Next Article in Journal
Investigating the Leishmania donovani sacp Gene and Its Role in Macrophage Infection and Survival in Mice
Previous Article in Journal
Assessment of Immune and Clinical Response in Patients with Mucosal Leishmaniasis Treated with Pentavalent Antimony and Pentoxifylline
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
TropicalMed
Volume 7
Issue 11
10.3390/tropicalmed7110385
tropicalmed-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh

by
Fariha Alam Mihika
1,2,*,
Md Abdullah Al Jubayer Biswas
1,
Md Maruf Haque Khan
2,
Syed Shariful Islam
2,
M. Atiqul Haque
2,
Sayera Banu
1 and
Md Zakiul Hassan
1
1
Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
2
Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2022, 7(11), 385; https://doi.org/10.3390/tropicalmed7110385
Submission received: 31 October 2022 / Revised: 13 November 2022 / Accepted: 14 November 2022 / Published: 17 November 2022
(This article belongs to the Section Infectious Diseases)
Browse Figures
Versions Notes

Abstract

:
Despite the enormous disruption of tuberculosis (TB) services reported globally, Bangladesh’s impact is not well documented. We aimed to assess the effect of the COVID-19 pandemic on the TB control program in Bangladesh from patients’ and service providers’ perspectives. We conducted a cross-sectional study from November–December 2021 at six conveniently selected Upazila Health Complexes (UHC) of the Dhaka division, Bangladesh. We conducted face-to-face interviews among 180 pulmonary TB service recipients and all TB service providers working in the selected UHC. We also reviewed TB registries from each UHC. All data were summarized using descriptive statistics tools. We found a 31% reduction in presumptive TB cases during 2021 compared to 2020. Other TB services, such as testing, were reduced by 16–36% during the same period. Service receivers reported a lack of transportation (95%), and a lack of adequate human resources (89%) as critical barriers to receiving and providing TB service, respectively. The findings of our study showed substantial interruption of TB service delivery during the COVID-19 pandemic, threatening the recent progress and pushback from achieving the 2035 End TB targets. Early mitigation of TB service delivery through adopting remote follow-ups using digital health technology and integrating COVID-19 and TB screening is essential for the continuity of essential TB services and achieving global TB targets.

1. Introduction

Globally, from the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic has substantially sabotaged many aspects of health systems [1,2]. The response to the pandemic, which included measures such as a nationwide state of emergency, reorganization of medical staff, supplies, and diagnostic instruments, along with a decrease in outpatient services, had a considerable influence on the way many health services, including tuberculosis (TB) services, functioned and responded [3,4,5]. As a result, it is hardly unexpected that TB detection and reporting have fallen dramatically in the first few months of the epidemic, whether in developing or developed countries [6,7]. Subsequently, modeling-based research predicted that, over a three-month shutdown period, worldwide TB case detection would reduce by an average of 25% compared to pre-pandemic levels [8]. Likewise, an investigation of the first three months of the pandemic was conducted in 165 countries, and 42% reported partial interruptions in TB case diagnoses and management [9]. The findings of another study on 33 sites across 16 countries also revealed a similar reduction in hospital discharges related to TB, first-time suspects of TB cases, the total number of outpatient TB treatment visits, newly Latent Tuberculosis and bacterial infection (LTBI), and LTBI outpatient care visits [1].
Similar to other countries, the COVID-19 pandemic in Bangladesh has significantly affected the healthcare systems and socio-economic structures, including diminishing the number of persons seeking and getting TB-related health treatment [7,10,11]. Bangladesh has 3.6% of the world’s cases of TB, and TB patients are advised to be treated at a TB hospital or a Directly Observed Treatment Short-course (DOTs) clinic, the most efficient and long-lasting component of the National Tuberculosis Control Program (NTP) [12]. Nevertheless, the massive confinement policy and the suspension of public and private transportation during COVID-19 led to a severe breakdown in the surveillance, treatment, and prevention of tuberculosis [7]. According to the US Agency for International Development (USAID) TB Data Hub, there was an increase in all forms of TB cases during the last ten years in Bangladesh, which significantly declined and hit an all-time low point of 74,000 in 2021 [13]. Difficulty in accessing a DOTs clinic, the suspension of essential laboratory services and the inaccessibility of the few remaining open testing facilities were the causes of such disruptions [7].
Even though much has been published about the influence of COVID-19 on TB treatment services and occupational safety, little is known about the country-specific evaluation of presumptive TB (PTB) cases, registered adult PTB cases and laboratory activities, including sputum microscopy and gene Xpert machine use [7]. Despite the significant interruption of TB treatment during the COVID-19 pandemic in Bangladesh, the challenges and barriers experienced by service recipients and providers at DOTs clinic are not widely documented. Therefore, we aimed to compare TB service delivery in DOTs facilities during the COVID-19 period in Bangladesh with data from the previous year. In addition, we also aimed to identify the difficulties and challenges encountered by service recipients and providers at DOTs facilities during the pandemic. Our study’s findings will provide a comprehensive picture of the TB situation in Bangladesh, including diagnosis and access to healthcare facilities during this global health crisis. The results will also allow policymakers to better comprehend and plan future steps to address the limitations in combating TB during any pandemic situation, such as COVID-19, in Bangladesh, as well as reinforce the plan to improve the guidelines.

