Essays On Tuberculosis

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A study of trends in TB incidence and their determinants in 134 countries found that the incidence declined more quickly in countries that had a higher human development index, greater health expenditure, lower child mortality and improved sanitation [8].

Incidence rates declined more quickly in high-income countries with lower immigration and in countries with lower HIV infection rates.

These conditions are intended to help decide whether public health measures can legitimize overriding moral values such as individual liberty and justice.

One condition is “effectiveness”, implying that any infringement of one or more moral considerations should be based on public, scientific evidence that the proposed intervention will do more good than harm.

Essential methods for TB diagnosis and treatment were integrated into the WHO’s new TB control strategy, Directly Observed Treatment, Short Course (DOTS).

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Avoiding interruption of TB treatment was considered one of the major challenges in preventing the spread of drug resistance.Further, no significant difference in clinical outcomes was found between DOT given at a clinic and DOT given by a family member or community health worker, or for DOT given by a family member compared with a community health worker [10].The impact of DOT on patients’ autonomy has been questioned [11].While DOTS programmes have significantly contributed to a decline in TB prevalence and TB mortality, socio-economic development is still the main reason behind the decline in TB incidence in different regions of the world [9].Directly observed treatment (DOT) is one component of DOTS.In 2004, the International Union Against Tuberculosis and Lung Disease (IUATLD) appointed an ethics advisory group to develop policies and operational guidelines based on the Helsinki Declaration [12].In 2008, the WHO’s Ethics and Health Team established a WHO task force to address ethical issues in TB care and control programmes.In 2010, the WHO published Guidance on Ethics of Tuberculosis Prevention, Care and Control to guide stakeholders in implementing TB control programmes [13].These guidelines emphasize the overarching goals of TB care and control programmes, which are: The guideline identifies ethical values that are important to TB care and control, such as “social justice and equity” (addressing underlying root causes and existence of inequalities in society), “common good” (meaning interventions should benefit whole communities), “respect for patient autonomy”, “participation” and “transparency” in decision-making processes, and “effectiveness” [13].Socially disadvantaged groups, such as the homeless, those employed as day labourers and those lacking rights as employees, face the highest burdens.From an ethical standpoint, we argue that a rigid practice of directly observed treatment is difficult to justify, and that responsiveness to social determinants of Tuberculosis should become an integral part of the management of Tuberculosis.


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