Decades of failure to end TB and tobacco use
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Shobha Shukla - CNS
Contd from previous issue
He was speaking at ‘Meet the Expert’ special session at the World Conference on Lung Health 2024 that was recently held in Bali, Indonesia.
Delayed diagnosis and treatment also mean that the person with TB suffers more, has a higher risk of TB death, while the infection spreads to potentially more people – all of this is so avoidable.
WHO lists tobacco use among the top 5 risk factors for TB – almost one in six TB deaths occur because of tobacco smoking. Tobacco use is also directly linked to dangerously increasing the risk of a range of life-threatening conditions, such as heart diseases and stroke, cancers, diabetes, chronic respiratory diseases, among others.
“Every single disease caused by tobacco is entirely preventable. Even one death is a death too many when it comes to tobacco and TB –because we have a range of evidence-based tools to save lives,” said Dr Bam.
As per the WHO Global TB Report 2024, globally 702,000 people suffered from active TB disease in 2023 because of tobacco use (out of 8 million). Almost half of them came from South-East Asian region (328,000). 191,000 people in Western Pacific region, and 89,000 people in Africa got TB disease due to tobacco use in 2023.
Dr Bam cited data from the latest Tobacco Atlas and said: “One in four TB deaths in China was because of tobacco use (25%). Nepal followed closely with 19.4% TB deaths occurring due to tobacco use. Next in line were Vietnam (17.8%), Philippines (17.5%), Indonesia (17%), Malaysia (16.7%), Myanmar (16.3%), Bangladesh (15.2%), Thailand (14.2%), and India (13%).
Tobacco delayed TB diagnosis and treatment in Nepal
Dr Donald Enarson who made lifetime and game-changing contribution to lung health worldwide, Dr Dirgha Singh Bam (former head of Nepal’s TB programme and former Health Secretary of Nepal government) and Dr Tara Singh Bam among others, did a study published in International Journal of TB and Lung Disease in 2016.
This study showed that delay in health seeking behaviour as well as TB diagnostic delay was alarmingly higher in those with tobacco use history.
Current smokers had the highest risk of long TB diagnostic delays (average: 133 days), followed by ex-smokers (103 days). Average delay in those who never smoked was 80 days.
There should be no delay in TB diagnosis. Early and accurate TB diagnosis is an entry-gate towards TB treatment, care pathway, reduces avoidable human suffering and risk of TB death. Early and accurate diagnosis of TB also stops the spread of infection.
Better TB treatment outcomes in those who quit tobacco use
A study published in 2022 in the reputed journal Thorax showed that TB treatment outcomes were significantly better among those patients who had quit tobacco use during the TB treatment in Pakistan and Bangladesh. More than 91% of TB patients who had quit tobacco use during TB treatment were successful in completing the therapy (compared to 80% who did not quit tobacco use).
TB relapse rates were also higher among those who did not quit tobacco use during TB treatment- 6% among those who had quit tobacco use and 14% among those who had not quit tobacco use during the treatment reported TB relapse.
(To be contd)
Contd from previous issue
He was speaking at ‘Meet the Expert’ special session at the World Conference on Lung Health 2024 that was recently held in Bali, Indonesia.
Delayed diagnosis and treatment also mean that the person with TB suffers more, has a higher risk of TB death, while the infection spreads to potentially more people – all of this is so avoidable.
WHO lists tobacco use among the top 5 risk factors for TB – almost one in six TB deaths occur because of tobacco smoking. Tobacco use is also directly linked to dangerously increasing the risk of a range of life-threatening conditions, such as heart diseases and stroke, cancers, diabetes, chronic respiratory diseases, among others.
“Every single disease caused by tobacco is entirely preventable. Even one death is a death too many when it comes to tobacco and TB –because we have a range of evidence-based tools to save lives,” said Dr Bam.
As per the WHO Global TB Report 2024, globally 702,000 people suffered from active TB disease in 2023 because of tobacco use (out of 8 million). Almost half of them came from South-East Asian region (328,000). 191,000 people in Western Pacific region, and 89,000 people in Africa got TB disease due to tobacco use in 2023.
Dr Bam cited data from the latest Tobacco Atlas and said: “One in four TB deaths in China was because of tobacco use (25%). Nepal followed closely with 19.4% TB deaths occurring due to tobacco use. Next in line were Vietnam (17.8%), Philippines (17.5%), Indonesia (17%), Malaysia (16.7%), Myanmar (16.3%), Bangladesh (15.2%), Thailand (14.2%), and India (13%).
Tobacco delayed TB diagnosis and treatment in Nepal
Dr Donald Enarson who made lifetime and game-changing contribution to lung health worldwide, Dr Dirgha Singh Bam (former head of Nepal’s TB programme and former Health Secretary of Nepal government) and Dr Tara Singh Bam among others, did a study published in International Journal of TB and Lung Disease in 2016.
This study showed that delay in health seeking behaviour as well as TB diagnostic delay was alarmingly higher in those with tobacco use history.
Current smokers had the highest risk of long TB diagnostic delays (average: 133 days), followed by ex-smokers (103 days). Average delay in those who never smoked was 80 days.
There should be no delay in TB diagnosis. Early and accurate TB diagnosis is an entry-gate towards TB treatment, care pathway, reduces avoidable human suffering and risk of TB death. Early and accurate diagnosis of TB also stops the spread of infection.
Better TB treatment outcomes in those who quit tobacco use
A study published in 2022 in the reputed journal Thorax showed that TB treatment outcomes were significantly better among those patients who had quit tobacco use during the TB treatment in Pakistan and Bangladesh. More than 91% of TB patients who had quit tobacco use during TB treatment were successful in completing the therapy (compared to 80% who did not quit tobacco use).
TB relapse rates were also higher among those who did not quit tobacco use during TB treatment- 6% among those who had quit tobacco use and 14% among those who had not quit tobacco use during the treatment reported TB relapse.
(To be contd)