Incidence of tuberculosis in Indonesia

In Indonesia, there are roughly 500,000 new cases of TB annually and 175,000 attributable deaths. Tuberculosis is the second major killer of adults after cardiovascular disease and the deadliest pathogen out of all infectious diseases.

The World Health Organization (WHO) has designated Indonesia a “high burden country” for tuberculosis.

There are 22 high-burden countries worldwide, accounting for about 80 per cent of the world’s tuberculosis infections. Expatriates or frequent travellers who spend significant time in a high-burden country may benefit from TB screening. Some countries may recommend that infants and children have a BCG vaccination.

In Indonesia, there are roughly 500,000 new cases of TB annually and 175,000 attributable deaths. Tuberculosis is the second major killer of adults after cardiovascular disease and the deadliest pathogen out of all communicable diseases.

In global terms, one billion people are infected with tuberculosis at any time. Eight million new cases are reported annually, with three million attributable deaths. However, despite these grim figures and without the influence of consistent treatment and immunization, its incidence is not as high as it was in the 20th century. The problem is that with inadequate and inconsistent treatment regimes, a pool of persistent sputum-positive cases is being created.

Poverty facilitates the transmission of “Mycobacterium tuberculosis”. Catching TB in poor, damp, dark or dusty conditions is easier. Tuberculosis bacteria can live longer in wet, dusty rooms with no fresh air. Prolonged delay in diagnosis and increased vulnerability due to malnutrition and/or HIV infection. If it is dark, bacteria cannot be killed by sunlight. Poor living conditions and overcrowding increase the risk of tuberculosis.

Symptoms and Diagnosis of tuberculosis

Active TB causes various symptoms that are sometimes vague but often include cough, fever, night sweats, unintended weight loss, and lethargy. Latent (inactive) TB causes no symptoms. Most strains of TB can be treated with antibiotics. Up to four different types of antibiotics may be used together to treat a patient. If left untreated, active TB can be life-threatening.

At the local level, diagnosis is best achieved through the microscopic detection of bacillus in a sputum smear. Culturing bacillus is expensive and impractical as it takes 6 weeks for results, and x-rays can be misleading. The most widely used test for diagnosing active TB in low- and middle-income countries rely on examining a patient’s phlegm under a microscope.

This method, developed almost 140 years ago, detects less than half of all TB cases and largely fails to detect the disease in children and people co-infected with HIV – who usually cannot. Produce the necessary sputum – and those with drug resistant forms of tuberculosis.

It has been recognized that males in the 25 to 34-year-old age group are the most common transmitters of the TB bacillus. An infectious case will typically infect up to ten other people in a year. In case-finding, the general rule is that anyone who has had a cough for more than 3 weeks should have a sputum smear.

Crowded dark places are ideal for spreading TB, as direct sunlight will kill the bacillus in a few minutes, but it can live in dark and dusty areas for up to 20 years.

Treatment of tuberculosis

No matter the treatment regime used, the following basic rules must be observed:

• Any drug intake must be supervised.
• Drug intake must continue until otherwise directed, which may be many months.
• There needs to be an uninterrupted drug supply to prevent emergent drug resistance.

When patients are resistant to the two most potent first-line antibiotics (rifampicin and isoniazid), they are considered to have multidrug-resistant tuberculosis.

Treatment is long and arduous, with the drugs having many potential side effects, including psychosis and deafness. People can take up to 20 pills a day for two years – only to have a cure rate of just under half. Extensively drug-resistant tuberculosis (XDR-TB) occurs when a patient is resistant to second-line drugs. Only a third of people with XDR-TB are cured.

It is essential that a patient completes all of their treatment, even when they begin to feel better. Incomplete treatment can lead to the development of drug resistance. Decentralizing treatment by having people care at home can help them adhere to treatment and overcome barriers they may face.