There is evidence now that majority of multidrug-resistant TB (MDR-TB) cases are occurring due to direct transmission. This all the more calls for calls for taking infection control seriously. Unfortunately it's importance is still not understood. The second pillar of the End TB Strategy talks of bold policies, one of which is that of infection control.
Do not neglect infection control
In most of the low and middle income countries (LMIC) proper infection control methods in healthcare facilities are often not in place.
Unless healthcare facilities adopt strict infection control measures, it will be difficult to contain TB. This would require a policy enforcement at the level of the Ministry of Health to ensure that all hospitals/clinics (and not just TB clinics) infra structure are provided with at least the basic elements of infection control, like proper air flow and ample sunlight, to prevent transmission of infection.
Infection control at home is equally important. For a majority of the TB patients, poor living and housing conditions have a direct bearing on this. so apart from diagnosing and treating TB cases quickly, it is equally important to address the economic and social determinants for TB care and control.
Also there is need to map the TB epidemic to understand where most of the TB patients are coming from. This could be geographical (like slum areas), or population specific --like those with diabetes (who have 3 times higher risk of getting TB), or those with HIV (whose risk of getting TB is 30 times higher), or those who are smokers/tobacco users. But then diabetes is much more prevalent/frequent than HIV. These are the various risk factors. It all is an issue of holistic health promotion and looking at the entire determinants of TB, beyond the obvious ones. We have to talk also about prevention of obesity, diabetes, smoking, alcohol abuse.
TB rates are declining, but decline has to be steeper!
At the current 1.5% rate of decline of TB incidence it will take a couple of centuries before we can get rid of TB. The End TB Strategy calls for a drastic acceleration in this decline by bringing it to 10% by the end of 2025. This is doable if countries show their political will reflected in their commitment and investment. It was told in the 46th Union World Conference on Lung Health Perhaps in Russia TB rates are already declining by 10%. Once this is confirmed, it will prove that the target is achievable.
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