2. Materials and Methods

2.1. Study Design, Study Setting, and Study Participants

We conducted a cross-sectional study from 1 January to 31 December 2021. During the study period, the second wave of COVID-19 began in mid-March, and a rigorous lockdown was enforced on 14 April 2021 [14]. As a result, research efforts were severely hindered; this is why we purposefully selected six Upazila Health Complexes (UHC) from the Dhaka division to minimize transportation difficulties and maintain COVID-19-related precautions. Our chosen UHCs were the Sirajdikhan Upazila Complex, Munshigonj; Kaliganj Upazila Health Complex, Gazipur; Savar Upazila Health Complex, Savar; Singair and Harirampur Upazila Health Complex, Manikganj; and the Rupganj Upazila Health Complex, Narayanganj. Table 1 represents the detailed demographic data of the study Upazila health complex. We recruited study participants and collected primary data from adults with pulmonary TB who were about to finish their treatment or had already completed their treatment and healthcare providers engaged in TB treatment services at UHCs. Healthcare providers encompassed medical officers (MO), medical officer disease control (MODC) DOTs clinic service providers and laboratory staff working in the TB control service at those six selected UHCs. We exclude those TB service recipients who had extrapulmonary TB, were pregnant women, had emergency medical conditions, and were under 18 years.

2.2. Sample Size and Sampling Technique

We calculated the sample size by using the following formula [22]. Since no relevant research was found in Bangladesh, we relied on the proportion of TB patients in India who did not finish treatment due to the COVID-19 pandemic. According to their findings, seventeen percent of TB patients were not able to receive treatment due to the COVID-19 pandemic [23].
Sample size, n = [DEFF ∗ Np(1 − p)]/[(d2/Z21 − α/2 ∗ (N − 1) + p ∗ (1 − p)].
Considering a 10,000 population size (N), 17% point estimate (p), 1% precision (d), 95% confidence interval (CI), 1 design effect (DEFE) and 20% non–response rate, the estimated sample size from the following formula is 178. We next allocated 180 recipients of pulmonary TB services recipients evenly across six UHCs, 30 from each UHC. Regarding recruiting service recipients, we utilized the non-probability convenience sampling technique considering the contemporary threat of COVID-19. Additionally, we selected all service providers working in the TB control program of each Upazila. There was one DOTs clinic in each Upazila, with an average of three service providers. In total, we enlisted 18 service providers from six Upazilas, three from each facility. Figure 1 depicts detail of the data collection survey procedure.

2.3. Data Collection Tools and Data Collection

We developed a semi-structured, standardized questionnaire following a comprehensive literature review [7,24,25,26,27,28]. We designed different survey questionnaires for service providers and service recipients. Additionally, we prepared a document-review checklist based on services offered by the DOTs corner to gather data from the DOTs corner’s TB registries. The questionnaires were pre-tested on five service providers and recipients and revised depending on their feedback. The final data set was prepared, excluding data gleaned during the pre-tested interviews. The survey questionnaire for service providers consisted of twenty questions separated into five sections: (a) demographic characteristics (seven questions); (b) obstacles and actions performed in the course of giving TB treatment (four questions); (c) COVID-19 screening of the TB patient (two questions); (d) adaptation in the DOTs clinic during COVID-19 (two questions); and (e) challenges in the management of TB patients (five questions). Similarly, the TB patient-related (service recipients) survey questionnaire had two sections with a total of seven questions, such as (a) socio-demographic (five questions), and (b) Access to healthcare for pulmonary TB patients during the COVID-19 pandemic (two questions) (Supplementary Materials S1). Service providers and receivers were interviewed face-to-face by trained data collectors. A team of field staff collected data. The field staff interviewed patients and providers, using a structured questionnaire to collect their data. The data collected included age, gender, designation duration of experiences, facing different challenges for providing or receiving service during the COVID-19 pandemic, different types of adaptation required in the DOTs clinic, etc. (Supplementary Materials S1). Field staff were also instructed to ensure that all participants provided written informed consent before conducting a face-to-face interview. During the consent process, participants were informed about the aims and objectives of the study, study procedure, benefits and risks of the participation, right to refuse to participate or withdraw from the survey, confidential data handling, and the principal investigator’s identity. The participants were also informed that anonymity and confidentiality were maintained by using identification numbers, and ensured that all data would be coded and stored in a locked cabinet. They were assured that the collected information would be used only for research purposes, and not otherwise.
In addition, the document review checklist consisted of TB service indicators, including the number of Presumptive TB patients, patients who tested sputum microscopy, registered adult PTB cases, and patients who tested by gene Xpert one year before COVID-19 and one year after the COVID-19 pandemic. We utilized the checklist to review TB registries from each UHC (Supplementary Materials S1). Figure 1 depicts the details of the study’s sampling technique and data collection survey process.

2.4. Data Analysis

We entered the collected data into MS Access, and then transferred it to the Statistical Package for Social Sciences (SPSS) version 23( International Business Machines Corporation, New York, United States). After this, we examined the data for incompletion or discrepancy due to inconsistent data, missing data and protocol deviations. Then, we identified the causes of the discrepancies, resolved them with supporting documentation, and updated the database. Before obtaining the final dataset, all variables were examined for inconsistencies, and all these problems were resolved. We used descriptive statistics tools to summarize all the variables, including frequency, percentage, mean, median, standard deviation (SD) and interquartile range (IQR), depending on the type and distribution of the variables. We computed the total number of patients in each service indicator from March 2020 to February 2021 (one year after COVID-19) and March 2019 to February 2020 (one year before COVID-19). All analysis was performed using SPSS 23.0.

