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| Sunday, 20 March 2005 |
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Features |  |
| News Business Features Editorial
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March 24 is World TB Day : Tackling TB with DOTS by Dr. Chandra Sarukkali, Director, National Programme for Tuberculosis Control and Chest Diseases Tuberculosis (TB) remains a major public health problem globally and in Sri Lanka. Nearly one third of the global population is infected with TB bacillus and at risk of developing the disease. There is an estimated 8 million new TB patients every year, out of which nearly 40 per cent are found in the South East Asia region. Tuberculosis being the number one communicable killer disease continues to kill up to two million people a year.
More than 90 per cent of global TB cases and deaths occur in the developing world. It affects mostly the age group between 15 - 54 which is the most economically productive age group. The average loss of income is around 20-30 per cent per patient each year. These estimates indicate the devastating financial losses, but what about the impact of TB on the family and community? There were instances where children had to leave school because one of the parents had TB. Their job opportunities were lost. People had to face the problem of family break-ups and the opportunity to get married. TB has been stigmatised as a disease of hereditary in origin and affects only those in the low socio-economic group. Tuberculosis is caused by bacteria called 'Mycobacterium tuberculosis.' The bacillus was discovered on March 24, 1882 by scientist Robert Koch. The day is being commemorated worldwide as the 'World TB Day.' The bacillus enters the body through inhalation and as such anybody who breathes can be infected with the bacillus. Tuberculosis can affect any organ in the body. The commonly affected are the lungs. Once the lungs are affected the person develops the common symptom, cough and bring out sputum. Many of these patients excretes bacilli in sputum when they cough and they are responsible for the transmission of the disease in the community. The group of patients having the disease affecting their organs other than the lungs are not a danger to the community, as the chance of infecting another person is minimal. Tuberculosis Control aims at reducing the spread of infection. The most effective method is identification (case detection) and cure of the most potent sources of infection. These are the patients who have tuberculosis in their lungs and excreting tubercle bacilli. In addition, Tuberculosis Control aims at curing all forms of the disease in order to reduce mortality and morbidity. Examination of a sputum smear under a microscope (sputum microscopy) to identify the bacilli is the most efficient way of identifying sources of infection in the community. In recognition of public health importance, WHO declared TB as a global emergency in 1993. 'DOTS' the global strategy for effective TB control was developed in response to this situation. 'DOTS' (Directly Observed Treatment Short course) consists of five components. 1. Political commitment, 2. Access to quality assured sputum microscopy, 3. Uninterrupted supply of quality assured drugs 4. Directly observed treatment, and 5. Accountability. In Sri Lanka DOTS strategy was accepted as a policy in 1996 and implemented for the first time in the Galle District in 1997. Today, 95 per cent of our population have access to DOTS. Direct observation of treatment means that intake of the drugs by the patient is directly observed by another person. This ensures treatment for the entire course with the right drugs in the right doses at the right intervals. DOT is necessary at least in the initial phase of treatment to ensure adherence to treatment and to achieve sputum smear conversion. Observation is a service to patients and providers. Why is it necessary to directly observe treatment? * At least one third of the patients receiving self-administered treatment do not adhere to treatment * Many patients do not take medicines regularly, even if excellent health education is provided it is impossible to predict which patients will take medicine. * A TB patient missing one attendance can be traced immediately and counselled. Treatment observer must be accessible and acceptable to the patient and accountable to the health system. Currently in Sri Lanka, the direct observation is done by a health staff personnel and the services have been extended up to the lowest health institution. The standard regime of treatment for a diagnosed new patient is the 4 drugs for two months (intensive phase) and two drugs for the next 4 months (continuation phase). The full course of treatment for 6 months should be continued to ensure cure. Though ideally the treatment should be directly observed for the full course, in most instances it is being done in the first two months of treatment because of the difficulties that the patient has to face when visiting a health institution (DOT centre) daily to swallow the drugs. If in future we are successful in our attempt to overcome the stigma attached to TB, we may extend the DOT services to the community level and making use of community leaders. If so, direct observation of treatment could be done for the complete 6 months and the number which default treatment could be reduced. The week beginning from today let us commemorate 'World TB Day', advocate and create awareness among the general public to achieve community participation for a TB free Sri Lanka. The importance of Folic Acid With Dr. Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician If you are planning to have a baby, there is a vital requirement you will have to fulfil before you turn your dreams into reality. That is consulting your doctor and taking sufficient amounts of Folic Acid (FA). FA is something that is essential to any living cell and involves the build up of DNA. It is needed to form the Central Nerve System (CNS) of the foetus. Pregnant women need an additional requirement of FA compared to non-pregnant individuals. What will happen due to FA deficiency To the foetus: The Central Nervous System (CNS) is formed within the first 20-days of pregnancy. Generally, Sri Lankan women suspect they are pregnant only when their periods stop. They also wait for another two weeks for a urine check up to confirm the pregnancy. Unfortunately by this time, the first 20-days have passed and the CNS has already been formed. If a woman takes FA after confirmaiton, it may be too late. If the FA status in the body is sufficient there would not be any problem. But if FA is not enough, that deficiency might lead to defects in the CNS which is called Neural Tube Defects (NTDs). Proper development of the brain and other structures requires FA. If there