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Introduction

Tuberculosis is a major public health problem in Bangladesh. The country ranks 6th on the list of 22 highest burden TB countries in the world. It is estimated that 300,000 new cases crop up each year, of which about half of them are infectious TB. It is further estimated that about 70,000 people die every year.

Hence, each hour eight persons die of the disease for which very effective treatment (DOT), free of cost, is available in Bangladesh. Before 1993 TB control was limited to TB clinics and TB hospitals. Field implementation of TB control integrated into the general health services, delivered by Upazila Health Complexes (UHC's), started back in 80s. However, NTP Bangladesh revised its strategies and adopted DOTS in 1993. NGO's have been involved since 1994.

Highlights

The NTP adopted the WHO recommended strategy of Directly Observed Treatment Short-course (DOTS) in 1993

The DOTS strategy consists of five components:
- Political commitment
- Diagnosis by direct microscopy
- Directly Observed Treatment
- (DOT)Uninterrupted supply of drugs
- Standard recording and monitoring of detection and treatment result

Goals and objectives of the National TB Control Programme ( NTP)

The overall goal of the NTP is to reduce morbidity, mortality and transmission of TB until the disease is no longer a public health problem.
The objectives are to detect 70% of new smear-positive pulmonary TB cases and cure at least 85 % of them by the year 2005 and be maintained thereafter to reach the MDG by 2015.

DOTS strategy
List of DOTS Centres

The NTP adopted the WHO recommended strategy of Directly Observed Treatment Short-course (DOTS) in 1993.The DOTS strategy consists of five components:

  • Political commitment
  • Diagnosis by direct microscopy
  • Directly Observed Treatment (DOT)
  • Uninterrupted supply of drugs
  • Standard recording and monitoring of detection and treatment results

Achievements

Since the introduction of DOTS the NTP and its partners have achieved satisfactory treatment results in new smear-positive patients, 84% treatment success among the patients detected during 2001. However, case detection has remained under 35%. During 2004 the detection rate of new smear-positive patients was 46%.During 2005 the detection rate of new smear-positive patients was 61% and treatment success rate 89%.


Recent developments

1. Treatment

  • Change in regimen for new smear-positive and for smear-negative and extra-pulmonary patients, as follows:
    • regimen for new smear-positive patients and other severely ill patients: 2HRZE/4H3R3
    • regimen for relapses and failures : 2SHRZE/1REHZ/5R3E3H3
    • regimen for smear-negative and extra-pulmonary patients: 2HRZ/4H3R3
  • Change in formula of the drugs, from loose drugs to fixed dose combinations (FDC's) of 4 drugs (smear-positive patients), 3 drugs (smear-negative and extra-pulmonary patients) and 2FD's (all patients during the continuation phase of the treatment).
  • Provision of FDC's in blister packs. After diagnosis the full treatment of the patient will be set aside.

2. Continuation of a pilot project on public-private partnership, involving 63 chest physicians and general practitioners in Dhaka City.

3. Public Private Partnership Project, an operational research project collaborated between NTP and Nuffield Institute for Health, University of LEEDS, UK started its activities in March, 2004. This project is aimed to develop an innovative partnership model for effective involvement of private practitioners in service delivery of the TB control activities in Bangladesh.

4. DOTS expansion in Dhaka and other metropolitan cities. After detailed preparation and training of staff, the number of diagnostic and treatment facilities in Dhaka and other city corporations has been increased.

5. Opening of new DOTS corners in medical colleges

6. Opening DOTS Centers at work places.

7. Expansion of DOTS in prisons.

Major challenges to reaching the case detection target

Major challenges include increasing and maintaining high levels of commitment at policy levels, improving the quality of the diagnostic services, intensifying partnership with NGO's, the private sector, academic institutes and workplaces, strengthening, monitoring and evaluation and implementation of HRD TB Control.

Important events( From January to March,2006):

  • Dr Mukund Uplekar- visited NTP to review the progress and current status of PPM, assist in development of PPM strategies for Bangladesh as proposed in GFATM 5th Round.

