Expanding further on the Previous Post #92. I will be touching briefly on a number of diseases with delayed effects with history of PRIOR EXPOSURE, where personal responsibility of people come into play. 3) Tetanus: Tetanus is an infection characterized by a state of generalized hypertonia that manifests in the form of painful muscle spasms of the jaw and neck.The disease most commonly occurs in those who are not vaccinated or in the elderly with waning immunity. Most common source of infection is a wound that is often trivial and may go unnoticed, such as a minor laceration from wood or metal splinters or thorns. The incubation period can last from one to 60 days but is, on average, around 7 to 10 days. (DELAYED effect) https://www.nhs.uk/conditions/tetanus/ The WHO estimates worldwide tetanus deaths in 1997 at around 275,000 with improved rates in 2011 at 14,132 cases. However, of these cases, the prevalence of tetanus is still disproportionately higher (some studies showing 135 times higher) in low-resource settings than rates in developed countries, with mortality rates of 20% to 45% with the infection. Mortality rates vary based on the availability of resources, notably mechanical ventilation, invasive blood pressure monitoring, and early treatment. https://www.ncbi.nlm.nih.gov/books/NBK459217/ ______ In developed Country US*. Cases reported of Tetanus in 2019 and 2018: ZERO In 2017: 33 In 2016: 34 CDC notes: Today, tetanus is uncommon in the United States, with an average of about 30 reported cases each year. Nearly all cases of tetanus are among people who did not get all the recommended tetanus vaccinations. This includes people who have never received a tetanus vaccine and adults who don’t stay up to date on their 10-year booster shots. https://www.cdc.gov/tetanus/about/index.html In Pakistan*: Cases reported of Tetanus in 2019: 509 In 2018: ZERO. (Not reported likely). In 2017: 478 In 2016: 667 *Source of cases reported: https://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencettetanus.html Reason for disparity: Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries. Various literatures reveal that TT vaccination coverage in Pakistan ranged from 60% to 74% over the last decade. Low vaccination coverage, the main driver for NT in Pakistan, is due to many factors, including demand failure for TT vaccine resulting from inadequate knowledge of TT vaccine among reproductive age females and inadequate information about the benefits of TT provided by health care workers and the media. Other factors linked to low vaccination coverage include residing in rural areas, lack of formal education, poor knowledge about place and time to get vaccinated, and lack of awareness about the importance of vaccination. Tetanus can be prevented by the administration of tetanus toxoid, which induces specific antitoxins. To prevent maternal and neonatal tetanus, appropriate doses of tetanus toxoid need to be given to the mother before or during pregnancy, and clean delivery and cord care practices need to be ensured. http://www.epi.gov.pk/vaccine-preventable-diseases/tetanus/ _________________________________ 4)Tuberculosis: ONSET: Mode of transmission: TB bacteria are spread through the air from one person to another. Latent: Persons with latent TB infection do not feel sick and do not have any symptoms. They are infected with M. tuberculosis, but do not have TB disease. The only sign of TB infection is a positive reaction to the tuberculin skin test or TB blood test. Persons with latent TB infection are not infectious and cannot spread TB infection to others. Overall, without treatment, about 5 to 10% of infected persons will develop TB disease at some time in their lives. About half of those people who develop TB will do so within the first two years of infection. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is considerably higher than for persons with normal immune systems. Persons with TB disease are considered infectious and may spread TB bacteria to others. If TB disease is suspected, persons should be referred for a complete medical evaluation. If it is determined that a person has TB disease, therapy is given to treat it. TB disease is a serious condition and can lead to death if not treated. https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm Trend of Tuberculosis in developed country: UNITED STATES over the years: In 2018, a total of 9,025 TB cases were reported in the United States. This represents a 0.7% decrease from 2017. In 2017, the most recent data available, 515 deaths in the United States were attributed to TB. This is a decrease from 528 deaths attributed to TB in 2016. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm Trend of Tuberculosis in developing country, PAKISTAN: TB is highly epidemic in Pakistan. According to the latest WHO estimations, the incidence, prevalence and mortality of TB in Pakistan are 230 per 100 000, 310 per 100 000 and 39 per 100 000, respectively. This indicates 410 000 incident cases of TB and 69 000 TB deaths in Pakistan every year. Pakistan is the sixth highest TB burden country in the world and by far the largest among the 22 countries of WHO’s Eastern Mediterranean Region. https://www.emro.who.int/emhj-volume-16-2010/volume-16-supplement/article-06.html A total of 369,548 people were notified as having TB in 2018. An estimated 44,000 HIV negative people die from TB disease in Pakistan each year https://tbfacts.org/tb-pakistan/ Incidence of Multidrug-resistant Tuberculosis in Sindh, Pakistan The frequency of MDR-TB patients being treated with first-line ATT was 40.2% (68/169). Among these cases of MDR-TB, there were 36 (53%) men and 32 (47%) women. The growing drug resistance of M. tuberculosis is a problem in Pakistan. Previous TB history, a history of multiple antituberculosis therapy (ATT) courses, prescriptions from multiple clinicians, unsupervised general practitioner management, age <45 years, male gender, immigration from another area with TB endemic/resistant strains, unemployment, and below satisfactory living conditions were associated with an increased risk of developing MDR-TB. Patients with evidence of the failure of the first-line ATT, patients who defaulted appointments, and patients who relapsed during the treatment are also at a high risk of developing MDR-TB. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605965/ Why the discrepancy? 1)Lack of education in Pakistan. 2)Lack of trust in doctors due to limiting beliefs. 3)Patients usually think they know "better" than the doctors and rely on Gharolu totkay or Hakeem. 4)Poor compliance to anti-tuberculous drugs again due to lack of trust at the end of the patients or lack of better counselling by the doctors. **** 5)Poverty, they are compelled to stay along with the patient in the same room because they cannot afford better accomodaton. People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers or schoolmates. 6)Patients failure to comply with doctor's instructions. More on precautionary measures pertaining to tuberculosis. More on this by WHO. Here's is an important survery conducted to access the perception of tuberculosis in Pakistan, in which Around 1817 (73%) respondents said that TB is a contagious disease, 447 (18%) said it is not contagious, and 212 (9%) did not know about contagiousness of TB. The government of Pakistan even launched DOT program in colloboration with WHO. DOT=directly observed therapy where doctors ensure that patients arrive at the clinic and take their medications on time. But poor compliance and failure to abide by the treatment protocol ARE STILL unfortunately HIGH. Nevertheless, the Pakistan National Tuberculosis Programme (NTP) has achieved a remarkable and steady improvement in numbers of TB cases detected, from 11 050 in 2000 to 248 115 in 2008, and treatment success rates reached 91% in 2007. This has been achieved through extraordinary commitment and financial inputs by the Government and health development partners, providing support for strategic and infrastructure improvements by the NTP. The World Health Organization (WHO) Directly Observed Treatment Short-course (DOTS) strategy for TB was adopted and piloted in Pakistan from 1995 onwards, but major progress in TB control was only achieved after the revival of the NTP in 2001 when TB had been declared a national public health emergency through the “Islamabad Declaration”. http://www.emro.who.int/emhj-volume-16-2010/volume-16-supplement/article-06.html I think this one is evident enough and one would understand where responsibility of government, doctors, patients and people come into play. More to come in sha Allah.