According to the Centers for Disease Control and Prevention (2013), a burden of disease “considers health, social, political, environmental and economic factors to determine the cost that disease and disability exert upon the individual and society”. In Bangladesh, tuberculosis (TB) takes the lives of around 80,000 per year on average with about 190,000 new cases occurring each year (Vassall, 2015). With that being said, TB is a concerning public health problem. Globally Bangladesh is considered in 6th place in terms of the burden of tuberculosis on the population as a whole and “therefore accounts for just under 9% of the deaths in Bangladesh every year” (Vassall, 2015). With the “high rates of migration and the transient population”, locals of Bangladesh are exposed to poverty, overpopulation and working/living conditions that are improperly ventilated enhancing the likeliness of TB to spread (World Health Organization, 2020). This journal will discuss an intervention that has shown to be successful and what determinants of health the intervention addressed.
An intervention that has shown to be successful in combating the disease burden TB in Bangladesh is the Directly Observed Treatment Short course (DOTS) which is overseen by the Bangladesh Rural Advancement Committee (BRAC). The DOTS approach “incorporates wide ranging health systems improvements, political commitment to improving TB programs, improved TB laboratory services, free TB drugs for all TB patients, and accurate documentation and monitoring of TB diagnosis and treatment outcomes” (Karumbi & Garner, 2015). In an attempt to improve the populations adherence, the infected individual is to be monitored while consuming each and every dose of the ordered drug. Resistance to anti-TB drugs occur when individuals are non-compliant with the drug course regimen or misuse the prescribed drugs. Multidrug resistant tuberculosis (MDR-TB) unfortunately “cannot be treated with the standard 6-month course of first line medication which is effective in most TB patients” resulting in “a different combination of second-line drugs usually for 18 months or more” (World Health Organization, n.d.). Successes for Bangladesh in the fight against TB consist of but are not limited to the increase of reported TB cases, a treatment success rate of 93% among new and relapsed cases, a success rate of 73% in regards to the effectiveness of the multi-drug resistant TB (MDR-TB) and the implementation of the National TB Prevalence Survey (World Health Organization, 2020).
In order for Bangladesh to continue to be successful with the DOTS strategy, several determinants of health had to be addressed. The Bangladesh Rural Advancement Committee first identified the gaps in service of delivery focusing on the “inadequacy of human recourses in the government setting”, the inadequacy of “community engagement and linkage to services” and the “inaccessibility of health care services in hard to reach areas” (Vassall, 2015). Economic barriers (i.e., transportation, investigation costs and wage loss), geographical barriers (i.e., distance to TB treatment facilitates), socio-cultural barriers (i.e., stigma, discrimination and lack of knowledge on TB) and health system barriers (i.e., “poor adherence to treatment and unfavorable treatment outcomes as well as inadequate diagnostic facilities for smear negative, extra-pulmonary and DR TB) are barriers to the universal access of TB care (Vassall, 2015). The BRAC Model addresses community-based TB care. Community health workers are trained with continuing education monthly. During home visits education is provided and measured by a teach back techniques. BRAC staff organizes “outreach sputum collections centers in hard to reach and slum areas” while also providing “financial support for diagnostic purposes in regards to poor presumptive cases” (Vassall, 2015). The staff also ensure DOT and follow up tests. In order to remain and continue success with this program, political advocacy, improved community engagement, socio economic focus and screenings for high risk populations need to be a priority of Bangladesh to ensure quality assured care while decreasing the burden of disease.
Centers for Disease Control and Prevention. (2013). NCD burden of disease. Retrieved from
Karumbi, J., & Garner, P. (2015). Directly observed therapy for treating tuberculosis. The
Cochrane database of systematic reviews, 2015(5), CD003343. https://doi.org/10.1002/14651858.CD003343.pub4
Vassall, A. (2015). Bangladesh perspectives tuberculosis. Retrieved from
World Health Organization. (n.d.). The shorter MDR-TB regimen. Retrieved from
World Health Organization. (2020). World tb day 2016. Bangladesh continues its battle against
the disease. Retrieved from http://www.searo.who.int/bangladesh/world-tb-day-2016/en/