INTRODUCTION

Tuberculosis is a common and deadly infectious disease caused by mycobacterium

tuberculosis. It is one of the emerging infectious diseases affecting both developed and
developing countries.
One third of the world’s current population has been infected by TB, and new infections
occur at a rate of one per second. Not every one infected develops full-blown disease;
asymptomatic, latent infection is most common. However, one in ten latent infections will
progress to active disease, which, if left untreated, kills more than half of its victims. In
2004, mortality and morbidity statistics included 14.6 million chronic active cases, 8.9
million new cases and 1.6 million deaths, mostly in developing countries. [1]
The rise in HIV infections in the neglect of TB control programs has enabled a resurgence
of tuberculosis .[2] The emergence of drug resistant strains has also contributed to this new
epidemic with, from 2000 to 2004, 20% of TB cases being resistant to standard treatments
and 2% resistant to second line drugs [3]. The World Health Organization (WHO) declared
TB a global health emergency in 1993, and the Stop TB Partnership developed a global
plan to stop tuberculosis that aims to save 40 million lives between 2006 and 2015. [4]
According to WHO, 2 billion people- one third of world’s population- have been exposed
to the tuberculosis pathogen. Annually, 8 million people become ill with tuberculosis, and
2 million people die of the disease world wide. In 2004, around 14.6 million people had
active TB disease with 9 million new cases. The annual incidence rate varies from
356/100,000 in Africa 241/100,000 in the America. TB is the world’s greatest infectious
killer of women of reproductive age and the leading cause of death among people with
HIV/AIDS. [5]
In developed countries, tuberculosis is less common and is mainly an urban disease. In
United Kingdom, TB incidences range from 40/100,000 in London to less than 5/100,000
in the rural south west of England; [6] the national average is 13/100,000. The highest rates
in Western Europe are in Portugal (42/100,000) and Spain (20/100,000). These rates
compare with 113 per 100,000 in China and 64 per 100,000 in Brazil. In the United States
the over all tuberculosis case rate was 4.9/100,000 persons in 2004. [7]
The incidence of TB varies with age. In Africa, TB primarily affects adolescents and
young adults. However, in countries where TB has gone from high to low incidence, such
as the United States, TB is mainly a disease of older people. [8]
Tuberculosis is a major public health and developmental problem in Pakistan. The country
has 7th highest burden of TB among the 22 high burden tuberculosis countries worldwide,
according to the WHO Global TB report 2006. Every year, approximately 280,000 people
develop TB with an incident rate of 181/100,000 and 62,000 people die of TB in the
country with a mortality rate of 37/100,000. 1 TB case is responsible for 5.1% of the total
national disease burden which is 3rd largest contribution to the disease burden in Pakistan.
As in most low income developing countries there has been almost no observable decline
in TB incidence. The absolute number of cases is likely increasing due to population
growth and worsening poverty. Despite progress towards the global target for TB control,
the treatment success rate (TSR) remains around 82% against the target of 85% and the
case detection rate (CDR) remains at 37% against the target of 70%.
Pakistan adopted the WHO recommended directly observed short course (DOTS) strategy
in 1995. In 2000 thanks to a World Bank funded scheme the program was expanded to the
provinces. Since 2001 the government has been handling TB as a national emergency.
DOTS have been extended to 34 of more then 100 districts, covering 25% of the
population. More provinces will be covered by the end of the year, and the Punjab, the
most populated province, will be covered by 2005. [9]
The justification of our study comes from the reason of up rise in TB cases during past
decade specially its prevalence in lower socio-economic environment and the emergence
of multi drug resistant cases due to inadequate surveillance and treatment plans for TB
affected areas. A number of factors prevail in the community like ignorance, different
social customs and taboos, treatment neglect especially for female community ad above all
poor compliance to the treatment because of lack of education. In the light of above
mentioned factors it is pertinent to study the current practices of people residing in this
remote study area. The data collected will help us to understand the problem in its full
magnitude and to improvise new strategies for counter acting this ailment.