In spite of the UAE’s rigorous health screening, with a constant influx of expat populations through the country, ongoing vigilance of TB is vital, say experts.
Dr Sandeep Pargi, specialist in respiratory medicine at Aster Hospital, Mankhool, says: “The UAE Government and DHA has a good system in place for screening,
detection and treatment of Tuberculosis cases. In comparison to other Asian countries, the UAE has a strong health policy to control the spread of Tuberculosis.
Due to the continuous influx of the expat community, there is always a need of strict Tuberculosis screening and early detection of positive cases.
“The current situation in the UAE poses a challenge, since new cases of Tuberculosis are being detected even though there is a screening process in place.
This is because of the re-activation of ‘latent’ cases of Tuberculosis and patients picking up the condition from their native homeland when they go for vacation.”
Carriers can simply return home on holiday and pick up the airborne respiratory disease, which affects the lungs, mainly found in high density, poverty stricken
According to the World Health Organisation’s Global Tuberculosis Report 2017, TB remains the top infectious killer in adults worldwide, and one of the top ten killers overall worldwide, though if caught early, is fully curable. It accounts for causing sickness in 10.4 million affected by this disease and death of 1.4million due to TB.
WHO statistics show that 64% of new cases in 2016 were found in just seven countries; India, Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa.
There have been huge shifts in the way TB is treated in the UAE, says Dr Nasreen Molla Adamjee, Director of Research and Programmes, at the Harvard Medical
School Centre for Global Health Delivery in Dubai. “It’s definitely being treated more humanely. There is less penalising and more effort to help reduce the stigma of the disease. The health authorities recognise that there are many people coming from the heavy burden TB countries.”
After a positive diagnosis, patients need to be referred to government medical centres for treatment and further management. If the condition is detected for the
first time before a potential resident has employment in the country, they are deemed “unfit” and will not be granted residency. Residents detected while on an
existing residence visa, are now fully treated before being sent back to work after completion of treatment. Dr Pargi praised the changes in the federal law which came into effect in 2016, which means patients can return to work rather than having to return to their home country. “The UAE has taken a good initiative to treat patients who are affected with Tuberculosis and allow them to work once they are free from it,” he said.
With a national TB registry in the country, in addition to the local ones such as that kept by the DHA, which is constantly being upgraded and improved, there is a constant eye on the condition, allowing private medical centres to notify of suspected and confirmed cases of the disease.
Dr Pargi said: “There is still apprehension, taboo and a lack of information among residents regarding Tuberculosis. Health awareness programmes in the work place by health authorities could help by providing the correct information and knowledge regarding Tuberculosis including when to suspect the condition, how to
avoid it from spreading and when to go for detection and treatment. The fear of being deported is the biggest hurdle that stops a patient from coming out and getting tested for Tuberculosis.”
Awareness among healthcare professionals must also be raised to the fact that once treated, the patient has successfully eradicated the disease and should be
able to reintegrate to their former employment, says Dr Adamjee. “Once, the patient is detected for disease, if treated correctly, he or she is totally cured,” she said.
Dr Salmaan Keshavjee, Director of the Harvard Medical School Centre for Global Health Delivery in Dubai, agrees that awareness is an ongoing challenge.
“It is critical to educate policy-makers, practitioners, and advocates that ensuring that people sick with the disease get the correct treatment as soon as possible and that their close contacts get the correct prophylaxis treatment as soon as possible. It is a critical part of stopping the epidemic. Once that happens, both the sick person and their close contacts no longer face the prospect of recurrent disease. This knowledge has to be translated better into public policy,” he says.
“Raising this awareness is critical to stopping stigma. People often think of TB as a personal failing. It is not. It is a disease that generally infects and causes sickness in people that are vulnerable, because of malnutrition, smoking, co-morbid diseases such as diabetes, over-crowded housing, immuno-compromise of any sort. But it is treatable and people can get completely cured.
This has been the case since 1948, but because people in poorer countries do not have access to treatment for disease and infection (with prophylaxis for contacts), the disease has continued to spread. So it can be stopped, and with that the stigma can be stopped. The continued spread of TB is a failure of public health systems and health care delivery systems rather than a failure of the individual. To stigmatize the individual or a family is a mistake.”
Rates are only dropping between 1.5 to 2% per year, he says, and the centre is spearheading a movement called the Zero TB Initiative to bring an international
community together to take drastic action. “This initiative aims to engage with cities to implement a comprehensive epidemic control to stop TB. The comprehensive approach, active case finding, treatment of all forms of TB, treatment of TB infection (so-called “latent” TB), and patient support, is summed
up as ‘search, treat, prevent’. We now have more than 40 cities wanting to be involved in this. Everybody realizes that to stop TB, one has to be able to screen
households and deliver care into the communities where patients live and work.”
What is Tuberculosis?
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease.
People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.
When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.
Since 2000, 53 million lives have been saved through effective diagnosis and treatment. Active, drug-sensitive TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. The vast majority of TB cases can be cured when medicines are provided and taken properly.
Source: World Health Organisation