Ensuring no one with TB is left behind
Salima, 41, coughed for about two months before she went to the hospital. She had tried fighting it with herbal medicines and drugs from chemists on her own to no avail. As at the time she got to the hospital, she was very weak and her husband and children had started coughing too. She was […]
Salima, 41, coughed for about two months before she went to the hospital. She had tried fighting it with herbal medicines and drugs from chemists on her own to no avail. As at the time she got to the hospital, she was very weak and her husband and children had started coughing too. She was diagnosed with tuberculosis and died two weeks later.
Her husband, Yakubu said they delayed going to the hospital because they were poor and afraid that they may incur bills if they go to the hospital for treatment.
Salima and family are among many Nigerians who are ignorant that treatment for TB is free of charge. They are also part of those who think coughing for more than two weeks is a minor ailment that they can take care of themselves with over- the counter- medicines, self medication and home or herbal remedies.
This has resulted in presentation at hospitals when it is too late or not at all before death.
Persistent cough for two or more weeks could be TB and any affected person should see a healthcare provider, said Dr. Adebola Lawanson , National Coordinator, National Tuberculosis and Leprosy Control Programme of the Federal Ministry of Health. She said diagnosis and treatment including TB drugs are available free of charge in all DOTS centres nationwide and that TB is curable.
She said Nigeria has the highest TB burden in Africa and ranks 4th in the World.
She said the disease is still a public health problem in the country, and the burden is further complicated by HIV/AIDS and emergence of drug resistant TB.
According to Dr. Ezie Patrick C, Deputy Clinical Lead HIV/AIDs and TB of the Daughters of Charity Hospital Abuja, Tuberculosis is spread by droplet infection, meaning that it is contracted when a person infected with TB coughs, or sneezes into the atmosphere.
He said this action releases thousands of mycobacterium into the air, which are easily inhaled by unsuspecting individuals, hence the spread is more effective in overcrowded areas and tight spaces. Outbreaks are fastest in prisons, buses, overcrowded beaches etc.
“The damage caused by this bacteria is gradual and may take weeks to months to multiply and invade the lung and even spread to the rest of the body. This spread is worse in individuals whose immunity is reduced for any reason such as HIV / AIDS, diabetes, individuals on steroids, pregnant women, and children especially under-fives. TB can be found in the vertebra column where it causes what is known as “Gibbus” commonly referred to as hunch back which is seen in lots of children in Africa,” he said.
Why are lots of Nigerians at risk?
Dr. Ezie Patrick C, said generally Nigerians have poor health seeking behavior and only present at hospital when cases have defied all interventions from chemists, herbalists, prayer houses and spiritualists.
He said this is a very troubling development as a person who is not diagnosed timely and referred to commence treatment for TB risks spreading the bacteria to those individuals each time he or she coughs during their interventions.
Dr. Ezie who is also the Secretary, Publicity Committee of the Nigerian Medical Association, Federal Capital Territory said some people above the middle class, erroneously belief they cannot contract the disease.
He said: “A top banker came down with tuberculosis and presented to the clinic, with all the symptoms. On further probe we found out that his driver was diagnosed with TB earlier on and of course, he and his family always ride in a fully air-conditioned car and when the driver coughs, he inoculated the entire family continuously with tuberculosis. Finally the whole family came with TB and had to be managed for TB.”
He said once a TB case was identified, medical experts engage in contact tracing, that is tracking individuals who have come in prolonged contact with the index case. In the case of the banker, it was a disaster because he works in an environment where there were no windows as banks don’t have windows and this resulted in massive infection of his colleagues. This same development can be seen when index cases cough in areas with large congregations like football stadiums, churches and mosques.
Dr Ezie also mentioned the case of a health worker who had been coughing for more than two months, each time he coughed he tried some antibiotics which seemed to relieve the cough and later it would resurface, he has a sputum cultured severally and treated the pathogen identified but still the cough persisted. He continued to manage the cough as he could. Eventually He was rushed to the hospital unconscious and died shortly after, a chest X-ray done revealed Tuberculosis.
According to him, many Nigerians fall into the category of the case above, “when we seek to treat cough by ourselves it’s a very deadly engagement, some may say why? Though TB presents as cough, it’s a very unique type, its test and confirmatory test are unique and cannot be confirmed in laboratories without the proper technology either a gene expert test or a AFB microscopy investigations.
“Secondly treating cough with antibiotics is equally potentially disastrous, as the TB bacillus is a very stubborn bacteria requiring a combination of a minimum of four antibiotics for a duration six months without interruption to achieve a cure. If unfortunately it happens that one of the antibiotics you took is one of the classes of the antibiotics used to treat TB, you have engaged in monotherapy and it will weaken the intervention of the four antibiotics if you are eventually diagnosed with TB and result in the development of what is called Multi Drug Resistant Tuberculosis (MDRTB),” he said.
Nigeria’s misses 500,000 TB cases yearly
National Coordinator, National TB, Leprosy Control Programme, Dr Adebola Lawanson said over 80% of tuberculosis cases in Nigeria are undetected.
Quoting the 2016 Global TB Report, she said, “Nigeria is among the ten countries that accounted for 77% of the global gap in TB case finding. In 2016 Nigeria notified less than 20% of the total TB cases estimated for that year, therefore more than 80% TB cases in the country are undetected.”
She said of the estimated 600,000 cases of TB in the country annually, only about 100,000 were being identified.
Lawanson disclosed this during a sensitization programme for internally displaced persons at the New Kuchingoro Camp in Abuja organized by the programme in collaboration with KNCV Tuberculosis Foundation/ Challenge TB Nigeria and Institute of Human Virology of Nigeria (IHVN ) among others to mark this year’s World Tuberculosis Day.
“From previous research, annually, there are about 600, 000 people living with tuberculosis and we are only able to detect 100,000 persons, this result shows that there are over 500,000 people living with tuberculosis on the field. One case can infect 10 to 15 people, this, calls for immediate attention. The government is concerned and ready to end tuberculosis in Nigeria by finding cases and giving treatment to infected persons,” said Lawanson.
Minister of Health, Prof. Isaac Adewole, last Friday commissioned a GeneXpert rapid diagnostic TB test facility at the Primary Health Care Centre, Kuchigoro.
He said Nigeria would stop at nothing to ensure a country free of tuberculosis by 2035, adding that to make this happen, government was collaborating with all its development partners, to increase awareness and establish more free specialised medical centres, GeneXpert laboratories, which he said had increased from 11 to 318 in a space of six years.
He said: “The issue is not money really, but awareness. If we work together, we will fight tuberculosis, end tuberculosis and make Nigeria proud. The test and treatments are free, join us to fight TB. There is absolutely no reason why anyone with tuberculosis should die.”
It is hoped that the government and all stakeholders would live up to this promise and ensure that factors responsible for missed cases such as ignorance, poverty, poor technology and contact tracking are addressed. The onus is on Nigeria to ensure that no one with TB is left behind.