Decades of conflict, uncertainty, and mass population displacement have exacerbated the public health challenges faced by Afghanistan. This is particularly true of Tuberculosis (TB). Despite the availability of diagnostic procedures and drugs, TB continues to be a major public health issue in Afghanistan, which is one of the 22 high-burden countries.

 According to the World Health Organization’s (WHO) Global Tuberculosis Control Report 2008, an estimated 40,000 TB cases occur in Afghanistan every year, with more 8,000 cases resulting in death. According to the latest WHO data published in April 2011 Tuberculosis Deaths in Afghanistan reached 9,349 or 2.55% of total deaths. The age adjusted Death Rate is 63.78 per 100,000 of population ranks Afghanistan 25th in the world.

The World Health Organization is concerned about the declining situation for the detection and control of tuberculosis in Afghanistan. WHO is also concerned about the possibility of further emergence of drug-resistant strains of the disease. Conditions are now ripe not only for spread, but for renewed illness.

Tuberculosis is easily spread from person to person amongst those living in crowded, poorly ventilated conditions. However those who were previously infected, but never ill, are now at further risk. Dormant TB bacilli can spring back to life and cause serious illness when people are especially stressed - for example when they're concerned about adequate food, shelter and warm clothing. Therefore adequate provision of humanitarian relief supplies can help minimize this risk of TB re-infection.

Every year March 24th, is celebrated as “World Tuberculosis Day” designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing the deaths of nearly one-and-a-half million people each year, mostly in developing countries.

The day is commemorated since 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch's announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch's discovery opened the way towards diagnosing and curing TB.

Tuberculosis (TB) is an airborne infectious disease which is caused by strains of mycobacteria, mainly Mycobacterium tuberculosis. There are roughly one third of the world's population are infected with tuberculosis where nine millions of new cases reported annually. Although tuberculosis can be prevented and treated, it continues to cause millions of deaths every year.

When infected individual coughs, sneezes or spits, M. tuberculosis is propelled into the air and infect those who breathe in the bacteria that exist in droplets of saliva. Primarily, tuberculosis will affect the lungs, known as pulmonary tuberculosis. It will also affect other parts of body, for instance lymph nodes, bones, brain and kidneys. Once a person is infected with tuberculosis, there are basically three possible ways that may occur. Firstly, the immune system plays a vital role and is strong enough to kill the bacteria. Secondly, immune system is not strong enough to fight off the bacteria but is able to build a defensive barrier against the bacteria.

 Individuals who are latently infected with M. tuberculosis show asymptomatic where these bacteria lie dormant in the lungs and able to reactivate after years. The disease is often reactivated in those who are immunocompromised or generally weakened. Lastly, the immune system fails to kill bacteria causing the bacteria to grow and spread towards other parts of body which is called active tuberculosis.

Tuberculosis spreads in the following manner:

• The infection spreads by inhalation of droplets expelled by the patient through, sneezing, coughing, yawning, speaking loudly, etc.
• Through direct contact by the patient.
• Inhalation of fine dust containing tubercle bacilli from sputum and discharges thrown on floor, walls, furniture etc.
• By consuming contaminated milk, food product, milk product and unpasteurized milk.
• Infected articles, clothes, utensils, etc. may spread the disease.
• Hereditary transmission of tuberculosis does not occur.
• Sometimes flies play an important role in spreading the disease.

The characteristic symptoms occur slowly. Initially, the patient feels easily exhausted and fatigue doing ordinary work and feels excessive weakness. Loss of appetite, hoarseness of throat, pain in the chest due to infected lungs. The cough secretion is tested for the presence of tubercle bacillus. X-ray film shows the extent of infection in the lungs. Patient sweats profusely at night and feels weak.

Child should be given B.C.G. (Bacillus Calmette Guerine) vaccine by intra dermal injection within the first three months of age.

Following steps need to be undertaken to control the spread of tuberculosis:

• Health and general sanitary conditions of the community should be taken good care of. Every human being should live in fresh air and sunshine. Open space for fresh air should be provided in the streets, markets, buildings etc.
• Workers of cotton and ginning mills, coalmines, tobacco bidi making, etc. should wear protective shield to prevent inhalation of dust or silica dust.
• Pasteurized milk should be supplied and hygienic practices should be followed in preparing milk products and other food items.
• Films, magazines, chart, posters, etc. should be used to educate the general masses about the ill effects of tuberculosis and its preventive measures.
• Government and other voluntary agencies should undertake the tuberculosis eradication project effectively so that the general masses benefit from the program.
• Tuberculosis is curable and should be diagnosed at the earliest so that treatment can be provided before its severity increases.
• Patient should be isolated. Children especially, newly born should not be allowed to go near the patient.
• Nourishing food and living conditions should be improved.
• The disinfestations of clothes, utensils, articles, rooms etc. should be properly ensured.
• Rehabilitations of tuberculosis patient after he has recovered is very important.

In some developing and underdeveloped countries the cause of spread is lower socio-economic status and large overcrowded cities. This is prevalent both in tropical and temperate climate.

The outburst of TB and other similar epidemic diseases can be brought to an end by propagating awareness among masses, making the use of mass media. Nevertheless, the government and international health organizations are liable to curtail this very disease using all the possible means on war footing.

 A required dispensation of satisfactory health services rests among core responsibility of the government –a requisite paired with claims of welfare democratic state, in making.