2.5. Ethical Consideration

The Institutional Review Board of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, reviewed and approved the study protocol (BSMMU/2021/8366). The protocol received administrative endorsement from the National TB Control Programme, Director-General of Health Services, Mohakhali, Dhaka a. Study participants provided informed written consent.

3. Results

Table 2 shows the demographics of the survey participants. We found that among 180 service recipients, 67% were male, 66% lived in rural areas, and the mean age was 43 years (standard deviation 17). Regarding service providers, 83% were male, the mean age was 39 years, and the average experience was nine months. On average, three service providers were employed in each TB control service clinic, and fifty percent were infected with COVID-19 while on the job and took twelve days off due to the infection (Table 2).

3.1. Reduction of TB Service Indicators

We found that during the first year of the pandemic, the overall number of notifications of suspected presumptive TB patients and sputum microscopy tests were significantly reduced by 31% and 36%, respectively, compared to the previous year. Similarly, the total number of cases that tested positive by sputum microscopy and registered adult PTB cases reduced by 32% and 15%, respectively, but these were not statistically significant (Table 3).
We also found a sharp fall in the indicators during March 2020, and then all the indicators rose gradually (Figure 2). Specifically, from March 2019 to April 2020, the number of presumptive TB cases and sputum microscopy tests exhibited overlapping patterns, beginning with 2720 cases in March 2019, after a fall in the number seen in both cases. After April 2020, both indicators showed a similar upward trend, and ended with 2956 and 2462, respectively (Figure 2A). Likewise, the number of patients who tested positive by sputum microscopy and registered adult PTB cases showed a similar pattern, but the overall number of registered adult PTB cases was lower than test-positive patients throughout the study period. Both exhibited consistent trends from March 2019 to April 2020, followed by a dramatic decline, with each number hitting an all-time low of around 117 and 253 by April 2020. Between April 2020 and February 2021, both indicators’ numbers showed an upward trend (Figure 2B).

3.2. Challenges and Dissatisfaction among Service Recipients

We found that nearly all service recipients attended for treatment, follow-up and regular anti-TB medicine administration. Regarding the reported barriers while receiving care from DOTs, 95% of service receivers claimed difficulty in transportation, 77% asserted fear of getting infected and 58% mentioned a reduction of income (Figure 3). About half of the people who received services during the study period were dissatisfied. Of these, 95% complained about the facility being more crowded than usual, 81% said they couldn’t get a consultation in time, 45% complained about the length of time it took to conduct an investigation and 21% complained about the number of follow-up visits being reduced (Figure 3).

3.3. Barriers Faced and Adaptation Reported by the Service Providers

Among 18 service providers, almost 89% reported challenges in providing TB services in the DOTs clinic due to the COVID-19 pandemic. Among those who reported barriers, all said a lack of workforce and increased workload, 63% mentioned interruption in the regular follow-up of the patients (Table 4). Interestingly, all service providers reported adjustments required in the DOTs clinic. The most adaptation stated by the service providers were adaptation in behavior (94%), TB management (94%), TB screening management (94%), TB diagnosis (78%) and follow-up (44%). Likewise, all the service providers cited sample collection interruptions, patient non-compliance and canceled follow-up appointments as the most common challenges to diagnosing, treating and follow-up TB patients (Table 4).

