Chronic Obstructive Pulmonary Disease (COPD) is an important cause of morbidity and mortality worldwide (Menezes, Perez-Padilla, Jardim, Muino, Lopez, Valdivia & Hallal, 2005). Menezes et al. (2005) states that COPD cases are often underdiagnosed and undertreated, resulting in underestimation of the burden of this disease. Despite many advances in modern medicine, mankind’s old adversary tuberculosis (TB) remains a significant public health problem both in developed countries as well as in developing world (Chakrabarti, Calverley & Davies, 2007). India is one of the developing countries where prevalence and spread of TB is vastly noted. The spread of TB occurs through droplet transmission; however, the disease can actually be present in various different organs of the body. As we know that developing countries often face the dilemma and hazards of improper sanitation and hygiene and therefore the disease like TB causes epidemic plagues affecting hundreds and thousands of lives throughout the country.
Menezes et al (2005), also states the presence of chronic obstructive pulmonary disease in Latin America. The first and foremost factors that trigger the spread of COPD or diseases like Tuberculosis are lack of sanitation/hygiene, second hand smoking and improper treatment and diagnosis. It has been observed and documented that people who have TB are underdiagnosed or neglected. As the cause and spread is through aerosol droplets the diseases spreads rapidly around the globe.
Lack of sanitation and hygiene is a red alert for the spread of TB. Also second hand smoking can increase the risk of TB. There are various incidences that are noted where a non-smoking person has been diagnosed of TB and lung cancer. The other cause of spread and prevalence of TB is improper diagnosis. Many a times it has been known that a positive Mantoux test is neglected thinking that the person has hypersensitivity to tuberculin.
Agarwal and Chauhan (2005), states that during 2004, it was estimated, about nine million new cases of TB occurred globally. India contributes a fifth of these cases, i.e., about 1.8 million, of which 0.8 million are new sputum-positive infectious cases. Nearly 400,000 estimated deaths occur annually due to tuberculosis. After this incidence various steps were taken simultaneously to cure the infective TB. According to Agarwal and Chauhan in 2005, The National TB Control Programm (NTCP) was started in 1962, using the District TB Centre model. However, due to inadequate ownership of the program by the states and some inherent flaws in design, it did not make any significant epidemiological impact. In 1992, the Government of India, together with the World Health Organization (WHO) and the Swedish International Development Agency (SIDA), reviewed the national programm and concluded that it suffered from managerial weaknesses, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes. Around the same time, in 1993, WHO declared TB a global emergency and devised the Directly Observed Treatment – Short Course (DOTS) strategy and recommended that all countries adopt this strategy. The strategy is built on five pillars, viz, political commitment and continued funding for TB control programmes, diagnosis by sputum smear examinations, uninterrupted supply of high quality anti-TB drugs, drug intake under direct observation, and accurate recording and reporting of all registered cases.
Udwadia, Pinto and Uplekar (2010), questions the efficacy of Tuberculosis management by private practioners in India in the past two decades. Udwadia et al. (2010) also states that with a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programm, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.
As little to no change has been noted to the cure of TB the efficacy of all the above mentioned programs is still questionable. I did my internship in Government TB hospital which was situated on the outskirts of the city, away from the populated city area. I personally saw that the patients were poorly treated.
I have still noted one major thing here in United States and that is freedom of smoking. I saw a mother warning her kid to cover his nose when a lady passed by. I saw that this lady was smoking openly without any concern of her surroundings. Second hand smoking causes obstructive diseases in non-smoking individual.
Do you think that authorities should regulate laws and prohibit smoking in public areas? What are impacts of second smoking on global health care?
Udwadia, Z.F., Pinto, L.M., & Uplekar, M.W., (2010). Tuberculosis Management by Private Practitioners in Mumbai, India. PLos one; 5(8): e 12023.
Chakrabarti, B., Calverley, M.A., & Davies, D.O., (2007). Tuberculosis and its Incidence, Special Nature, and Relationship with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis; 2(3): 263–272.
Menezes, A.B., Perez-Padilla, R., Jardim, J.B., Muino, A., Lopez, M., Valdivia, G., & Hallal, P.C., (2005). Chronic Obstructive Pulmonary Disease in Five Latin American Cities (the Platino Study): a prevalence study. Lancet. 366(9500), 1875-1881. doi:10.1016/S0140-6736(05)67632-5