is a deficiency in development that means your baby may not be alive. The NTDs are defects in the skull, which is the hard part of the head and spine. In worst case scenarios the baby's skull may be missing due to severe FA deficiency and babies may also be born with defective spinal cords. The nerves may jut out of the holes in the spinal cord and this is called meningonyelolele. These babies cannot walk and surgery is needed. To the Mother: FA helps divide the cells and in the functioning of the red and white cells. This will help reduce anaemia during pregnancy. According to some international research, FA helps to reduce incidences of miscarriages and pregnancy induced hypertension. It will also reduce the risk of separation of the placenta. From where we can get Folic Acid This is a chemical just like a vitamin and can be found in vegetables and green leaves. FA can be destroyed by over washing and over cooking. So the best way to save FA in veggies and green leaves is to wash them before cutting and eat them as salads. However, the easiest and surest way of getting the required amount of FA is in the form of tablets sold over the counter. But it is better to consult your doctor before taking the FA supplements. Milk products, cereals and other food items fortified with FA would also be fine sources for routine consumption. There is no over-dozing of FA and no harm in taking more than 400 mg, which is our daily requirement. The excessive FA will be passed out as urine. Important to remember Scientific studies show that consumption of additional amount of FA will reduce the incidence of NTDs. But it is important to remember that there are many other compounding factors, which can lead to NTDs. The deficiency of FA is only one factor that causes NTDs. The genetic factors may also lead to NTDs. Since the NTDs can be prevented, it is worth taking the required amount of FA. The pre-conceptional FA is a must for mothers who want to conceive. If you have any pregnancy related questions, you can send them to Health Guide, Sunday Observer, No. 35, D.R. Wijewardene Mw, Colombo 10, and Dr Hemantha Dodampahala will answer them for you. Ayurveda and nature's laws by Dr. Danister L. Perera Ayurveda is more than just a medical system. It is not only a system of healthcare but also an art of living. We are all part and parcel of nature. Just as animals and plants live in harmony with nature and utilise the Laws of Nature to create health and balance within their beings, we too, adhere to these very same principles. Therefore, it is fair to say that Ayurveda is a system that helps maintain health in a person by using the inherent principles of nature to bring the individual back into equilibrium with their true self. In essence, Ayurveda has been in existence since the beginning of time because we are always being governed by nature's laws. Ayurveda is one of the oldest independent natural systems of medicine. In the medieval period however, the system faced utter neglect at the hands of foreign rulers. Some authentic literature was destroyed in these turbulent times. Even then Ayurveda contributed to public health system due to its safe and most effective herbal formulations and easy availability. The seers who initiated Ayurveda inducted in it sufficiency, soundness and sustenance and it survived as a result. In the Sri Lankan context, indigenous systems of medicine is traditionally inherited with its cultural values and norms embedded on Indian theoretical basis of Ayurveda. There are several aspects to Ayurveda that are quite unique whereas, other modern systems have neglected human organism and nature. Its recommendations will often be different for each person, regarding which food and lifestyle they should follow in order to be completely healthy. Everything in Ayurveda is validated by observation, inquiry, direct examination and knowledge derived from the ancient texts. It understands that there are energetic forces or bio-regulatory principles that influence nature and human beings. These forces are called the Thridosha. The aim of Ayurveda is to give complete health and not just getting free from physical diseases or impairments. Ultimately, Ayurveda intends at making a happy, healthy and peaceful society. Two of the most important aims of Ayurveda are: to promote and keep up the health of healthy people. To cure the diseases and relieve discomfort of sick people. (Continued next week) Woman's health and sterility by Dr. Y. M. Mousoom, Homeopathic and Unani practitioner Sterility is an emotive topic. It is considered a main issue in case of divorce. Obstetrics is one of the most ancient branches of medicine and it still continues to develop. Methods of prophylexis, diagnosis and treatment are being constantly improved to keep pace with scientific developments. The reproductive organs of the woman are usually divided into the external and internal genitalia. The external female genitalia are mainly the organs of pleasurable sensations, while the internal organs perform the reproductive function. Sterility can occur either in males or in females. In the case of females, it is a condition, wherein a woman will be unable to conceive. Conception is the union of the sperms of the male and the ovum of a female. The woman is considered to be sterile if conception does not occur. On the other hand, if a male does not have sufficient number of sperms he is considered to be sterile. Sterility depends upon several factors which produce diseases and derangement in the organ, which are enunciated in the production of foetus. According to ancient medical science or indigenous system of medicine, sterility is mainly due to the vitiation of Tridoshas 'vata, pitta and kapha.' The causes for sterility in females are major diseases of the fallopian tubes, uterus and ovaries, and hormones, which control the functions of these organs. If sterility is due to functional defects of these organs, then it can be treated successfully. If it is due to structural defects like trauma to the genital organs then it must be treated surgically. Congenital deformity of the uterus, or any causes producing inflammation of vagina or uterus and displacement of the uterus, will also produce sterility in females. Even diseases like anaemia, blood poisoning and malnutrition may cause sterility in females. Proper counselling and medicinal treatment will cure more than 75 per cent of sterility in patients. It is better to avoid hot, pungent and alkaline foods and too much of fatty foods, as they have a bad effect on the production of ovum in the female. |
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| Produced by Lake House |
If TB is left unchecked, almost one billion people will become newly
infected, 200 million will develop the disease, and 35 million people will
die of the disease in the next 20 years. 
