TB and diabetes co-morbidity is a public health challenge in Nepal
Three years ago, Hitesh Chhetri (name changed), a resident of Nuwakot, Nepal and truck driver by profession, was diagnosed with diabetes. He then consulted a doctor and started taking medicines. Being the sole bread winner of his family Hitesh was struggling economically. Yielding to economic burden, he worked even though he was on medicines.
Talking even a day off was out of question for him. He had to drive a truck loaded with commodities from the markets to the villages via dusty roads. He would be at work for 16-18 hours daily. Few months later, Hitesh felt that he was getting physically weaker. His weight dropped drastically, accompanied by fever and cold, and loss of appetite. Making matters worse, he would vomit up blood. He could no longer work.
Already living with diabetes, Hitesh was now diagnosed at Patan Hospital, Lalitpur, Nepal to be suffering from TB also. He knew he had got TB due to his incessant smoking and working in very dusty conditions, but it was too late. His case of TB has already elevated to MDR-TB. Currently, he is undergoing treatment of both diabetes and MDR-TB.
Not only Hitesh, but many other people are increasingly found to have been suffering from diabetes and TB simultaneously. What is more surprising is that Nepal still does not have the system to diagnose and know if a person with diabetes is also suffering from TB at the same time. There is no medical facility for the special treatment of such cases. This has become a great problem for the patients suffering from both these diseases. According to the Nepal Tuberculosis Center, out of about 40,000 TB patients, nearly 5000-7000 lose their lives. However, there is no authentic data on how many of them are suffering from diabetes and TB both.
This dual-morbidity of diabetes and TB has been emerging as a critical challenge to public health, not only in Nepal, but all over the world. This issue is sure to exacerbate if no any suitable measures are adopted sooner or later. Based on the Post-2015 sustainable development goals, it is necessary to come up with effective programmes to eradicate the TB epidemic from the globe by 2030.
According to Paul Jensen, Senior Advisor (Policy), International Union Against Tuberculosis and Lung Disease (The Union), the efforts to eradicate TB without addressing the issue of diabetes-TB co-infection, will be of no use.
Most of the countries are still not serious regarding the issue of diabetes-TB. The situation is such that where there are higher number of TB cases, the diabetes issues are shadowed, and vice-versa. They are still ignorant of the fact that it is not possible to do away with TB and diabetes unless they are addressed jointly. According to Senior physician of Nepal, Dr. Dirgha Singh Bam, it is important to consider that people living with diabetes increase their risk of contracting TB by 2 to 3 times.
“The case is more complicated when it is reversed. Similarly the probability of repeatedly being infected with TB, and even succumbing to it, is more when a person is suffering from both TB and diabetes,” Bam says.
Research shows that over 80% of the lives lost to diabetes are from the countries with low and middle income levels. This shatters the myth that ‘diabetes is the rich man’s disease’. Therefore, it is urgent to concentrate upon the efforts to control this disease in such third world countries.
WHO reports that in 2013 diabetes affected more than 350 million and more than 9 million fell sick with TB around the world. Globally 10% of the TB infected patients are found to have been co-infected by diabetes at the same time– this amounts to nearly 1 million people. A large proportion of people with diabetes as well as TB is either not diagnosed or is diagnosed too late. It is feared that as diabetes spreads, it will cause more and more people to develop TB. Even though WHO had in the past prepared the structure to control and treat TB-HIV coinfection through integrated programmes, the implementation part was less than the standard. This resulted in a large number of HIV infected people dying from TB.
Learning from this experience, experts warn not to repeat such mistakes in the case of TB-diabetes. Paul Jensen, Senior Advisor (Policy), International Union Against Tuberculosis and Lung Disease (The Union) says, “For this, it is necessary to check if the TB patients are suffering from diabetes or not. If found, they should be treated under special observation.”
WHO calls for the effective treatment facility and management for the dual cases of diabetes-TB. This calls for integrated healthcare approaches. All people with TB should be screened for diabetes and screening for TB in people with diabetes should be considered, especially in high TB prevalence settings.