Tuberculosis burden in Bangladesh: epidemiological estimates and people’s perspectives

Tuberculosis (TB) is one the major causes of sickness and deaths among adults worldwide including Bangladesh. In 2007-2009 Bangladesh continued to be one of the 22 high TB burden countries in the world, yet the true burden of disease in the country is not exactly known. National notification data have the limitation of being vulnerable to underreporting of TB cases, while reliable data from national surveys are absent in the country. In this thesis, we presented results from the studies on the TB burden in Bangladesh in terms of prevalence of the TB disease, and the prevalence of the TB infection. In addition we described the social aspects of TB, care seeking behaviour of TB cases and persons with symptoms suggestive for TB and knowledge on TB-related issues in the community.
The study results showed that the prevalence of smear-positive TB decreased significantly from the previous estimates, based on a survey 45 years ago. At the same time it was also observed that prevalence remained 5 to 6 times higher among the poor, in the rural population, among males, and less educated persons. Especially the poor seemed to be disconnected with the free TB services proivided by the national control programme and mostly utilized care from infomal providers. The moderate reduction in the prevalence of infection and slow decline of the annual risk of tuberculous infection after two decades of DOTS implementation indicates considerable ongoing transmission. Universal and sustainable coverage can never be achieved without reaching the poor.