Blaming poverty and malnutrition for TB is no excuse for complacency

All of us know that there is a pool where TB bacilli that can flourish and can cause TB infection in children. We are the ones who together with our knowledge and experience aim to eliminate the pool, so that no more infections can occur. How does infection take place? Infection is caused by a TB patient excreting Acid Fast Bacilli (AFB) in sputum. While coughing he will disseminate sputum into the air. The smallest particles called the droplet nuclei will remain floating and when inhaled, can pass the mouth/nose/bronchi and bronchioli to end up at the alveoli of the healthy person. The bigger sputum particles will reach the ground and cannot cause infection (unable to form floating droplet nuclei).

In the developing and poor countries there are several risk factors which could make the children prone to TB infection and could accelerate infection into disease  Examples:

Children become prone to infection in over-crowded homes, where large number of people live in a small space and be at higher risk of TB. In the proximity to an index adult case, where ventilation and illumination are poor or absent.

In the developing and poor countries there are factors accelerating TB infection towards TB disease. Examples are malnutrition, pollution (cigarette smoke), biomass fuels, unhygienic condition, co-existing infectious disease: viral disease (measles, pertussis, smallpox, HIV etc), anemia, malignancy, diabetes

The question is, can we do something about those circumstances which are basically caused by poverty, poor nutrition and ignorance? 

It is not the task of the TB control centers or advocates to change this sad situation inherent to a poor socio-economic community.

What can we do? The answer is: Detect, treat and cure all infectious cases we encounter in the community, so that no longer they can spread the infectious bacilli to others (children).

Once the infectious sources are identified and treated, all, each and every earlier mentioned risk factors will become irrelevant. Even under the most miserable socio-economic conditions where poverty and poor nutrition prevailed, TB can still be stopped successfully, even on an ambulatory basis as was reported from Madras. 

The Madras study (1966) showed that home-treatment is not less effective than sanatorium-treatment. That even poor nutritional status and hardships, like continued working under harsh conditions, do not reduce the success of treatment. And that the spread of TB is halted as soon as chemotherapy was started.  This fact was later also shown by Riley R.L. with his experimental guinea pigs and by Prof Jacques Grosset in his laboratory. 

Then Dr Karl Styblo developed the DOTS strategy since the 19-eighties  as the world's most effective means of controlling the tuberculosis epidemic. And this was considered to be among the most cost -effective system of all interventions in fighting sickness and disease in the Third World. Implemented by WHO in 1995, the DOTS strategy has shown to be successful even in the lesser developing countries. Let's not blame poverty or poor nutrition for the spread of tuberculosis.

Instead of waiting for socio-economic situation to improve, let's now concentrate on stopping the spread of TB.  The surest way to instantly stop infection is to immediately treat the infectious sources.

Finally, lest we forget. The TB bacilli contained in sputum droplet nuclei, floating in the air are the very ones that can penetrate the bronchi and bronchioli. While landing on the alveolus, the droplet cum bacillus can cause infection when inhaled. The poor and undernourished people are the preferential targets of TB. Notwithstanding, according to West European records, there were various kings and many world famous artists, who also were victimized by TB. 

Technically speaking, TB infection is not caused by poor disinfection or poor management of excreta from infectious tuberculosis patients. 

Also, spitting on the roads and defecating in the open, are indicative of poor hygiene but for sure, these acts cannot help in the spread of tuberculosis germs. 

Consequently, bed linen, pillow cases, blankets, handkerchiefs, and personal clothing from untreated infectious TB patients are contaminated, but not contagious (observation from the Netherlands before the invention of anti-TB drugs!).

EPILOGUE: For almost thirty years by now, our service providers in 5 outpost clinics of Jakarta, used to sit within reach or next to each TB patient. They (the providers) wear no mask, don't take preventive medicines, daily vitamins or food supplements. Yet, no one of our workers got the disease. Praise the Lord!

Dr Muherman Harun
(The author is a senior TB expert and is with St.Carolus TB Program, Jakarta, Indonesia. Email:

Published in:
Citizen News Service(CNS), India/Thailand
Elites TV News, California, USA