4. Discussion

Our study revealed that the COVID-19 pandemic caused significant disruptions to TB service delivery. Overall, within a year of the onset of the COVID-19 pandemic, there was a substantial drop in the number of presumed TB patient notifications, undergoing sputum microscopy testing, sputum microscopy-positive cases and registered adult PTB cases. These findings highlight the need for urgent actions to ensure the continuity of TB care to achieve the global TB targets by 2035 set by the WHO End TB Strategy.
The reduction in PTB patient notification or registration in our study was comparable to the reports found in the early months of COVID-19 in several other TB-burdened countries, including Pakistan, Nepal and Malawi, where fear about contracting the virus and the temporary shutdown of healthcare facilities were reportedly the key factors [29,30,31,32]. Our results are also consistent with studies showing a drop in TB program activities of 67.3% in sputum microscopy tests in Nepal and 44.1% in recorded adult PTB cases in Malawi during the first months of COVID-19 compared to the same period in the previous year [32,33,34].
Additionally, our study found that a significant amount of service recipients reported difficulty in transportation, particularly the lack of available vehicles and/or the high cost of travel. Receiving treatment from DOTs clinics was also highlighted as a barrier due to fears of contracting an infection. During the pandemic, it is possible that people were afraid to go outside since the media constantly reported the latest fatalities. As a result of hearing about these deaths, individuals might have dreaded contracting COVID-19. Furthermore, TB and COVID-19 have many of the same symptoms, leading to increased stigmatization of those with TB who were concerned about contracting COVID-19 [28]. Our findings suggested that ensuring more accessible TB treatment and care services to patients with PTB may enhance service delivery activities during the pandemic, especially in TB notification and registration. Besides, awareness efforts may also be implemented among people with suspected cases of TB to alleviate the stigma and fear surrounding the current and potential future pandemics.
We found transportation as a key barrier in receiving TB services due to the countrywide lockdown, which is consistent to reports from other countries [35,36]. During lockdowns, all kinds of transportation remained halted, except those necessary for emergencies [35,36]. A study in India on TB patients reported transportation as a major barrier [37]. This study informed that transportation expenses were high during the lockdown period, notably in faraway places where mass transportation was unavailable [37].
Other than that, our survey identified overcrowding in the healthcare facility and the inability to obtain timely consultations. This was likely due to suspending regular treatment at many healthcare facilities’ DOTs clinics during the COVID-19 pandemic, which swamped the remaining operational TB clinics [7]. Thus, a strategic approach to facilitate transport or door-to-door serum collection during the pandemic can be adopted for TB patients who had trouble affording access to TB examination and out-of-pocket transportation charges.
Moreover, a lack of personnel, increased workload, stoppage in the routine follow-up of patients, interruption in the TB diagnosis and interruption in the medicine supply were cited as obstacles experienced by the TB services provider. Possible reasons for these issues include the redeployment of personnel from national TB programs, TB laboratories, and TB wards to the battle against COVID-19. A worldwide alliance of TB civic groups’ study found that TB treatment and research resources had been diverted to combating the newly emerged virus COVID-19 [38]. Our results are also supported by several studies from countries with a high Tb burden. In China, 75.2% of the country’s healthcare workers were reallocated to combat COVID-19 [39]. Likewise, in Pakistan, TB-dedicated laboratories were converted into additional COVID-19 testing centers [40]. Due to such reallocation and conversion, regular TB treatment services were significantly hampered; in South Korea, for instance, an estimated 2.3% of drug-susceptible PTB cases were lost to follow-up [41].
A potential solution to reallocate resources to minimize TB service disruption could be integrating COVID-19 and TB screening. Such adjustments in TB service during the COVID-19 pandemic have been reported in several countries, including India, Indonesia and South Africa. In India, state governments proposed implementing door-to-door TB screening programs and ordering District TB officers to examine COVID-negative individuals for TB [42,43]. In South Africa and Indonesia, strategies for screening for both TB and COVID-19 in both directions were outlined by the National TB Elimination Program (NTEP) [44,45].
This study had several strengths. Firstly, we gathered real-time data on regular monthly services from six different UHC DOTs corner registries to investigate interruption of service indications. Next, we compared the logged information with the records kept by monitoring and evaluation personnel; therefore, the data are more reliable and accurate. Secondly, we compared data across two consecutive 12-month periods, enabling us to account for any seasonal fluctuation that could have affected access to health facilities, such as during the rainy season. However, our analysis had several limitations. Due to data collection challenges during the ongoing pandemic, we only include subdistrict hospitals from one of seven administrative divisions (e.g, Dhaka division). Hence, our results may not represent another part of the country not studied. However, the structure and facilities are similar across all subdistrict hospitals, and the reported impact of such lockdown would be similar across Bangladesh. Lastly, while HIV status is a key factor in determining TB risk, we could not assess HIV status, as testing facilities are not widely available, including in our study hospitals. Future studies should incorporate assessing the HIV status of TB cases as recommended by the Nation TB control program guidelines [46].

5. Conclusions

The COVID-19 pandemic caused a substantial decrease in TB service delivery, including case detections and testing threatening the recent progress and pushback from achieving the 2035 End TB targets. Our studies highlighted several challenges faced by the TB service receiver and service provider. Some of these challenges included a lack of transportation, a lack of adequate human resources, and logistics. Mitigating these challenges through adopting remote follow-up using digital health technology and integrating COVID-19 and TB screening would be important for maintaining essential TB services. Home-based sample collection facilities and sending reports using mobile technology can also be emphasized as potential solutions to minimize disruption of TB services during the future pandemic period. Lessons from the current pandemic can also inform the country’s preparedness for future epidemics, and should involve ‘catch-up’ plans for screening, evaluation and treatment of TB during an epidemic.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/tropicalmed7110385/s1.

Author Contributions

Conceptualization, F.A.M., M.Z.H. and S.B.; data collection, F.A.M.; data curation, M.A.A.J.B. and F.A.M.; formal analysis, M.A.A.J.B.; investigation, F.A.M., M.M.H.K., S.S.I. and M.Z.H.; methodology, M.A.A.J.B. and M.Z.H.; project administration, F.A.M.; resources, F.A.M., M.M.H.K. and S.S.I.; software, M.A.A.J.B.; supervision, M.M.H.K., S.S.I. and M.Z.H.; validation, S.B.; visualization, M.A.A.J.B.; writing—original draft, F.A.M. and M.A.A.J.B.; and writing—review and editing, S.B., M.M.H.K., S.S.I. and M.A.H. All authors have read and agreed to the published version of the manuscript.

