Tuberculousis

TUBERCULOSIS and POVERTY

By: Fajar Zakaria| TI 5 Reguler | 4314010025

Preliminary

Tuberculosis (TB) remains a public health problem until now. At least one person is infected with TB every second. Every day 20,000 people fell ill with TB, meaning that every 5 seconds a person falling ill with TB in the world. Every day 5,000 people die because of TB, so in this world every 20 seconds a person dies because of TB. TB kills nearly one million women annually. The figure was higher than female mortality due to pregnancy and childbirth. TB kills 100,000 children each year. About 40% of the TB burden in the world occurred in Southeast Asian countries joined in the coordination of WHO South East Asia Regional Office (SEARO). In this area every year there are about 3 million new cases and 750,000 TB deaths, or nearly 2,000 people die every day. In India, every minute there is one person who died because of TB. Until now, no country in the world that has free from TB.^[1] Therefore, it is no exaggeration when people ask, how the image of TB in the future? When the TB control situation remains as it is today, the number of TB cases in 2020 will increase to 11 million, meaning that 200 million cases of TB in the first two decades of the 21st century year.^[2] TB incidence will continue to rise, from 8.8 million cases in 1995 to 10.2 million cases in 2000 and 11.9 million new TB cases in the year 2005.^[3] 

WHO’s data shows that Indonesia is the third largest contributor to the case in the world. Every year the number of new cases of infectious TB is 262,000 people and the total number of patients is 583,000 people annually. Indonesia is estimated that approximately 140,000 people die each year because of TB. Every single minute in Indonesia came a new patient with pulmonary tuberculosis, every two minutes came a new patient of pulmonary TB are infectious, and every four minutes one person died from TB TB.^[4] no longer a public health problem in the country when the number of new patients less contagious than one person for every one million inhabitants. That is, to Indonesia should be less than 200 people annually. Strictly speaking, our job is to decrease the number of 262,000 currently to 200 people. Obviously, it is a tough challenge.

Countermeasures

Various health programs have been carried out, indeed progress has been felt, but the fact that TB is also a problem. TB control program which is now the main approach to directly observed treatment short course (DOTS). DOTS contains five components.

First, the guarantee of political commitment to combat TB in a country. In general, government commitment is built on an awareness of the magnitude of the TB problem and knowledge about TB gulangan penang program that has proved successful. That commitment should begin with the decision of the government to make TB a priority important / major in health programs. To get a sufficient impact, the political commitment should be translated into three important things, namely policy formulation, resource mobilization, and program implementation. For it must be made a comprehensive national program that explains how DOTS can be implemented. Once these foundations have been laid, the necessary funding and executive personnel who are trained to be able to realize the program into real activity in their community. Another important thing is the placement of the TB control program in the health sector reform in general, including at least two important things, namely to strengthen and empower the activities and decision making capabilities at the district level as well as increased cost-effectiveness and efficiency in the delivery of health services.

Second, the discovery of cases by microscopic examination, mainly carried out on those who come to the facility due to lung and respiratory complaints. That approach is called passive case finding. It's been given a general microscopic examination is the most cost effective in TB case finding. In certain circumstances radiographic examination can be done with clear criteria that can be applied in the community.

The third is the provision of controlled drugs directly, or known as directly observed therapy (DOT). Patients is observed  directly when they swallow the medicine. Drugs given to be standardized and given free in all patients with infectious TB and relapse. Treatment for TB takes six months. After taking medication 2 or 3 months is not uncommon patient complaints had disappeared, so he felt he had been healthy and stopped the treatment. Therefore there must be a system that ensures the patient would complete the entire treatment period. Who should see the patient to swallow the medicine? That can be done by health workers, by local community leaders, neighbor patient, or his own family.

The fourth is a guarantee of the availability of drugs on a regular basis, thorough, and timely. The main problem in this case is the planning and maintenance of stocks of medicines at various local levels. It required the recording and reporting of medicines use, for example, the number of cases in each category of treatment, the cases handled in the past (forecasting), accurate data on the stock in each warehouse, etc.

The fifth is a system of monitoring, recording, and reporting. Each treated TB patients must have an identity card which is then recorded in the patient record in the district TB. No matter where people go, he had to use the same card, so as to continue his treatment and did not get recorded twice. The most important factor of the process of recording and reporting of data is recording the cohort system, which is a systematic way of observation to determine the development of treatment and treatment success.

Impact

From the foregoing it is clear that political commitment is the first component of the DOTS program. That is, the health authorities should be able to convince political decision makers that TB is a significant problem. For that we can not only speak of aspects of health alone, the economic aspect will probably be more "talk" to convince the public policy makers, let alone the issue of poverty.

Public health issues simply can’t be separated from the problem of poverty. At least 1.3 billion people around the world are poor, those who have to survive on less than 1 US $ each day.1 Relations disease and poverty can be as vicious cycles. Because of the poor, people become malnourished, living in an unhealthy place, and can’t perform the maintenance of good health. As a result, the poor will get sick. Because of his illness he was forced to seek treatment. The cost of treatment is quite expensive, as a result of the poor will get poorer again, so stop treatment, getting worse and so on.

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