A nurse tends to a TB patient at a tuberculosis and lung diseases hospital in Vietnam.

Tuberculosis will continue to spread if the public and private health sectors in Ho Chi Minh City do not lift their game.

The declining rate of TB patients getting treatment at public hospitals and the high rate quitting their treatment abruptly are alarming as this indicates that the sources of infection are multiplying and spreading.

That was the consensus at a special conference held by the HCMC Department of Health on Tuesday.

Dr. Dang Minh Sang from Pham Ngoc Thach Hospital, the city’s main clinic for chest diseases, said that from 2004 to 2008 the number of TB patients seeking free treatment through the public health system had fallen by 5-6 percent every year.

The most worrisome problem is that fewer and fewer patients between 15 and 24 years old avail themselves of the free treatment, although they are at the highest risk of HIV infection and substance abuse, Dr. Sang said.

His colleague Dr. Tran Ngoc Buu quoted a survey at a public TB clinic where it was found that two thirds of the 213 recorded patients in 2007 had failed to take their medication for at least six months as prescribed.

According to the records of Pham Ngoc Thach Hospital, between 25 and 30 percent of TB patients are immigrants from other provinces.

Since most of them can only find temporary manual work, if they catch TB and lose their job they will quit their free treatment early and head back home, spreading the disease when they return, and this trend is rising, doctors warned.

An estimated 1,000 fresh cases of tuberculosis are diagnosed every year, Dr. Buu said.

The public health system might be the pivot of the free tuberculosis treatment program but it is failing in its task, said Pham Ngoc Thach Hospital director Dr. Nguyen Huy Dung.

There are still five of the city’s 34 public hospitals that do not have the wherewithal to diagnose TB despite the health department’s instruction that they participate fully in the mission to ferret out, treat and contain tuberculosis.

Not to mention that only eight of the 29 hospitals can offer treatment, while the others transfer TB cases to clinics and hospitals in the national TB prevention network.

Also brought up was the fact that very few doctors in the public health system take advantage of the specialized training available through the city’s TB Prevention Program, and that only two public hospitals, Trung Vuong and Gia Dinh People’s, report their TB cases as a matter of course.

Dr. Dung said the disease could come from many regions and sources, even foreign visitors, and lamented the absence of patient management in so many TB cases.

In response, a representative of FV Hospital said they had admitted several foreigners with tuberculosis but there were no regulations to guide them in patient management.

Private sector concerns

According to one speaker at the conference, many TB patients prefer private clinics since they are not subject to strict management rules or complicated administrative procedures, yet the treatment is still free.

Three quarters of the TB patients surveyed by Pham Ngoc Thach Hospital last year had opted for private clinics for their diagnosis and tests, while for actual treatment the proportion was around 30 percent.

Last year at least 2,000 patients went to private clinics for treatment yet none of their names were recorded, Dr. Buu said.

In the public health system, on the other hand, the names of 15,000 patients were recorded as they had been registered for free treatment.

On top of poor patient management, most of the doctors attending the conference went so far as to openly question the standard of TB diagnosis and treatment at the private clinics.

By the health department’s reckoning, only 48 of the 1,647 private medical clinics in HCMC employ tuberculosis specialists.

While over 80 percent of patients in the national TB program complete their treatment, the rate in the private health sector is only half this, the conference heard.

The nearly 30 private hospitals and more than one thousand private clinics could make a significant contribution to preventing the spread of tuberculosis if there were regulations on public-private cooperation, said Duong Quang Trung, chairman of the HCMC Private Medical Practices Association.

A memorandum of understanding on public-private cooperation to halve the rate of TB fatalities by the year 2015 is a step in the right direction, said health department director Dr. Nguyen Van Chau.

Vietnam ranks 12th on the World Health Organization’s list of 22 countries with the highest incidence of TB.

Slow progress in global TB fight

While the United Nations’ health agency said in its annual report on TB control that the overall rate of TB infection had fallen to 139 cases per 100,000 people in the past three years, it warned that progress in tackling the disease was way too slow.

More HIV-infected people are discovered to be dying from TB; in fact, one out of every four TB deaths is HIV related, twice as many as previously thought.

There are severe shortcomings in tackling TB and coordinated care for both diseases largely due to feeble health care in the developing countries that are the hardest hit, according to the report released on Tuesday.

Just one in seven HIV patients gets vital preventive treatment for TB, said WHO’s HIV/AIDS director, Kevin De Cock.

Overall, more than one third of tuberculosis cases are not diagnosed, leaving many out of reach of treatment and, crucially, increasing the risk of spreading the disease.

Globally some 9.27 million people contracted the contagious lung disease in 2007, an increase of 30,000 from the previous year, and 1.75 million of these died, according to the report released on Tuesday.

The countries with the highest number of cases are India, China, Indonesia, Nigeria and South Africa.

The agency says that this year a total of US$3 billion is available for TB control in 94 countries that reported data, and which account for 93 percent of the world’s cases.

Source: TN, Agencies (With input from AFP)