  • Dr Mamel Quelapio (Tempo Adviser/STC for HQ) & Eva Nathanson- visited NTP for preparation of proposal to GLC  (supported by NTP, Microbiologist and Clinician from NIDCH) also preparation of DOTS-Plus Guideline (supported by NTP, Microbiologist and Clinician from NIDCH) 

  • Mr Somsak Rienthong, Chief of NTRL, Bangkok visited NTP Bangladesh to assist  NTP- to monitor on-going activities of National Reference Laboratory (NRL) at NIDCH, planning of HRD for Laboratory services and to monitoring existing EQA system and recommend measure for its strengthening.

  • Ms. Fujiki of RIT, Japan (JICA Short term expert on Laboratory Management) visited NTP Bangladesh to conduct the orientation and the refresher training on EQA, to make observation visit to EQA centers, diagnostic centers to collect information on EQA activities for AFB microscopy and to discuss future technical assistance on TB Lab services on NTP.

  • Ms Christa Arent of GFATM to evaluate 2nd phase Round 3 and to review GFATM Round 5, 1st Phase for signature of PRs.

  • Mr Mehran and Mr Danial Bleed of WHO H/Q visited Bangladesh to work on the Bangladesh chapter of Global database system of TB as well as to share the Global database system (STAR project)

 Training and  Workshops (From  January to March, 2006):

 National:

  • Management Course on TB- for Barisal Division held at CS Office, Barisal . This course is  designed for UH&FPOs & MOs of Barisal district, Barisal Medical College & Hospital, Barisal City Corporation and BRAC. Total Thirty Two participants  attended at the course.
  • Quarterly Monitoring Meeting( ) -  for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Dhaka Division- Sherpur, Jamalpur, Mymensingh, Netrokona, Kishoreganj, Narshingdi.
  • Quarterly Monitoring Meeting -  for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Rajshahi Division- Rajshahi, Chapai, Naogaon, Natore, Pabna, Sirajgonj.
  • Quarterly Monitoring Meeting -  for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Barisal Division- Barisal, Pirojpur, Jhalokhati, Bhola, Patuakhali, Borguna.
  • Quarterly Monitoring Meeting -  for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Khulna Division- Khulna, Bagerhat, Satkhira, Jessore, Narail, Jhenaidaha.
  • Quarterly Monitoring Meeting -  for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Chittagong Division- Khagrachari, Rangamati, Bandarban, Cox’s Bazar, Noakhali, Feni.
  • Field Level Training- for Khulna Division (11 Districts), Rajshahi Division (16 Districts.)
  • Advocacy Workshop on DOTS in Medical Colleges- for GP, Doctors, and Senior staff nurses of the General Hospital , Tangail. Total 160 participants attended at the course.

  • Management Course on TB- for Rajshahi Division held at CS Office, Kurigram. This course is  designed for UH&FPOs & MOs of Kurigram & Gaibandha and BRAC & RDRS. Total thirty seven participants attended at the course.

  • Management Course on TB- for Chittagong Division held at CS Office, Comilla. This course is designed for UH&FPOs & MOs of Comilla & B. Baria and BRAC. Total Thirty Five participants at attended the course.

Management Course on TB- for Defense/Private Hospital

  • Management Course on TB- At Cox’s Bazar for UNHCR

  • Quarterly Monitoring meeting- for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of  Dhaka Division (Rajbari, Faridpur, Madaripur, Gopalganj, Shariatpur districts

  • Quarterly Monitoring meeting- for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of  Rajshahi Division (Lalmonirhat, Nilphamari, Dinajpur, Thakurgaon, Panchagar districts).

  • Advocacy Workshop on DOTS in Medical Colleges- Community Hospital, Gonoshastho etc

  • Planning Workshop with NTP Partners

 International(From  January to March, 2006):

·         International Course in Management, Finance and Logistics for TB Control, Jaipur , India- 2 GoB  

                officials participated at the course.

