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Pakistan ranks 5th, amongst the 22 high TB burden countries, and 27 high multi-drug resistant (MDR) TB burden countries in the world1. Currently the country is facing a challenge of growing number of MDR-TB cases annually, whereas low case enrolment is also seen. In 2013, from an estimated 12997 drug resistant TB incident cases, only 1570(13%) were enrolled for treatment2. Despite this low number, the public health significance of MDR-TB is still high because of economic and social costs associated with this type of TB disease. It is considered a serious threat for TB control and elimination. The average cost calculated for an eighteen months full course of second line drugs (SLDs) which is required to treat a single drug resistant TB case is about US$ 5,000 and the drug is also not readily available in the country. To diagnose and treat a MDRTB case, free of cost the TB control program and health departments have no such Government financial resources, and the program is completely relying on donor's assistance. MDR-TB patients are mostly very ill and poor and could not afford the cost of treatment. They also sometimes need hospitalization in the initial stages which not only increases the economic cost but also has social implications due to stigma associated with the disease.
The TB control program in Pakistan is facing several constraints resulting in not detecting and enrolling...