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Figure
¨ With proper treatment, TB can almost always be cured.
Tuberculosis (TB) is a serious disease that usually affects the lungs. Every year TB causes more deaths than any other infectious disease - more deaths than tropical diseases, malaria, and AIDS combined. About 2 billion people (1/3 of the world’s population) carry the TB germ in their bodies. Of these, 10 million people are actually sick with TB right now.
As living and work conditions become more crowded, even more people are becoming infected or sick with TB. This is because TB spreads easily in crowded conditions - for example, in cities, slums, refugee camps, factories, and office buildings - especially in indoor areas where the air does not move much. Also, people who are infected with HIV and TB can easily get sick with TB because their immune systems are weak and unable to fight disease.
WOMEN AND TB
TB affects both men and women, but fewer women than men get treatment. Nearly 3000 women die every day from TB, and at least 1/3 die because they never knew they had the disease or because they did not receive proper treatment. It is often more difficult for a woman to get health care to cure TB because she may not be able to leave her family and work, or does not have the money to travel to a clinic. In some places a woman may not seek treatment for TB because she fears her husband will reject her as ‘sickly’ or too weak to do her work. A woman who works outside the home is often afraid she will be dismissed because her employer may think she will infect others.
¨ Caring for sick family members may also put a woman at greater risk of becoming infected with TB.
TB is caused by a small germ, or bacteria. Once this germ enters a woman’s body, she is infected with TB and will remain so for many years, probably for life. Healthy people can usually fight off the sickness, and only a small number of people who are infected actually get sick with TB. About I out of 10 persons infected becomes sick with TB in his or her lifetime.
Figure
But if a person is weak, malnourished, diabetic, very young or very old, or infected with HIV, the TB germs may start to attack her body. Usually this happens in the lungs, where germs eat holes in the tissue and destroy blood vessels. As the body tries to fight the disease, the holes fill with pus and small amounts of blood.
This is what lungs look like
inside the body.
Without treatment, the body starts to waste away, and the person usually dies within 5 years. If a person is infected with HIV and TB, she or he may die in a few months without treatment.
¨ Sometimes TB germs attack other body organs, the lymph nodes, or the bones and joints. This is called extrapulmonary TB. When TB germs attack the spine and brain, it is called TB meningitis.
TB spreads from one person to another when someone who is sick with TB coughs germs into the air The TB germs can live in the air for hours.
People who are sick with TB in their lungs can spread the germs to others. People who are infected with TB but not sick with signs of TB, and those who are sick with TB in other parts of the body, are not contagious.
If not treated correctly, a person sick with TB will infect about 10 more people with TB each year. But once a person has been taking medicines for about a month, he or she is probably no longer contagious.
¨ Women who are sick with TB often infect their children and others they take care of every day.
This year, about 10 people
will be infected by each person who is sick with TB
today.
A person with these signs is likely to have TB in the lungs:
· cough for more than 3 weeks, especially if the cough brings up mucus (sputum) from the lungs· blood in the sputum
· weight loss
But the only way to know for sure that a person has TB is to have the sputum tested. To get a sample of sputum - and not just saliva (spit) - a person must cough hard to bring up material from deep in her lungs. The sputum is then examined in a laboratory to see if it contains TB germs (is positive).
A person should take at least 2 sputum tests, ideally 2 mornings in a row. If both of her sputum tests are positive, the woman should begin treatment. If only one of the 2 tests is positive, she should have her sputum tested again and, if it is positive, begin treatment. If the third test is negative, she should get a chest x-ray, if possible, to be certain that she does not need treatment.
¨ If someone with signs of TB in the lungs has negative sputum tests, she should see a health worker trained in treating problems of the lung. She may have pneumonia, asthma, or cancer of the lungs.
TB can almost always be cured if a woman has TB for the first time, and if she takes the right kinds of medicines in the right amounts for the full length of the treatment.
The treatment has 2 parts. In the first, a woman takes 3 to 4 medicines for 2 months, and then her sputum is tested. If it is negative, she begins part 2, in which she takes 2 drugs for another 4 to 6 months (a total of 6 to 8 months of treatment). When the treatment is finished, her sputum should be checked again to make sure that she has been cured.
The medicines usually given to treat TB include ethambutol, isoniazid, pyrazinamide, rifampicin, streptomycin, and thiacetazone. For information about these medicines see the “Green Pages.” But the treatments used to cure TB vary from country to country. A health worker should always follow the recommendations of the TB program in her or his country.
