LAHORE, 24 March 2008 (IRIN) - Uzma Hassan (not her real name) will never forget the day almost five years ago she was told her son, then aged 10, had contracted tuberculosis (TB).

"He had been coughing and losing weight, but we never thought of TB, because, frankly, that's a sickness associated with poor people," Hassan, aged 40, told IRIN. "We couldn't believe it when the doctor told us he had tested positive for TB."

Uzma is an interior designer, her husband is a bank executive and they live in Lahore. Even though the relatively wealthy couple had access to the best medical care, their son's sickness was not diagnosed for almost a year.

Today, after completing a course of treatment that included anti-TB antibiotics, the teenager is fit and healthy. His family chose to tell only the closest family members of the diagnosis and even today do not talk about their son's encounter with the disease. The stigma attached to TB makes it all the more difficult to detect and treat.

According to the World Health Organization (WHO), in 2007 Pakistan ranked sixth among 22 nations of the world with a high burden of TB, despite considerable advances in combating the disease since special TB control programmes at the national and provincial level were introduced in 1995.

Pakistan's anti-TB campaign continues to be run with WHO and international support. Despite this, the illness, contracted by inhaling droplets released when an infected person coughs, remains one of Pakistan's leading causes of death amongst infectious diseases, say health experts.

International organisations, including the United States Agency for International Development, which has been contributing to Pakistan's TB control programme since 2003, report that at least 250,000 people in the country contract TB annually.

Government efforts

Federal Secretary for Health Kushnood Akhtar Lashari said the government was "fully committed to supporting and improving" ongoing programmes at all levels.

Today, all government health centres run programmes to train staff to detect TB symptoms - which most often include a lingering cough sometimes with blood in the sputum, a loss of appetite, fever and sometimes chest pain.

TB usually takes root within the lungs, but the bacterial infection can spread to other parts of the body, including bones.

The staff at medical centres are also trained to direct those with suspected TB to centres where a diagnosis can be made, usually through a chest X-ray, and encourage them to take any prescribed medication.

Various non-governmental organisations (NGOs), international agencies and charitable organisations are involved in efforts to support patients requiring medication, which on average cost about US$10 a month, an amount difficult for many families to manage.

As a consequence, nearly two-thirds of those diagnosed with TB stop taking drugs before completing the prescribed course.

"In some cases, they are simply unable to afford the medicines. In others they believe, once symptoms begin to subside, that they have been cured," said Dr Sameena Arif, who works on a voluntary basis in poor communities in and around Lahore. This in turn has led to the emergence of new, drug resistant forms of TB that are far harder to treat, she warned.

The WHO has also stressed the need in Pakistan for "collaborative TB/HIV activities" and for a national policy to manage cases of multi-drug resistant TB. It has pointed out that there is, as yet, no policy for such sufferers.

Stigma

There are also other difficulties. One of the most problematic issues is the deep social stigma that surrounds TB, a disease strongly associated with poverty and over-crowded living conditions.

Additionally, many people believe it cannot be cured, though this is not true. Government campaigns in the print and electronic media have attempted to stress this fact, but the message will take time to filter through in a society where literacy levels still hover around the 50 percent mark and where there is considerable distrust of government messages.

"I took my daughter, Saba, 22, to a clinic. The doctors say she has TB, but we are too terrified to tell her husband. If we do, he may abandon her," said Kausar Bibi, 45, a widow who sells vegetables to earn a living.

She is currently trying to save sufficient money to begin the medications her daughter urgently needs.

Some sufferers and their families turn to quacks or faith healers.

These factors contribute to the rise of TB in the country, and the failure, despite stepped up efforts, to bring the disease fully under control, even though awareness levels have been on the rise over the past decade, according to health experts.

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