Funding

This publication was produced with the support of the United States Agency for International Development (USAID) under the terms of USAID’s Alliance for Combating TB in Bangladesh activity cooperative agreement no. CA # 72038820CA00002. Views expressed herein do not necessarily reflect the views of the U.S. Government or USAID. icddr,b is also grateful to the Government of Bangladesh, Canada, Sweden, and the UK for providing unrestricted/institutional support.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Bangabandhu Sheikh Mujib Medical University (BSMMU) (BSMMU/2021/8366 and date of approval).” for studies involving humans.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Acknowledgments

The study was undertaken as part of the USAID’s Alliance for Combating TB in Bangladesh fel-lowship program. The authors are very much thankful to the National Tuberculosis Control Programme (NTP), USAID, icddr,b and the core donors of icddr,b for their generous support provided during the research project. The authors are also grateful to the authorities of selected upazila health com-plexes, their officials and all the study participants for finding time amidst the threat of COVID-19 pandemic to complete the survey. The authors also thank the Department of Public Health and Informatics (DPHI), Bangabandhu Sheikh Mujib Medical University (BSMMU) for unparalleled support during this research work.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Migliori, G.B.; Thong, P.M.; Akkerman, O.; Alffenaar, J.-W.; Álvarez-Navascués, F.; Assao-Neino, M.M.; Bernard, P.V.; Biala, J.S.; Blanc, F.-X.; Bogorodskaya, E.M. Worldwide effects of coronavirus disease pandemic on tuberculosis services, January–April 2020. Emerg. Infect. Dis. 2020, 26, 2709. [Google Scholar] [CrossRef] [PubMed]
  2. World Health Organization. Second Round of the National Pulse Survey on Continuity of Essential Health Services during the COVID-19 Pandemic: January—March 2021; Interim Report 22 April 2021; World Health Organization: Geneva, Switzerland, 2021; Available online: https://apps.who.int/iris/handle/10665/340937 (accessed on 21 June 2022).
  3. Meneguim, A.; Rebello, L.; Das, M.; Ravi, S.; Mathur, T.; Mankar, S.; Kharate, S.; Tipre, P.; Oswal, V.; Iyer, A. Adapting TB services during the COVID-19 pandemic in Mumbai, India. Int. J. Tuberc. Lung Dis. 2020, 24, 1119–1121. [Google Scholar] [CrossRef]
  4. Furtado, I.; Aguiar, A.; Duarte, R. Getting back on the road towards tuberculosis elimination: Lessons learnt from the COVID-19 pandemic. J. Bras. Pneumol. 2021, 47, e20210123. [Google Scholar] [CrossRef] [PubMed]
  5. Drummond, M. Sleep labs, lung function tests and COVID-19 pandemic–only emergencies allowed! Pulmonology 2020, 26, 244. [Google Scholar] [CrossRef] [PubMed]
  6. Chiang, C.-Y.; Islam, T.; Xu, C.; Chinnayah, T.; Garfin, A.M.C.; Rahevar, K.; Raviglione, M. The impact of COVID-19 and the restoration of tuberculosis services in the Western Pacific Region. Eur. Respir. J. 2020, 56, 2003054. [Google Scholar] [CrossRef]
  7. Hasan, M.J.; Akther, A.; Fardous, J.; Khan, M.A.S. Syndemic of Tuberculosis and COVID-19 in Bangladesh. Asia Pac. J. Public Health 2021, 33, 992–994. [Google Scholar] [CrossRef]
  8. Glaziou, P. Predicted impact of the COVID-19 pandemic on global tuberculosis deaths in 2020. MedRxiv 2020. medRxiv 2020.04.28.20079582. [Google Scholar] [CrossRef]
  9. World Health Organization. Pulse Survey on Continuity of Essential Health Services during the COVID-19 Pandemic: Interim Report; 27 August 2020; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
  10. The Daily Star.COVID Pandemic Worsening Prognosis of Tuberculosis. Available online: https://www.thedailystar.net/country/news/covid-pandemic-worsening-prognosis-tuberculosis-2070829 (accessed on 15 July 2022).
  11. Biswas, M.A.A.J.; Hassan, M.Z.; Monjur, M.R.; Islam, M.S.; Rahman, A.; Akhtar, Z.; Chowdhury, F.; Banu, S.; Homaira, N. Assessment of standard precaution related to infection prevention readiness of healthcare facilities in Bangladesh: Findings from a national cross-sectional survey. Antimicrob. Steward. Healthc. Epidemiol. 2021, 1. [Google Scholar] [CrossRef]
  12. Nazneen, A.; Tarannum, S.; Chowdhury, K.I.A.; Islam, M.T.; Islam, S.H.; Ahmed, S.; Banu, S.; Islam, M.S. Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals. PLoS ONE 2021, 16, e0246923. [Google Scholar] [CrossRef]
  13. USAID. Bangladesh Dashboard. Available online: https://hub.tbdiah.org/dashboards/countries/bangladesh (accessed on 21 June 2022).
  14. iMMAP. iMMAP/DFS COVID-19 Situation Analysis—Part One: Sectoral Analysis. Available online: https://reliefweb.int/report/bangladesh/bangladesh-immapdfs-covid-19-situation-analysis-part-one-sectoral-analysis-may (accessed on 8 June 2022).
