1.2 Bangladesh scenario

Although Bangladesh has achieved notable progress in improving a multitude of health indicators over the last decade, including those related to TB diagnosis and treatment, TB remains a public health concern in the country. With an estimated population of 164 million, Bangladesh is listed among the 30-high burden countries for TB and 27 for MDR-TB. With 3.6% of the estimated global incident cases, it continues to be among the top 8 countries accounting for two-thirds of the Global TB burden. According to the Global TB Report 2020, 292,942 TB patients were notified to the National Tuberculosis Control Programme (NTP) in 2019. The childhood TB cases reported are nearly 4% of all cases which is still a huge challenge in Bangladesh. The incidence rate for all from of tuberculosis is 221 per 100,000 population per year. The TB mortality is 24 per 100,000 population per year with over 38,000 deaths annually. Similarly, MDR-TB was 0.7% among new and 11% among retreatment cases with a large absolute number of patients (~3,300 MDR/RR cases) that need to be treated with the second line anti-TB drugs (SLDs). Although TB treatment coverage increased from 27% in 2002 to 81% in 2019, an estimated 68,000 (19%) TB patients remain undetected every year with a static TB incidence - between 225/100,000 and 221/100,000 from 2001 to 2019.

In 1993 WHO declared TB as a global emergency and recommended a standard strategy for control of the disease known as "DOTS" or Directly Observed Treatment, Short-course. The NTP adopted the DOTS strategy in 1993. Since the introduction of DOTS, remarkable progress has been achieved in TB control in the country. The program has managed to successfully treat >85% of TB patients since 2003. This has further improved to above 90% since 2005. Further, the program achieved the initial target of detecting at least 70% of new smear positive (NSP) cases in 2006 and has been successful in consistently sustaining this.

In 2016, Bangladesh adopted WHO’s End TB Strategy based on the Three Pillars, namely,(I) Integrated patient cantered care and prevention; (II) Bold policies and supportive systems and (III) Intensified research and innovation underpinned by the 4 key principles of (1) government stewardship & accountability, (2) strong coalition with civil society organizations & communities, (3) protection & promotion of human rights, ethics & equity and (4) adaptation of the strategy and targets at country level. The Government of Bangladesh, together with its many and diverse partners from the public and private sectors, is committed to further intensify the TB control activity in order to sustain the success achieved thus far and to reach the TB control targets linked to the WHO End TB Strategy well in time.

Vision of the National TB Control Programme

TB Free Bangladesh: Zero deaths, disease and suffering due to TB

Mission the National TB Control Programme

The NTP aims to strengthen TB control efforts through establishing effective partnerships, mobilizing necessary resources and ensuring quality diagnostic and treatment services under the DOTS strategy. It strives to make services equally available and accessible to all people in Bangladesh irrespective of age, sex, religion, ethnicity, social status or race.

Goal of Tuberculosis Control

The overall goal of TB control in Bangladesh is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem.

The objectives of the National Tuberculosis Control Programme

Ninety percent (90%) reduction in the absolute number of TB deaths and 80% reduction in the TB incidence rate (compared with 2015 baseline) by 2030 (linked to the SDGs) 4 National Guideline and Operational Manual for Tuberculosis
Ninety five percent (95%) reduction in the absolute number of TB deaths and 90% reduction in the TB incidence rate (compared with 2015 baseline) by 2035
Reduce transmission of TB infection though strengthening systematic contact investigation and expanding TB preventive treatment for latent TB infection (LTBI)
Achieve zero catastrophic costs in TB affected households by 2020 and sustain that thereafter (level in 2015 unknown and needs to be assessed)

In addition to target for 2030 (linked to SDG) and for 2035, there are specific milestones for 2020 and 2025.