Printing and  Publications (From January to March 2006)

·         Fact sheet on Tuberculosis on the eve of World TB Day-2006

Important events (Till December, 2005)

  • NTP initiated dissemination of TB information  since February 2005 through  cable TV network at urban and peri-urban areas of Dhaka city. The information is being displayed by courtesy of  United Commercial Services( UCS)  and Dhaka City Corporation Network (DCCN).
  • Ms. Ineke Petter, Consultant, HRD visited Bangladesh from 10 to 17  February, 2005   to assess HR capacity, assist to review existing curriculum and provide technical guidance in updating different training curriculums. During her visit she also assisted NTP in developing tools for monitoring and training.
  • Ms Eva, Consultant, DOTS-plus, Geneva, WHO visited Bangladesh from 12 to 17  February, 2005 to prepare plan for Drug Resistance Surveillance (DRS) .She also assisted NTP to explore  the  scope of  DOTS-plus in Bangladesh.She visited NIDCH, National Reference Laboratory, Shaymoli and Mirzapur clinic (Damien Foundation) for conducting need assessments for DRS and piloting and expanding MDR-TB management under NTP.
  • NTP and BRAC  participated  at cricket carnival from 19th to 23rd  February  organized  by Bangladesh Cricket Board  to disseminate TB  messages through display of banner at play ground  and distribution of  printed materials to the audiences.
  • Bangladesh Scouts participated  at  11th Rover Scout Moot from 25th February to 1st March, 2005   and actively participated to disseminate TB messages. More than 1000 rover scouts and leader from different colleges and universities  all over Dhaka district participated at the scout camp. They worked at 3 villages to disseminate TB related information through distribution of poster/stickers and interpersonal communication.
  • Ms. Angela Smith, Fund Portfolio Manager, The Global Fund to Fight AIDS, TB and Malaria(GFATM), Geneva visited Bangladesh from 28th February to 7th  March, 2005   to discuss implementation status of GFATM activities  in Bangladesh . She discussed different financial and programmatic issues with MOH&W, WHO, NTP and its partners.
  • NTP organized a Strategic Planning workshop from 13th to 15th March at Training and Resources Center of BRAC at Savar. The objective of the workshop was to develop a draft strategic plan for 2006 to 2010. NTP and its partner NGOs(BRAC, NSDP, UPHCP, NATAB, Damien Foundation, ICDDR,B) and WHO attended at the workshop.
  • Mr. Gani Perla, PPM DOTS Consultant, visited Bangladesh from 20th March  to 2nd April, 2005 to assist NTP  to  review current PPM activities, assess progress and provide technical guidance for Public-Private partnership initiatives  for  National TB control Program in Bangladesh .
  • World Stop Day-2005 was celebrated on 24th March in a befitting manner in Bangladesh . The slogan for World Stop TB Day-2005 for Bangladesh was ‘Stop TB-Ensure your participation. As a part of activities of World TB Day,  conference, rally and discussion  at national,  divisional  and district level were organized jointly by WHO,NTP and partner NGOs.
  • Mr Taufiqur Rahman, Team Leader, South and West Asia , The Global Fund to Fight AIDS, TB and Malaria(GFATM), Geneva visited Bangladesh from May 8th    to 15th , 2005   to discuss implementation status of GFATM activities  in Bangladesh . He also discussed different financial and programmatic issues with MOH&W, WHO, NTP and its partners. 
  • Dr. Armand Van Deun, MD, Bacteriology Consultant for The Union Mycobacteriology Unit, Institute of Tropical Medicine and Dr Somsak Rienthong, Senior Medical Scientist and chief of National TB Reference Laboratory Centre (NTRLC) visited Bangladesh from 12th  to 25th  June, 2005 to provide technical support   on (a) External quality assurance (b) New settings for National  Reference  Laboratory(NRL) (c) Linkage of National Reference Laboratory with other laboratory net works (d) Guidelines for  NRL
  • Dr. Peter Helbling and Dr. Christine Whalen of GDF visited Bangladesh from 22nd  to 26th August-2005 to assess adherence to GDF terms and conditions of support, program management (including case finding and treatment outcomes), financial and drug management, drug needs for next year of GDF support and issues raised by the GDF Technical Review Committee (TRC)
  • Ms. Christa Arent, Fund Portfolio Manager and Mr. Taufiqur Rahman, Team Leader, South and West Asia , The Global Fund to Fight AIDS, TB and Malaria(GFATM), Geneva visited Bangladesh from  6th    to 14th   October, 2005   to discuss implementation status of GFATM activities  in Bangladesh . They also discussed different financial and programmatic issues with MOH&W, WHO, NTP and its partners
  • Quarterly Monitoring Meeting ( From July 16th to 19th, 2005 ) for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Sylhet Division.
  • Quarterly Monitoring Meeting ( August 20- Sepmber 06,  2005) for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Dhaka Division.
  • Quarterly Monitoring Meeting (September 17 – October 06, 2005 ) for UH&FPO, MO, LTCA, Pharmacist, Medical Technologist (Lab) of Dhaka Division.
  • NTP-NGO Partners meeting ( Oct. 30, 2005 ) held at NTP H/Q to review the progress of GFATM 3rd round  activities and discussion on the future course of Action.