  15. Directorate General of Health Services. Real Time Health Information Dashboard. Available online: http://103.247.238.81/webportal/pages/hrm_post_summary.php (accessed on 21 June 2022).
  16. Bangladesh National Portal. Sirajdikhan Upazila. Available online: http://sirajdikhan.munshiganj.gov.bd/en (accessed on 21 June 2022).
  17. Bangladesh National Portal. Kaliganj Upazila. Available online: http://kaliganj.gazipur.gov.bd/en (accessed on 21 June 2022).
  18. Bangladesh National Portal. Savar Upazila. Available online: http://savar.dhaka.gov.bd/en (accessed on 21 June 2022).
  19. Bangladesh National Portal. Singiar Upazila. Available online: http://singiar.manikganj.gov.bd/en (accessed on 21 June 2022).
  20. Bangladesh National Portal. Harirampur Upazila. Available online: http://harirampur.manikganj.gov.bd/en (accessed on 21 June 2022).
  21. Bangladesh National Portal. Rupganj Upazila. Available online: http://rupganj.narayanganj.gov.bd/en (accessed on 21 June 2022).
  22. Moin, S.; Farooqi, J.; Jabeen, K.; Laiq, S.; Zafar, A. Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan. Antimicrob. Resist. Infect. Control. 2020, 9, 1–8. [Google Scholar] [CrossRef]
  23. Rai, D.K.; Kumar, R.; Pandey, S.K. Problems faced by tuberculosis patients during COVID-19 pandemic: Urgent need to intervene. Indian J. Tuberc. 2020, 67, S173. [Google Scholar] [CrossRef] [PubMed]
  24. Razu, S.R.; Yasmin, T.; Arif, T.B.; Islam, M.; Islam, S.M.S.; Gesesew, H.A.; Ward, P. Challenges faced by healthcare professionals during the COVID-19 pandemic: A qualitative inquiry from Bangladesh. Front. Public Health 2021, 2021, 1024. [Google Scholar] [CrossRef] [PubMed]
  25. Zimmer, A.J.; Heitkamp, P.; Malar, J.; Dantas, C.; O’Brien, K.; Pandita, A.; Waite, R.C. Facility-based directly observed therapy (dot) for tuberculosis during COVID-19: A community perspective. J. Clin. Tuberc. Other Mycobact. Dis. 2021, 24, 100248. [Google Scholar] [CrossRef] [PubMed]
  26. Dlangalala, T.; Musekiwa, A.; Brits, A.; Maluleke, K.; Jaya, Z.N.; Kgarosi, K.; Mashamba-Thompson, T. Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review. Diagnostics 2021, 11, 2221. [Google Scholar] [CrossRef]
  27. Rodrigues, I.; Aguiar, A.; Migliori, G.B.; Duarte, R. Impact of the COVID-19 pandemic on tuberculosis services. Pulmonology 2022, 28, 210–219. [Google Scholar] [CrossRef]
  28. Togun, T.; Kampmann, B.; Stoker, N.G.; Lipman, M. Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes. Ann. Clin. Microbiol. Antimicrob. 2020, 19, 1–6. [Google Scholar] [CrossRef]
  29. Soko, R.N.; Burke, R.M.; Feasey, H.R.; Sibande, W.; Nliwasa, M.; Henrion, M.Y.; Khundi, M.; Dodd, P.J.; Ku, C.C.; Kawalazira, G. Effects of coronavirus disease pandemic on tuberculosis notifications, Malawi. Emerg. Infect. Dis. 2021, 27, 1831. [Google Scholar] [CrossRef]
  30. Khanal, M.N.; Sharma, S.; Neupane, B.; Shah, N.P.; Joshi, P.R.; Sharma, B.; Hada, M.; Kandel, S.; Koirala, B.; Adhikari, K.; et al. Rapid Assessment Report; Effect of COVID-19 Pandemic on Tuberculosis Program in Nepal. Available online: https://nepalntp.gov.np/wp-content/uploads/2021/02/Rapid-Assessment-Report-Feb2021.pdf (accessed on 14 July 2022).
  31. Awan, H.A.; Sahito, A.M.; Sukaina, M.; Khatri, G.; Waheed, S.; Sohail, F.; Hasan, M.M. Tuberculosis amidst COVID-19 in Pakistan: A massive threat of overlapping crises for the fragile healthcare systems. Epidemiol. Infect. 2022, 150, e41. [Google Scholar] [CrossRef]
  32. GFATM. Global Fund Survey: Majority of HIV, TB and Malaria Programs Face Disruptions as a Result of COVID-19. 2020. Available online: https://www.theglobalfund.org/en/covid-19/news/2020-06-17-global-fund-survey-majority-of-hiv-tb-and-malaria-programs-face-disruptions-as-aresult-of-covid-19/ (accessed on 1 March 2022).
  33. Sah, R.; Singh, U.; Mainali, R.; Vasquez, N.; Khan, A. Impact of COVID-19 on TB detection in the private sector in Nepal. Int. J. 2021, 25, 777–778. [Google Scholar] [CrossRef]
  34. Thekkur, P.; Tweya, H.; Phiri, S.; Mpunga, J.; Kalua, T.; Kumar, A.M.; Satyanarayana, S.; Shewade, H.D.; Khogali, M.; Zachariah, R. Assessing the impact of COVID-19 on TB and HIV programme services in selected health facilities in Lilongwe, Malawi: Operational research in real time. Trop. Med. Infect. Dis. 2021, 6, 81. [Google Scholar] [CrossRef]
  35. The Daily Star. Govt to Issue Circular on Extending ‘Lockdown’ Till May 23. Available online: https://www.thedailystar.net/coronavirus-deadly-new-threat/news/decision-extend-ongoing-lockdown-likely-tomorrow-2093029 (accessed on 30 September 2022).
  36. The Daily Star. Lockdown: Govt Announces Nationwide Strict Shutdown from Monday for a Week. Available online: https://www.thedailystar.net/frontpage/news/lockdown-2118105 (accessed on 30 September 2022).
