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BADAS-USAID TB CARE II ProjectTuberculosis (TB) continues to infect an estimated one-third of the world’s population, to cause disease in 8.7 million people per year and to kill 1.4 million of those afflicted. The global burden of Diabetes Mellitus (DM) is expected to mount from an estimated 180 million prevalent cases currently to a predicted 366 million by 2030. The association between DM & TB and their synergistic role in causing human disease has been recognized for centuries. In Asia, the prevalence of DM is increasing at a spectacular rate, particularly India, China and Bangladesh and estimated number of DM patients in Bangladesh is around 8.6 million in 2011. Persons with diabetes have a radically increased risk of active TB, which is 2 – 3 times higher than in persons without diabetes.

Recent studies also reflected increasing concern among field workers in TB facilities, that DM may be a key potency in converting latent infection into overt disease. With almost 8% of diabetes death take place in low & middle income countries, around 7 million people of Bangladesh have been suffering from Diabetes as the number of such patients is rising by 5 – 6 percents each year.

Bangladesh is one of the TB endemic countries. This country is ranked 6th among the 22 high TB burdened countries with 337,000 new cases and 64,000 death per annum. Incidence of smear positive TB cases is 100/100,000. In the setting of the escalating overlap of populations at risk for both diseases, the combination of TB & DM represents a potential health threat for Bangladesh.

Our Objectives :

In our country DM & TB are currently addressed through vertical delivery program systems that are separated from each other. Keeping this in mind, Bangladesh Diabetic Association (BADAS) has taken the initiative for the comprehensive multi-component approach to increase access to TB services for DM patients by improving Prevention, Early case detection and Quality of care for persons with diabetes and TB, thereby contributing to decline in the morbidity and mortality rates in persons with TB-DM co-morbidity.

Realizing the national and global TB and Diabetes Mellitus situation BADAS-USAID TB CARE II Project, Bangladesh has been operational since July, 2013 aiming to increase the access TB services for Diabetic patients. Since the TB CARE II project has completed successfully in June 2015 another similar project titled BADAS-USAID Challenge TB Project, Bangladesh has been launched in July, 2015 with the same objectives. To achieve the objectives a series of activities have been accomplished during the last year (July 2015 to June 2016)

Objective – 1: Improve the early detection of TB in persons with Diabetes

Since modern equipments are precondition for early detection of TB cases, one Gene Xpert and one LED microscope is operational in BIRDEM General Hospital to promote the early detection of TB patients.
During the reporting year total 986273 DM patients have been screened for TB through a simple questionnaire. Among them 15180 patients were presumptive TB and 11715 patients under went for sputum AFB microscopy. Through the sputum microscopy total 1074 pulmonary positive cases were diagnosed. To increase pulmonary negative and extra pulmonary TB cases the project also gave financial support for X-ray and FNAC.

During the reporting period total 2452 & 84 DM patients got X-ray and FNAC support respectively. Through this initiative 311 pulmonary negative and 207 extra pulmonary TB cases were diagnosed. All the diagnosed TB patients referred to their convenient DOTS centers for regular continuation of treatment. Additionally the GeneXpert gave 213 TB cases from 1595 patients those who were smear negative in sputum microscopy. From these Xpert detected patients 11 were rifampicin resistance who were referred to NIDCH for MDR management.
Drug resistance TB is a threat to control TB. So the project initiated 1 GeneXpert machine for yearly diagnosis of rifampicin resistance. Total 531 presumptive MDR TB cases underwent for GeneXpert and detected 4 rifampicin resistance cases that were also referred to NIDCH for MDR management.

Objective – 2: Strengthen providers’ capacity in TB-DM diagnosis & case management

Capacity building is pre-requisite to improve early case detection and provide quality services. So, to achieve the objective – 2 the project has been operational for providing various sorts of trainings. During the reporting period 193 doctors have been oriented through a day long orientation program on TB-DM co morbidity management.
In the mean time 250 nurses and 110 other health staff have also been oriented on TB diagnosis among DM patients respectively through a day long orientation program. The awareness which has been built during the project period among doctors, nurses and other health workers will be active to fight against TB even beyond the project period.

Objective –3 : Increase patients awareness about TB-DM co-morbidity

Development of awareness is an important task to promote early cases detection and prompt treatment delivery. During the reporting period various kind of awareness activities have been accomplished to build ware DM patients as well as mass population regarding TB. Since DM patients are more prone to have TB so the message regarding TB has been incorporated in 100,000 DM guide books. Total 22037 DM patients have been counseled through 240 counseling sessions to build awareness among DM patients. Besides, 600 posters and 150,000 leaflets have been developed on TB- DM co morbidity.

To sensitize mass population total 4 TV and 4 radio programs have been aired. To sensitize medical care provides and to maintain common management for all patients of TB with DM total 1500 National Guidelines on management of TB-DM co morbidity and 500 training manuals have been developed during the reporting period.

To build awareness in DM patients regarding TB and Diabetes 10 LED monitors have been installed in OPDs of BIRDEM General hospitals, NHN, BIHS, Barisal, Chittagong, Pabna, Faridpur and Chapainwabganj. For raising awareness in general population 2 days were observed during the reporting period (World TB Day and World health Day) with various activities like, rally, discussion meeting, displaying posters and banners, TB and Diabetes screening camp and talk show on radio& TV etc.

Geographical Coverage :

The geographic coverage of the project is Dhaka City Corporation (DCC) and 63 districts of Bangladesh where BADAS has diabetic program implemented by its affiliated associations.

Our Key Activities :

1. Improve early detection of TB in persons with diabetes.

  • Detection of TB case
  • Management of TB cases
  • Patient follow-up
  • Develop referral networks with NGOs
  • Infection Prevention

2. Strengthen providers’ capacity in diabetes-TB diagnosis & case management.

  • Training of the Trainers (TOT)
  • Training of Medical Doctors
  • Orientation of doctors, nurses and other health staff

3. Increase patients’ awareness about TB-DM co-morbidity

  • An education & counseling session for 2 hours daily is conducted routinely at BIRDEM by the professional counselors and dieticians. BADAS is incorporating a short session on the awareness of TB in the ongoing session, so that every DM patients become aware of TB symptoms. The ACSM activities will also dome by leaflets, posters, message on TB-DM co-morbidity in patients’ diabetic guide book.

Poster displayed at BIRDEM OPD