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“Yes! We can end TB” is the theme of this year’s World Tuberculosis Day, March 24. For Hai Duong, the progress towards ending TB is being made by the health sector, the entire political system, and the people, but there are still certain barriers.
Potential risk of tuberculosis in the community
Vietnam is still a country with a high burden of tuberculosis, ranking 11th out of 30 countries with the highest number of tuberculosis patients globally, and also ranking 11th out of 30 countries with the highest burden of multidrug-resistant tuberculosis in the world (according to WHO Global TB Report 2023). Hai Duong is one of 20 provinces and cities in the country where tuberculosis is still circulating. With a population of over 1.9 million people, the disease is latent in the community, many people have not been detected with the disease, which is a risk factor for the source of infection. In fact, at medical facilities, through screening for other common diseases, tuberculosis cases are still detected in the community.
Mr. NH D., Ngoc Lien commune (Cam Giang) is being treated at Department of Internal Medicine 3 (TB-HIV-Drug Resistance) of Hai Duong Lung Hospital due to tuberculosis. Mr. D. said: "I suddenly lost my voice, coughed... so I went to the Commune Health Station for examination and was suspected of having tuberculosis. After that, I was referred to the Lung Hospital for treatment...". This is one of many tuberculosis patients in the community who do not know they carry the disease because they only think it is a cough, fever, or common illness.
Thanh Ha is one of the districts that has implemented the community tuberculosis control program well. On average, each year, over 60 people with tuberculosis are detected in the district. Of these, about 60% are detected by the Health Center and Commune Health Stations through positive sputum tests. The remaining patients are suspected by local people and proactively go to higher-level hospitals for treatment.
According to statistics from Hai Duong Lung Hospital, in 2023, only 0.7% of the population in the province was screened for tuberculosis. Through screening, 1,091 cases of tuberculosis of all types were detected and treated, of which 655 had pulmonary tuberculosis with evidence of bacteria (the main source of infection in the community). The number of people tested is still modest, and the number of people with tuberculosis managed above cannot fully cover and count the number of people with tuberculosis in the community in the province.
Along with the latent TB situation in the community, the trend of TB infection becoming younger, the situation of TB patients voluntarily abandoning treatment, and patients with drug-resistant TB due to non-compliance with the regimen are challenges in the fight against TB, and at the same time, these are potential sources of infection for other healthy people. The whole province is currently managing 46 people with drug-resistant TB (7 patients with single-drug resistance, 3 patients with pre-super drug resistance, super drug resistance, and the rest with multi-drug resistance). If these drug-resistant patients are not detected early and treated promptly, they will be a dangerous source of infection for the community.
Barriers to tuberculosis management and treatment
Tuberculosis patients in recent years tend to be younger. Patients of working age and students are often absent from their locality. There are even cases where patients do not comply with treatment such as taking medication at the wrong time; being tired, or stopping taking medication...
Some people with TB are elderly and lonely and lack management and support. The grassroots health staff is small, has many jobs, and is not specialized in TB prevention and control, so they do not regularly monitor patients being treated at home. The TB treatment regimen is quite long, leading to many patients not complying completely with treatment, skipping follow-up visits or not being treated on schedule.
Some people with TB have other chronic diseases such as diabetes, high blood pressure, chronic obstructive pulmonary disease, so they need to take many drugs along with TB drugs, which can potentially cause side effects. After a period of treatment, the symptoms of the disease decrease, but testing samples (sputum) is difficult... Some people with TB are still hesitant and self-conscious, so they want to hide their disease. In particular, many patients with HIV and people on Methadone treatment do not cooperate in screening for disease detection...
Along with the proactive examination and early detection of pulmonary tuberculosis patients in the community and at anti-tuberculosis facilities in the area to cut off the source of infection and combined with good management and treatment of tuberculosis patients is always considered the key to the success of the National Tuberculosis Control Program in the province. The efforts of the health sector are not enough, but there also needs to be strong participation and support from the entire political system and people in the province. On the other hand, it is also necessary to pay attention to the funding source for TB screening activities in the community, and to allocate funding for officers in charge of the TB control program in communes and towns...