  37. Chatterjee, S.; Das, P.; Vassall, A. Impact of COVID-19 restrictive measures on income and health service utilization of tuberculosis patients in India. BMC Infect. Dis. 2022, 22, 711. [Google Scholar] [CrossRef] [PubMed]
  38. Tb Civil Society Organizations. The Impact of COVID-19 on the TB Epidemic: A Community Perspective. 2020. Available online: https://spark.adobe.com/page/xJ7pygvhrIAqW/ (accessed on 1 October 2022).
  39. Fei, H.; Yinyin, X.; Hui, C.; Ni, W.; Xin, D.; Wei, C.; Tao, L.; Shitong, H.; Miaomiao, S.; Mingting, C. The impact of the COVID-19 epidemic on tuberculosis control in China. Lancet Reg. Health West. Pac. 2020, 3, 100032. [Google Scholar] [CrossRef] [PubMed]
  40. National TB Control Program, Pakistan. Resource Center. 2021. Available online: https://ntp.gov.pk/resource-center/ (accessed on 1 October 2022).
  41. Min, J.; Kim, H.W.; Koo, H.-K.; Ko, Y.; Oh, J.Y.; Kim, J.; Yang, J.; Kwon, Y.; Park, Y.-J.; Kang, J.Y. Impact of COVID-19 pandemic on the national PPM tuberculosis control project in Korea: The Korean PPM monitoring database between July 2019 and June 2020. J. Korean Med. Sci. 2020, 35, e388. [Google Scholar] [CrossRef] [PubMed]
  42. Tb Ppm Learning Network. Tb Ppm Covid Tracker. 2020. Available online: https://www.tbppm.org/topics/17342/page/tbppm-covid-tracker (accessed on 1 October 2022).
  43. Ghosh, A. As TB Diagnosis Sees a Fall, States are Now Testing Covid-Negative Patients for the Disease. 2020. Available online: https://theprint.in/health/this-is-how-up-karnataka-gujarat-are-addressing-fall-in-tb-diagnosis-due-to-covid-impact/483463/ (accessed on 1 October 2022).
  44. Xinhua. Indonesia Steps Up Battle against Tuberculosis Amid COVID-19 Pandemic. 2020. Available online: https://www.xinhuanet.com/english/2020-07/21/c_139229561.htm (accessed on 1 October 2022).
  45. Devdiscourse. Provinces experimenting with combining TB and COVID-19 screening. 2020. Available online: https://www.devdiscourse.com/article/health/1197889-provinces-experimenting-with-combining-tb-and-covid-19-screening. (accessed on 1 October 2022).
  46. Directorate General of Health Services. National TB Control Programme: Directorate General of Health Services; Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh; National Strategic Plan for TB Control 2021–2025. Available online: https://www.ntp.gov.bd/wp-content/uploads/2022/03/Clear_FINAL_NSP-Bangladesh-2021-2025.pdf (accessed on 21 June 2022).
Tropicalmed 07 00385 g001 550
Figure 1. Flowchart depicting the data collection survey procedure.
Figure 1. Flowchart depicting the data collection survey procedure.
Tropicalmed 07 00385 g001
Tropicalmed 07 00385 g002 550
Figure 2. Monthly change in service delivery indicators from March 2019 to February 2021, Dhaka division, Bangladesh (A) monthly change in presumptive TB patients and sputum microscopy test (B) monthly change in registered adult PTB cases and patients testing positive by sputum microscopy.
Figure 2. Monthly change in service delivery indicators from March 2019 to February 2021, Dhaka division, Bangladesh (A) monthly change in presumptive TB patients and sputum microscopy test (B) monthly change in registered adult PTB cases and patients testing positive by sputum microscopy.
Tropicalmed 07 00385 g002
Tropicalmed 07 00385 g003 550
Figure 3. Different challenges and causes of dissatisfactions, 2021, Dhaka division, Bangladesh (A) type of challenges experienced by service receivers who received DOTs corner services during COVID-19 (N = 180; multiple responses) and (B) type of causes for dissatisfaction mentioned by service recipients who did not feel satisfied for any of the listed issues (N = 102; multiple responses).
Figure 3. Different challenges and causes of dissatisfactions, 2021, Dhaka division, Bangladesh (A) type of challenges experienced by service receivers who received DOTs corner services during COVID-19 (N = 180; multiple responses) and (B) type of causes for dissatisfaction mentioned by service recipients who did not feel satisfied for any of the listed issues (N = 102; multiple responses).
Tropicalmed 07 00385 g003
Table
Table 1. Demographic data of the study Upazila and Upazila Health Complex, 2021 Bangladesh [15,16,17,18,19,20,21].
Table 1. Demographic data of the study Upazila and Upazila Health Complex, 2021 Bangladesh [15,16,17,18,19,20,21].
Upazilla Demographic Data, 2021Upazila Health Complex Demographic Data, 2021
NameTotal Area in sq. kmTotal
Population		Population
Density
per sq. km		NameNo. of BedsOPD VisitsEmergency VisitsAdmissions
Sirajdikhan180.19288,1071599Sirajdikhan Upazila Complex5095,31513,4793834
Kaliganj271.51239,6601101Kaliganj Upazila Health Complex50106,04210,3266011
Savar280.121,442,8854948Savar Upazila Health Complex50123,71583114351
Singair217.56287,451-Singair Upazila Health Complex5066,81761776687
Harirampur245.42139,318698Harirampur Upazila Health Complex5062,17929392688
