Tuberculosis (TB) may be seen as a disease of the past in Ireland, but China faces a TB epidemic, reports Clifford Coonanin Beijing
TUBERCULOSIS IS practically a forgotten illness in Ireland, but it remains China's top epidemic killer, claiming 130,000 lives every year, and the number of infections continues to rise. China is second only to India in the number of deaths from TB annually, and the Beijing government has implemented a campaign to fight the disease, focusing in particular on migrant workers.
The campaign has been a success - but the government is constantly stressing vigilance because the hundreds of millions of migrant workers, the poor farmers who come from China's countryside to build the gleaming cities of the eastern seaboard and the rich south, or the Olympic buildings in Beijing, are particularly at risk.
These farmers-turned-workers are more at risk because of comparatively poor medical awareness, high-density living conditions, and mobile lifestyles, Jiang Shiwen, director with the National Centre for TB Control and Prevention, tells the Xinhua news agency.
Research in China shows that, left untreated, each person with active TB disease will infect on average 10 to 15 people yearly. Of those who die, many end up with drug-resistant TB, which is probably caused by delayed medical intervention.
The Chinese government has launched a special care programme for China's 200 million migrant workers, says Jiang. You can see posters at building sites and places where migrants live.
"TB awareness-raising campaigns among workers should be intensified, as many simply endure the disease without seeking timely treatment for fear of being fired and inability to pay high medical costs," Jiang says.
Besides free examinations and treatment, a monthly 100 yuan (€9.33) allowance is distributed to each infected migrant worker in the two municipalities of Shanghai and Tianjin and five other "economically advanced provinces".
Xiao Donglou, vice-director of the health ministry's disease prevention and control bureau, says migrant workers now have full access to free healthcare services in TB screening and treatment.
"People infected with the airborne contagious disease should turn to local TB prevention and treatment organisations, where free disease screening tests and further treatment are provided for all citizens who need them, locals and migrants alike," said Xiao.
China's war on TB really kicked off in 2001, when the country's cabinet, the State Council, promised free examinations and treatment for people infected with TB and earmarked 40 million yuan (€3.8 million) in funds, a not inconsiderable amount in China. It has risen factorially every year to hit €380 million in 2006.
TB is primarily a rural phenomenon - of China's five million TB patients, 80 per cent live in the countryside. According to tests, the prevalence of active and smear-positive TB cases is 2.4 times and 2.8 times higher in the countryside than in cities.
A big factor is drug resistance, which affects 28 per cent of China's total TB patients. This often comes about from improper treatment by healthcare workers, and failure to ensure that patients complete the whole treatment course.
The Chinese government has been trying to gather information about this in a survey and hopes to use the information to set up a monitoring system for drug resistance as the study progressed.
Treating a TB patient who has developed drug resistance costs up to 20,000 yuan (€1,865), while regular treatment costs 150 yuan (€14).
"Compared to other places in mainland China, the TB situation in cities like Shanghai, Beijing and Guangzhou, as well as South China, is much better, but the disease is very severe in the west of China," says He Jinlong, deputy director of the respiratory disease centre at Shanghai Infectious Disease Hospital.
"Every month our hospital receives more than 10 TB patients on average. We treat over 100 TB patients annually. Because China requires all TB patients to go to hospitals in their own living areas for treatment, patients we have treated are all from the Jinshan district of Shanghai," says He.
"Our country offers free basic treatment of tuberculosis for patients. Five basic drugs are provided free to TB patients. However, some patients do not like the free drugs, as they think those drugs are not good enough. They just dump the drugs finally. We are seeing fewer TB patients every year, but the slowdown is quite slow," adds He.
Most of those affected by the illness in China are young - 25- to 35-year-olds account for 54 per cent of cases, 36- to 45-year-olds account for 37.3 per cent and the rest are elderly.
Ma Anlin, deputy director of the infection unit of the China-Japan Friendship Hospital, says the situation is severe but improving. "The TB situation in China is indeed very severe. In our hospital, every month we will receive several TB patients. Then we will organise to transfer those patients to a typical TB hospital. Although I am not aware of the exact statistics, the situation is getting better and better every year," says Ma.
The World Health Organisation praises China's success in reaching the global targets for case detection and treatment success for the second consecutive year. "The Chinese NTP (National TB Control Programme) is now working to improve access to high-quality TB care for all people with TB, including those with TB/HIV, those with MDR-TB (multidrug resistant TB) and unofficial internal migrants (the 'floating populations')," the WHO says in its country report on China.
However, information about human resources at sub-national levels is not available centrally, the WHO says.
"The NTP identifies a shortage of trained staff as one of the challenges to implementing the Stop TB Strategy. The relationship between TB dispensaries run by the NTP and general hospitals continues to be problematic, and pilot projects are under way to improve collaboration," the report says.