, women, children, and the elderly can bypass barriers to care and receive the information needed to change their health outcomes. These camps serve everyone, free of charge; as trusted entities in the community, working in collaboration with teachers and religious leaders, they are able to elicit sustainable change. The need for these camps represent an unmet need in the country and the burden of tuberculosis.
What is Tuberculosis?
Tuberculosis (TB) is a serious bacterial infection that primarily impacts the lungs. This disease is preventable and treatable, but it remains one of the leading causes of death worldwide. This burden impacts many different countries, but it has an especially heavy burden on Pakistan. As of 2021, Pakistan ranks 6th in the world for the most TB cases. The country itself has an overburdened health system and widespread poverty; this fuels the current public health crisis, impacting the most vulnerable.
One intervention that can possibly combat TB is Directly Observed Therapy (DOT), where healthcare providers supervise their patients while they are taking their medicine. This helps improve adherence long term. Despite its proven success, DOT is implemented in only 3% of clinics in Pakistan, compared to 25% of clinics in India. By working to expand DOT through the region, treatment adherence would improve significantly.
The Impact of TB
TB is caused by Mycobacterium tuberculosis and has particularly severe outcomes for immunocompromised individuals. Alarmingly, two-thirds of the global TB burden is concentrated in the Eastern Mediterranean region, with Pakistan at the center. With 1.5 million people in Pakistan living with TB currently, and over 500,000 TB cases each year, there is reason for concern
In the context of TB, multidrug-resistant (MD) TB impacts many — around 15,000 patients annually to be exact, making Pakistan the 5th highest in the world for MDR. Without interventions like DOT being easily accessible to the most vulnerable, poor adherence is practically guaranteed, which further drives this issue.
Source: CDC Global Health via Wikimedia Commons
The Most Vulnerable: Whom TB Impacts
TB does not discriminate, as it is a viral disease. However, some groups are disproportionately burdened by TB. Upending global trends, women in Pakistan account for slightly more cases than men. This is the result of social stigma discouraging women from seeking healthcare which then compounds disparities and further delays treatment.
In Pakistan’s Dir Valley, the disease is prevalent among those who are 21-40 years old. Oftentimes, TB spreads due to social factors like workplace contact and urban environment. The general trend across the world is that those living below the poverty line experience greater prevalence rates compared to others.
Beyond demographic factors, geography impacts the distribution of the disease in Pakistan. Punjab accounts for 51% of cases of Multi Drug Resistance (MDR) TB, followed by Sindh and Khyber Pakhtunkhwa. Punjab’s dense population and industrial landscape foster conditions that accelerate TB transmission.
Source: Ground Report on Flickr
Risk Factors for TB
There are many risk factors that drive TB in Pakistan. This ranges from urbanization to poverty; considering the latter, around 20% of the population is living under poverty. This results in many individuals not having access to sanitation, ventilation, nor adequate access to housing, all driving TB development.
Biological factors also contribute to the development of TB; research suggests that having diabetes can double the risk of TB. This is key for Pakistan as around 26% of adults in Pakistan have diabetes, which presents as a comorbidity that further worsens TB outcomes.
Acting Now
TB has a negative financial impact in Pakistan, as well. Economically, the cost of TB is staggering. In the US, treatment for one patient can cost up to USD $ 23,000, including medical care and follow-ups. Prevention, in contrast, can cost as little as USD $17. This treatment cost can close off opportunities for the patient and their families. In Nigeria, around a 24.9% income loss is reported for many households who have a TB patient; for an already vulnerable family, this expands their financial hardships and puts them in a position of vulnerability.
In order to address TB in Pakistan, DOT needs to be mobilized effectively. Through subsidies for private collaborations with companies, while concurrently increasing educational campaigns, DOT can be mobilized through the entire country. By not only improving patient outcomes, but motivating conversations around normalizing prevention resources, scaling up TB prevention and intentional treatment would ameliorate the TB crisis. Working to support TB control in Pakistan can accelerate international progress in addressing TB and reducing its negative impact, promoting the human right to health for all.
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