Training and  Workshops  (Till December, 2005)

1. International

  • Workshop on GFATM, a strategic approach to TB proposal in round 5,  21-25 February, 2005
  • Annual Meeting of the National TB Control Program Managers of the SEA region and meeting of the Technical Working Group,  9-11 February, 2005, WHO- SEARO, New Delhi
  • International  Course in Management, Finance and Logistics for TB Control, Jaipur , India , 6-21 February, 2005.
  • Third Meeting of Public Private Mix Subgroups for DOTS expansion, Manila , Philippines , 4-6 April,  2005.
  • Consultant’s Workshop for Integration of Advocacy, Communication and Social Mobilization in Global Fund proposal, Egypt , Cairo , 2-9 April, 2005.
  • 23rd International Conference on Tuberculosis and Lung Diseases Eastern Region- (IUATLD-ER) in Lahore, Pakistan under the auspices of IUATLD in collaboration of National TB Control Program, Government of Pakistan and Pakistan Chest Society, September 25th  to 28th , 2005
  • DOTS Expansion Working Group meeting and the 36th Union World Conference on Lung Health, France , October 15th to 22nd, 2005
  • Program Manager's Meeting at Nepal (Dec.04 -10)

2. National

  • Management Courses On Tuberculosis(16th to 21st  April, 2005)-Twenty six participants attended.
  • Management Courses On Tuberculosis(23rd to 28th  April 2005): Twenty five participants attended .
  • Training on  AFB microscopy for Medical Technologist( January to April): Total 19 courses were organized and 228 medical technologists attended.
  • Management Course on Tuberculosis (July 2-7) for Khulna Division & Barisal Division held  an NTP H/Q. Total thirty (Khulna-19, Barisal-11) participants attended at the course.
  • Management Course on Tuberculosis(July 23rd to 28th,  2005) for Dhaka Division held  at  NTP H/Q. Total Twenty eight participants from GoB & NGOs (UPHCP & NSDP) attended  at the course    
  • Orientation on DOTS( July  20, 2005 ) for tea garden service providers in Sylhet for Medical Officers & Paramedics.
  • Laboratory Course (Basic) (July 2–7)for Medical Technologist (Lab) held at TB Control and Training Institute, Chankharpul, Dhaka .
  • Laboratory Course (Basic) ( July 9–14, 2005 ) for Medical Technologist (Lab) held at TB Control and Training Institute, Chankharpul, Dhaka .
  • Laboratory Course (EQA)( June 16 – 28, 2005 ) for Medical Technologist (Lab) and Lab Supervisors held at CDC,  Shaymoli, Dhaka .
  • Laboratory Course (EQA) (July 10 – 14) for Medical Technologist (Lab) and Lab Supervisors held at CDC, Shaymoli, Dhaka
  • Orientation on DOTS for General Practitioners (GPs)( July 08-2005) held at NTP H/Q.
  • Management Course on TB(August 13th to 18th -2005) for Khulna City Corporation and Khulna Jail working on TB. Total Thirty participants  attended at the course 
  • Management Course on TB(August 20th to 25th -2005)  for Khulna Division. This course was designed for UH&FPOs & MOs of Jessore & Khulna District. Total Thirty Six participants from GoB & NGO (Salvation Army) working on TB attended at the course.
  • Management Course on TB ( From 13th to 18t  August-2005)  for Rajshahi Division. This course was designed for UH&FPOs & MOs of Rajshahi & Chapai Nowabganj District. Total twenty nine participants from GoB & NGOs  working on TB attended at the course.
