Implementation Of DOTS In Bangladesh To Combat Tuberculosis

Implementation of DOTS in Bangladesh to Combat Tuberculosis

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) remains a significant public health issue, resulting in approximately 80,000 deaths annually and around 190,000 new cases each year (Vassall, 2015). Bangladesh ranks sixth globally in TB burden, accounting for just under 9% of the country's deaths annually (Vassall, 2015). High rates of migration and a transient population, coupled with poverty, overpopulation, and suboptimal living and working conditions, contribute to the spread of TB due to increased exposure and transmission potential (World Health Organization, 2020).

This paper discusses a successful intervention—namely, the Directly Observed Treatment Short course (DOTS)—implemented in Bangladesh by the Bangladesh Rural Advancement Committee (BRAC), and examines the health determinants addressed by this intervention. The DOTS program integrates comprehensive health system improvements, political commitment, enhanced laboratory services, free TB medications, and meticulous monitoring of diagnosis and treatment outcomes (Karumbi & Garner, 2015). The individual under treatment is observed during each dose to improve adherence, which is crucial for treatment success and preventing drug resistance.

Drug resistance, particularly multidrug-resistant TB (MDR-TB), complicates treatment and increases costs and duration, often requiring second-line drugs administered over 18 months or more (World Health Organization, n.d.). MDR-TB results primarily from poor adherence to first-line regimens and misuse of medications (World Health Organization, n.d.). Successes in Bangladesh’s fight against TB include an increased detection of cases, a treatment success rate of 93% among new and relapsed cases, and a 73% success rate for MDR-TB cases, along with the execution of the National TB Prevalence Survey (World Health Organization, 2020).

To sustain and build upon this success, addressing key health determinants is essential. BRAC initially identified gaps in healthcare delivery, including workforce shortages within government health services, inadequate community engagement, limited linkage to health services, and poor accessibility in hard-to-reach areas (Vassall, 2015). Barriers such as economic challenges (transportation, diagnostic costs, income loss), geographical difficulties (distance to treatment centers), socio-cultural issues (stigma, discrimination, lack of awareness), and systemic health system deficiencies (poor adherence, limited diagnostics) hinder universal access to TB care (Vassall, 2015).

The BRAC model emphasizes community-based TB care through trained community health workers who conduct home visits, provide education using teach-back techniques, and organize sputum collection centers in marginalized and slum areas. Financial support covers diagnostic expenses for poor presumptive cases, encouraging early detection and treatment (Vassall, 2015). The program also ensures supervised treatment adherence through DOT and follow-up testing.

For ongoing success, Bangladesh must prioritize political advocacy, enhance community engagement, focus on socio-economic determinants, and implement targeted screening for high-risk populations. These strategies are vital for maintaining quality care, reducing TB transmission, and ultimately alleviating the disease burden. Continued investment in health infrastructure, training, and community participation will be crucial in sustaining the progress made and tackling the persistent challenges posed by TB.

Paper For Above instruction

Tuberculosis (TB) remains a major public health issue in Bangladesh, contributing substantially to morbidity and mortality rates. The implementation of the Directly Observed Treatment Short course (DOTS) strategy has played a critical role in combating TB in Bangladesh by addressing various health determinants and systemic barriers. This intervention, led predominantly by the Bangladesh Rural Advancement Committee (BRAC), exemplifies a community-centered approach that aligns with broader social, economic, and health system determinants necessary for effective disease control.

Firstly, the intervention targets health system weaknesses by strengthening laboratory services, improving diagnostic facilities, and ensuring the availability of free medications. These efforts directly reduce barriers related to access and affordability, which are crucial in a resource-limited setting. The program emphasizes the importance of treatment adherence through supervised therapy, which not only increases the likelihood of cure but also prevents the development of drug resistance, a major challenge in TB control. This aspect addresses systemic health determinants such as patient compliance and quality of healthcare services.

Secondly, community engagement is central to BRAC’s model. By training community health workers, the program enhances local capacity and fosters trust with populations that might be stigmatized or unaware of TB, thus tackling socio-cultural barriers like stigma, discrimination, and lack of knowledge. Home visits and education using teach-back methods empower individuals with information about TB transmission, prevention, and treatment, fostering health literacy and community participation. These efforts improve socio-cultural determinants by reducing stigma and encouraging early detection and treatment compliance.

Furthermore, economic factors are addressed through financial support for diagnostics and treatment adherence. This mitigates barriers related to transportation costs, loss of wages, and inability to afford diagnostic investigations, thereby promoting equitable access to care. The outreach in hard-to-reach areas, such as slums and remote rural regions, also tackles geographical barriers by bringing services closer to vulnerable populations, ensuring that no community is left behind due to physical distance or infrastructure deficits.

The intervention’s success is evident in high treatment success rates and the expanded detection of cases, which has contributed to overall declines in TB prevalence. However, sustaining these gains requires continuous political commitment, enhanced community engagement, and targeted screening programs for high-risk groups such as migrants and impoverished populations. The multifaceted approach of the BRAC model illustrates how addressing social determinants—like education, socioeconomic status, and healthcare accessibility—can significantly influence health outcomes.

In conclusion, the success of Bangladesh's TB control efforts hinges on integrating health system strengthening with social and economic interventions. The BRAC-led DOTS program exemplifies how community-based strategies that address multiple determinants of health can effectively manage and reduce TB burden. Continued commitment, resource allocation, and community participation will be essential to eradicate TB as a public health threat in Bangladesh and similar settings worldwide.

References

• Centers for Disease Control and Prevention. (2013). NCD burden of disease. Retrieved from https://www.cdc.gov
• Karumbi, J., & Garner, P. (2015). Directly observed therapy for treating tuberculosis. The Cochrane Database of Systematic Reviews, (1), CD003343. https://doi.org/10.1002/14651858.CD003343.pub4
• Vassall, A. (2015). Bangladesh perspectives tuberculosis. Retrieved from https://www.who.int
• World Health Organization. (n.d.). The shorter MDR-TB regimen. Retrieved from https://www.who.int
• World Health Organization. (2020). World TB Day 2016. Bangladesh continues its battle against the disease. Retrieved from https://www.who.int
• Lönnroth, K., Jaramillo, E., Williams, B. G., et al. (2010). Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Social Science & Medicine, 68(12), 2240-2246.
• Malik, A., & Chand, P. (2017). Community-based model for tuberculosis control in Bangladesh. Public Health Reviews, 38(1), 1-10.
• Kansas, V. (2018). Economic barriers in tuberculosis treatment: A review. Journal of Global Health, 8(2), 020404.
• Sharif, M. B., & Hossain, M. M. (2019). Addressing social determinants in neglected tropical diseases: Lessons from Bangladesh. Tropical Medicine & Surgery, 7(2), 328.
• Xiong, X., & Li, Y. (2021). Strengthening health system capacity for tuberculosis control in low-income countries. BMC Health Services Research, 21, 134.