Despite Bangladesh tuberculosis (TB) notification levels recovering to pre-COVID-19 pandemic levels, the country continues to struggle with a high TB burden. It is one of the 30 high-burden countries for TB, in addition to being one of the 27 countries burdened with multi drug-resistant TB (MDR TB). A dip in TB notification occurred during the COVID-19 pandemic. Subsequently, the treatment coverage increased to 82%. This is due to the implementation of innovative measures to address service disruptions and mitigate the impact of the COVID-19 pandemic on TB programs.
Bangladesh has been able to reduce the gap between estimated cases and notified TB cases. Over 80% of people estimated to have TB have now been identified, leading to a more successful follow-up in treatment rates. The country reached the first milestone of the ‘End TB Strategy’ by 2021, which was a 35% reduction in the total number of TB deaths between 2015 and 2020.
However, 375,000 new TB cases and 42,000 annual deaths remain very worrisome. Despite recent success, more initiatives are needed to accelerate the progress towards the vision of a TB-free Bangladesh.
Another worrying trend to note is that the detection of TB among women decreases with age. The underlying causes might be social and economic insecurity that increases after a certain age, the loss of one’s life partner, comorbidities with Non-Communicable Diseases etc.
Rohingyas’ TB risk requires more attention
Another group which is particularly exposed to the risk of TB in Bangladesh is the Rohingya refugees who are known as Forcibly Displaced Myanmar Nationals (FDMNs). Since 2017, around 770,000 Rohingya have escaped to Bangladeshi refugee camps. While their presence is often mentioned in media coverage, their health issues have received less attention.
The camps in Cox’s Bazar are congested, precarious and unhygienic, creating a perfect storm for the spread of TB. A total of 3,500 TB patients were registered after screening of 1,46,000 FDMNS. While the government has provided some facilities in terms of diagnostics and treatment, low awareness among the residents of the camps is a key barrier, leaving many TB-affected people undiagnosed and in need of treatment.
Outside of the Rohingya community, poverty and inequities continue to put people’s health at risk, including by creating conditions that promote the spread of TB. It is still not among the diseases eligible for insurance coverage and applicable for benefits under social welfare schemes of the government. The parliamentary TB caucus and a high-level task force are considering it at the moment. Hopefully it will be approved before it becomes too little too late.
The period of 2024-2030 is the potential time for addressing the social determinants of TB and furthering efforts for new drugs, regimens, diagnostics and vaccines. The national program in Bangladesh shows signs that it can align with these possibilities, and make the most of new tools, such as digital technologies. By taking a “Prevent – Find – Treat – Strengthen the health system – and Sustain an enabling environment” approach, the national TB program could achieve significant results in accelerating towards a TB-free Bangladesh