  • Management Course on TB( Aug. 20 – 25, 2005 ) for Rajshahi Division. This course was designed for UH&FPOs & MOs of Natore & Noagaon District. Total Thirty Four participants attended at the course
  • Management Course on TB( Aug. 20 – 25, 2005 )  for Sylhet Division held at Moulovibazar CS Office. This course was designed for UH&FPOs & MOs of Moulovibazar & Hobiganj District and HEED. Total Thirty One participants attended at the course.
  • Management Course on TB( Aug. 20 – 25, 2005 )   on TB for Dhaka Division held at NTP H/Q. This course was  designed for UH&FPOs & MOs of Dhaka , Gazipur & Narayanganj District. Total Thirty Four participants  attended at the course.
  • Management Course on TB (August  27 – September  01, 2005 )    for Chittagong Division held at Chittagong CS Office. This course was designed for UH&FPOs & MOs of Chittagong District and BRAC/Ashar Alo. Total thirty two participants  from GoB & NGOs working on TB attended at the course.
  • Orientation on DOTS( August 05, 2005 ) for GPs of PPPPP( Public-Private Partnership Pilot Project) & respective NGOs held at NTP H/Q.
  • Orientation on DOTS for GPs( August 15th 2005 ) of Khulna City Corporation held at Khulna C/S Office, Khulna
  • Orientation on DOTS for GPs (31st August-2005) of Chittagong City Corporation held at C/S Office, Chittagong
  • Laboratory Course (Basic)( Aug. 13 – 18, 2005) for GoB/NGO designated Laboratory Technicians held at TB Control and Training Institute, Chankharpool & Shyamoli.
  • Laboratory Course (Basic) (Aug. 20 – 25, 2005)for GoB/NGO designated Laboratory Technicians held in TB Control and Training Institute, Chankharpool & Shyamoli.
  • Laboratory Course (Basic) (Aug. 27 – Sep. 01, 2005)for GoB/NGO designated Laboratory Technicians held in TB Control and Training Institute, Chankharpool & Shyamoli.
  • Workshop on Quality Care, Supervision and Monitoring on DOTS(1st batch- September 03 to 05, 2005 and 2nd batch-September 06th  to 08th, 2005 ) held at BRAC Centre, Dhaka  
  • Workshop on Quality Care, Supervision and Monitoring on DOTS ( Sept. 17 – 19, 2005 ) held at Khulna
  • Management Course on TB( September 10th  to 15th , 2005 ) for Rajshahi Division held at Pabna Sadar Hospital , Pabna. Course was designed for UH&FPOs & MOs of Sirajganj, Pabna Districts and LEPRA. Total Thirty Eight participants working on TB attended at the course from GoB & NGOs  .
  • Management Course on TB ( September 10th  to 15th , 2005 ) for Dhaka Division held at NTP H/Q. Course was designed for UH&FPOs & MOs of Munshiganj, Narayanganj & Norshingdi Districts and Gono Shastha Kendra. Total thirty six participants attended at the course from GoB & NGOs working on TB.
  • Management Course on TB ( September 10th  to 15th , 2005 ) for Khulna Division held at School Health Clinic, Khulna . Course was designed for UH&FPOs & MOs of Satkhira & Bagherhat Districts and BRAC. Total thirty four participants attended at the course from GoB & NGOs  working on TB.
  • Advocacy Workshop( Sept. 01 – 02, 2005 ) on DOTS at   Bajitpur Medical College
  • Advocacy Workshop( Sept. 22, 2005 )  on DOTS at BIRDEM Hospital
  • Management Course on TB (October 01- 06, 2005) for Rajshahi Division held at Rangpur C/S Office. This course was designed for UH&FPOs & MOs of Ranpur & Lalmonirhat Districts,  BRAC and  RDRS. Total thirty two participants from GoB & NGOs working on TB attended at the course.