If a woman’s sputum is still positive after 2 months of treatment, she should see a health worker for more tests. These can show if her TB germs are resistant to the medicines.
¨ TB medicines can make hormonal methods of family planning (like birth control pills) less effective. Women being treated for TB should use a different family planning method.
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TB treatment during pregnancy A pregnant woman should never take streptomycin, because it may cause deafness in her unborn baby. She should also avoid taking pyrazinamide whenever possible, because its effect on the baby is not known. TB medicines may cause pain and numbness in the hands and feet, especially during pregnancy. Taking 50 mg of pyridoxine (vitamin B6) daily will help. |
IMPORTANT
Persons infected with HIV must not
take thiacetazone, because it can cause their skin to peel off. If there is any
possibility that a person is infected with HIV, other medicines should be used
instead.
Anyone who is being treated for TB should follow these rules:
· Take all the medicine. Never stop treatment when you feel better. If you do stop, the illness will come back and you can infect others.· Learn which side effects are normal and which are serious for the medicines you are taking. If you have serious side effects, you should stop taking the medicines and see a health worker immediately. The health worker may have you start them again one at a time or give you a new medicine.
· Get plenty of rest and eat as well as possible. If you can, stop working until you begin to feel better.
· Keep from spreading TB germs to others. If possible, sleep separately from those who are not sick with TB for one month after starting medicines. Cover your mouth when coughing and spit sputum into a piece of paper. Throw it into a latrine or toilet, or burn it.
Figure
· If you give birth during treatment, your sputum should be tested. If it is negative, your baby should be given a BCG (Bacille Calmette-Guerin) vaccine, but no medicines. If your sputum is positive, your baby will need medicines. You do not need to be separated from your baby or to stop breastfeeding.
¨ After the first 2 months of treatment, it is sometimes possible to take medicines 2 or 3 times a week, instead of every day. Talk to a health worker to see if you can get this kind of treatment.
If a person does not take enough of the right kinds of medicine, or stops taking medicines before the treatment is finished, not all the TB germs will be killed. The strongest germs will survive and multiply, and then the medicine will be unable to kill them. This is called ‘resistance’. Anyone whose sputum is still positive after 2 months of treatment may have TB germs that are resistant to the medicines she is taking. She should see a health worker trained in treating TB to get other medicines to take.
¨ If a woman is infected by someone with drug resistant TB, the germs causing her sickness will also be resistant.
Germs that have become resistant to both isoniazid and rifampicin can cause drug-resistant TB, which is very difficult to treat. The treatment takes between 12 to 18 months, and is much less successful and more expensive than treatment for ordinary TB. A person with drug-resistant TB can still spread the disease to others for several months after beginning treatment.
¨ Health workers should always ask if a person has been treated for TB before. If she has, she is more likely to have drug-resistant TB.
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Because the treatment for TB is so long and the effects of stopping treatment are so serious, extra care should be taken to make sure that a person takes all her medicine. A health worker or community volunteer should watch the sick person take every dose and record that it is taken. This is called ‘directly observed treatment, short-course’, or DOTS. Health workers should use DOTS whenever possible, but it is most important for the first 2 months of treatment. |
IMPORTANT
The best way to prevent the spread of
TB is to cure people who are sick with TB.
Figure
These things can also help:
· Encourage people to get tested for TB if they live with a person who is sick with TB and have any signs, or if they have a cough for 3 weeks or more.· Try to keep the air moving in enclosed areas. This reduces the number of TB germs in that area.
· Let sunlight in whenever possible. Sunlight helps kill TB germs.
· Immunize healthy babies and children with BCG vaccine to prevent the most deadly forms of TB. But children sick with AIDS should not get BCG vaccine.
Creating effective TB control in your community requires:
· community and family education about the signs of TB and how it is spread. Encourage women to seek treatment for the signs of TB.· trained health workers or community volunteers to participate in the DOTS program, and to find and work with persons sick with TB if they stop treatment early. DOTS programs must be flexible to be able to meet each person’s needs.
· a continual supply of medicines so that treatment does not get interrupted, and laboratory equipment and trained workers for testing sputum.
· a good system for keeping track of who has TB, how the treatment is going, and when a person is cured.
A good TB program must give care to all people sick with TB, including women. TB services can help more women by:
· providing care and treatment in women’s homes or as near to the home as possible.· including midwives and traditional birth attendants in TB screening and DOTS programs.
· combining TB screening and treatment with other health services women are more likely to use.
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