Rupganj234.76403,6292291Rupganj Upazila Health Complex5047,74550202463
OPD = outpatient care department; sq. km = square kilometer.
Table
Table 2. Background characteristics of service providers and recipients, 2021, Dhaka division, Bangladesh.
Table 2. Background characteristics of service providers and recipients, 2021, Dhaka division, Bangladesh.
CharacteristicsService RecipientsService Providers
n (%)n (%)
Total180 (100)18 (100)
Age in year
  Mean ± SD43 ± 1739 ± 9.5
Sex
  Male121 (67)15 (83)
Residence
  Urban62 (34)-
  Rural118 (66)-
Type of family
  Nuclear119 (66)-
  Joint61 (34)-
Occupation
  Homemaker43 (24)-
  Daily wager25 (14)-
  Employee23 (13)-
  Laborer22 (12)-
  Business19 (11)-
  Retired20 (11)-
  Other18 (10)-
  Student10 (6)-
Designation
  Laboratory staffs-5 (28)
  TLCA-5 (28)
  Medical officer-4 (22)
  MODC-2 (11)
  DOTs service provider-2 (11)
Experience in working TB control program (months)
  Mean ± SD-8.6 ± 7.6
Persons working in TB control program
  Mean ± SD-3 ± 0.6
Ever infected with COVID-19
  Yes-9 (50)
Days of taking leave due to being infected with COVID-19 (n = 9)
  Mean ± SD-12 ± 4.7
Note: DOTs (Directly Observed Treatment Short-course); MODC (medical officer disease control); SD, (standard deviation); TLCA (Tuberculosis and Leprosy Control Assistant).
Table
Table 3. Comparison of TB service delivery indicators between before and during the COVID-19 pandemic, March 2019 to February 2021, Dhaka division, Bangladesh.
Table 3. Comparison of TB service delivery indicators between before and during the COVID-19 pandemic, March 2019 to February 2021, Dhaka division, Bangladesh.
Service IndicatorsTotal Number% Reduction
Before COVID-19 (19 March–20 February)During COVID-19 (20 March–21 February)
Presumptive TB patients’ notifications30,24420,76131
Sputum microscopy tests30,24419,20436
Patients tested positive by sputum microscopy1929131132
Registered adult PTB cases3677309116
Table
Table 4. Types of reported barriers faced by the service providers in the DOTs clinic while providing service during COVID-19, 2021, Dhaka division, Bangladesh (n = 18).
Table 4. Types of reported barriers faced by the service providers in the DOTs clinic while providing service during COVID-19, 2021, Dhaka division, Bangladesh (n = 18).
Frequency (%)
Faced any challenges during providing services due to COVID-19
  Yes16 (89)
Challenges told by them due to CVOID-19 pandemic * (n = 16)
  Lack of manpower16 (100)
  Increased workload15 (94)
  Interruption in the regular follow-up of the patient10 (63)
  Interruption in the TB diagnosis10 (63)
  Interruption in the drug supply4 (25)
Any adaptation in the DOTs corner due to COVID-19
  Yes18 (100)
Type of adaptation in the DOTs corner * (n = 18)
  Behavioral adaptation17 (94)
  Management of TB patients17 (94)
  TB screening management17 (94)
  TB diagnosis14 (78)
  Follow-up8 (44)
Having any barrier in contact screening performing
  Yes16 (89)
Type of barriers in contact screening told by them * (n = 16)
  Lack of workforce15 (94)
  Lack of patient compliance16 (100)
Any barrier in TB diagnosis due to COVID-19
  Yes16 (89)
Type of barriers in TB diagnosis * (n = 16)
  Interruption in the sample collection16 (100)
  Reduced visits of the patient to the facility due to COVID-19 panic16 (100)
  Interruption in the performing test10 (62)
  Interruption in the report delivery7 (44)
Type of barriers in TB treatment * (n = 16)
  Lack of patient compliance16 (100)
  Reduced number of visits of the patient to the facility due to COVID-19 panic14 (87)
  Co-infection with COVID-199 (56)
Any barrier in TB patients’ follow-up due to COVID-19
  Yes15 (83)
Type of barriers in TB patients’ follow-up * (n = 15)
  Follow-up visit cancellation10 (67)
  Reduced number of visits13 (87)
  Others10 (67)
* Multiple responses.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Mihika, F.A.; Jubayer Biswas, M.A.A.; Khan, M.M.H.; Islam, S.S.; Haque, M.A.; Banu, S.; Hassan, M.Z. The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh. Trop. Med. Infect. Dis. 2022, 7, 385. https://doi.org/10.3390/tropicalmed7110385

AMA Style

Mihika FA, Jubayer Biswas MAA, Khan MMH, Islam SS, Haque MA, Banu S, Hassan MZ. The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh. Tropical Medicine and Infectious Disease. 2022; 7(11):385. https://doi.org/10.3390/tropicalmed7110385

Chicago/Turabian Style

Mihika, Fariha Alam, Md Abdullah Al Jubayer Biswas, Md Maruf Haque Khan, Syed Shariful Islam, M. Atiqul Haque, Sayera Banu, and Md Zakiul Hassan. 2022. "The Effect of the COVID-19 Pandemic on Pulmonary Tuberculosis Control in the Selected Upazila Health Complexes of Dhaka Division, Bangladesh" Tropical Medicine and Infectious Disease 7, no. 11: 385. https://doi.org/10.3390/tropicalmed7110385

Article Metrics

Back to TopTop