  • Management Course on TB (October 01- 06, 2005)  for Rajshahi Division held at Bogra C/S Office. Course was designed for UH&FPOs & MOs of Bogra & Joypurhat Districts and BRAC. Total Thirty Eight participants attended at the course from GoB & NGOs working on TB.
  • Management Course on TB (Oct. 01 – 06) for Rajshahi Division held at Feni C/S Office. Course was designed for UH&FPOs & MOs of Feni, Noakhali & Laxmipur Districts and BRAC. Total thirty five participants  from GoB & NGOs  working on TB attended at the course.
  • Mid Level Training (Oct. 25 – 31)  for LTCA, PO , MA, held at respective District H/Q
  • Advocacy Workshop on DOTS ( Oct. 05 – 06, 2005 )  at Rangpur Medical College
  • Orientation on DOTS for GPs ( Oct. 05, 2005 ) of Rangpur Municipality held at C/S Office, Rangpur
  • Workshop on Quality Care, Supervision and Monitoring on DOTS (Nov. 13 -15)- for Rajshahi Division held at BRAC INN, Dhaka.
  • NTP Coordination Meeting With Partners held at NTO HQ, Dhaka (Nov. 17)
  • Orientation on DOTS for GPs of Sylhet, Jessore & Cox's Bazar (Nov. 26)
  • Advocacy Workshop on DOTS in Ragib-Rabeya Medical College and North-East Medical College, Sylhet (Nov. 27 -28)
  • Management Course on TB - for Khulna Division held at BMA BHABAN, Jessore (Nov. 26 - Dec. 01)
  • Management Course on TB- for Sylhet Division held at CS Office, Sylhet (Nov.26 - Dec.01)  
  • Management Course on TB-for Rajshahi Division held at CS Office, Dinajpur (Nov.26 - Dec.01)
  • Management Course on TB-for Sylhet Division held at CS Office, Sylhet (Dec.03 - 8)
  • Management Course on TB-for Chittagong Division held at CS Office, Cox’s Bazar(Dec.03 - 08)
  • Management Course on TB-for Dhaka Division held at CS Office, Mymensingh (Dec.03 - 08)
  • Management Course on TB-for Khulna Division held at BMA BHABAN, Jessore (Dec.03 - 08)
  • Management Course on TB-for UH&FPOs & MOs of Nilphamari, Panchagar, Thakurgaon districts held at CS Office, Thakurgaon (Dec.03 - 08)
  • Management Course on TB-for Dhaka Division held at CS Office, Mymensing (Dec.03 - 15)
  • Management Course on TB-for Dhaka City Corporation (Dec.03 - 15)

Printing and  Publications

  • Revision of laboratory manual on smear microscopy for tuberculosis and its quality control in the NTP of Bangladesh, third edition
  • Revision of National Guidelines for Tuberculosis Control, third edition
  • Reprinting of Handbook on control of tuberculosis for village doctors
  • Reprinting of Facilitators Guide for training of village doctors
  • Annual report of the NTP for 2004
  • Treatment and laboratory algorithm for DOT and Microscopic centers.
  • Printing of laboratory manual on smear microscopy for tuberculosis and its quality control in the NTP of Bangladesh, Bengali version, first  edition
  • Printing of brochure,  flip chart, posters, stickers
  • Printing of Handbook on control of tuberculosis for scouts
  • Printing of Handbook on control of tuberculosis for  cured TB patients, village leaders  and other volunteers
  • Printing of fact sheet on the eve of world TB Day-2005
  • Quarterly Report: 2nd and 3rd  quarter, 2005
  • Guidelines on Public Private Mix- PDF

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