On the Occasion of the World’s Day to Combat TB Yemen Succeeds to the Tune of 89% to Combat TB during 2000 [Archives:2001/14/Health]

Isma’el AlGhaberi
Yemen Times
On the occasion of the World’s Day to Combat TB, Dr. Amin Noman Al-Absi, NTP’s Director said that the results of the comprehensive national survey carried out by the program in collaboration with the Japanese International Cooperation Agency (JICA) to vaccinate children between 6-12 years old showed an incidence of more than 25,000 TB cases in the country in 1999 out of which 5565 were positive. In addition, deaths of TB have been estimated at 2000-2500 cases every year.
Tuberculosis is still considered one of the major public health problems in the most developing countries, including our country. Every year many precious lives are lost and many more are suffering on account of this dreadful disease.

Health situation
Health services were very poor and limited in urban areas and nearly absent in rural areas before 1970.
After ALMA-ATA conference, Yemen followed the primary health care system and succeeded well in the 1980s, but unfortunately due to several factors, most importantly, due to financial difficulties and lack of the public co-operation, the primary health care services which was the main health services provided to the people, got worse.
Therefore, health, social and economic situation are getting worse have lead to spread of communicable diseases and epidemics, one of the most important being tuberculosis.

The extent of the Tuberculosis Problem in the Republic of Yemen

1)General information
Tuberculosis is still considered as one of the major public health problems in the Republic of Yemen. Almost 85% of tuberculosis cases are in the working age group (15-55). In other words, tuberculosis is not only the health problem but also the socio-economic problem in this country.
The cure rate of the registered new positive pulmonary tuberculosis cases is still under 50%. Epidemiologically, this figure does not improve the effectiveness of the program. In this guidelines, the improvement of this insufficient cure rate is given the first priority by the progressive implementation of new policy of Directly Observed Treatment, Short Course Chemotherapy (DOTS). Other factors which also influenced the cycle of the tuberculosis infection in the community should be given the same priority such as:
– Improving of the general socio-economic conditions and health status of the people;
– Increasing the level of awareness of the people about health and disease.

Almost 30% of the total population are infected. But between 15-64 years of age, primarily among the productive age group, almost half of them are already infected.

Epidemiology of Tuberculosis and Estimation of Tuberculosis problem in the Republic of Yemen
Using the above mentioned epidemiological indicators in a calculation, the tuberculosis problem can be estimated as follows:
– The total population of country is 15,804,654 (last census in 1994).
– ARI is 0.9%.
– An incidence of 50 new smear positive pulmonary tuberculosis cases per 100,000 population in a year may be estimated from 1% of ARI.
– So, an incidence of 45 new smear positive pulmonary tuberculosis cases per 100,000 population in a year may be estimated from 0.9% of ARI in this country.

Based on these estimations in the Republic of Yemen:
– The incidence of new smear positive pulmonary tuberculosis cases is estimated as more than 7,000 in each year.
– The incidence of all types of tuberculosis cases is estimated as more than 15,400.
– The prevalence of all types of tuberculosis cases is estimated at more than 30,000.

It is also expected that the reported tuberculosis death is only a fraction of actual deaths from tuberculosis due to an insufficient death reporting system.
Meanwhile, the strategy for tuberculosis control in Yemen is to provide adequate and efficient treatment, i.e., short-course chemotherapy (SCC) to, at least, all smear positive TB cases identified. With the coming years, SCC will be implemented country-wide in a phased manner. Proper cases management conditions, which includes directly observed treatment, short-course (DOTS) will be maintained. Initially these guidelines for the NPT and DOTS will be introduced as small demonstration projects in sites to be selected in each province of the country. Based on the success of these demonstration sites, judged by sputum-smear conversion and cure rates, the project will be expanded gradually throughout the country.

The first priority of any tuberculosis program is the treatment and cure of tuberculosis patients, especially of patients whose sputum is positive on direct microscopy. Sputum smear-positive patients are the most potent sources of infection and, without chemotherapy, have poor outcomes and as many as two-thirds of them die within 2-3 years. Smear-negative patients must also be given chemotherapy if the presence of active tuberculosis is likely (for instance, patients with extra-pulmonary tuberculosis, and patients whose clinical picture is highly suspicious of tuberculosis and have not responded to two weeks of broad spectrum antibiotics).

In Yemen, case-finding and treatment of tuberculosis will be carried out in the network of general health services by medical officers/paramedical workers, after they are properly trained, motivated and regularly supervised. Cure of infectious cases of tuberculosis is the key to effective control of the disease. Treatment of tuberculosis patients reduces suffering and, if adequately applied, prevents death from tuberculosis.
BCG vaccination in new-born and early childhood will continue within the Expanded Program on Immunization; however, the preventive effect of BCG vaccination on the infectious types of adult TB, and thus on transmission of TB, is limited. Therefore, cure of infectious cases of TB is the best prevention, as cure of the disease prevents future transmission of TB bacilli. The implementation of this strategy requires full commitment of the Government and health staff at all levels of the system.
In order to implement this strategy effectively and achieve the above objectives, the main activities of the program are the following:
– ensure effective chemotherapy to all patients diagnosed for the recommended duration of 8 months;
– promote early detection of sputum smear-positive pulmonary cases on the basis of sputum smear examination;
– establish a network of laboratories (1 in each district) and a system for ensuring quality of sputum smear microscopy;
– organize treatment delivery as close to a patient’s home as possible and supervision of program activities at various levels of the system;
– introduce a standard system of registration and reporting;
– ensure continuous drug supply by establishing a system for national procurement, storage, delivery and monitoring of anti-tuberculosis drugs at various levels of the system;
– monitor the results of treatment and evaluate progress of the program by means of quarterly cohort analysis;
– provide continuous training for all staff involved in the program at various levels of the system;
– strengthen co-operation between NGOs and bilateral donors involved in the tuberculosis control program;
– co-ordinate tuberculosis control activities with the PHC activities being carried out in the country, especially EPI and other disease control programs.

Note: Some information was taken from ‘Manual of the Nation – Tuberculosis’

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