Examining roles of men in heightening TB cases
By Racheal Abujah The World health Organisation (WHO) observes that Nigeria is one of the countries with the highest TB caseloads globally and number one in Africa. Also, the National Tuberculosis and Leprosy Control Programme (NTBLCP) expresses concerns about the high burden of TB in the country. Worried by this, NTBLCP has declared that “Nigeria […]
By Racheal Abujah
The World health Organisation (WHO) observes that Nigeria is one of the countries with the highest TB caseloads globally and number one in Africa. Also, the National Tuberculosis and Leprosy Control Programme (NTBLCP) expresses concerns about the high burden of TB in the country.
Worried by this, NTBLCP has declared that “Nigeria is sitting on a keg of gunpowder with 440, 000 new infections recorded yearly.”
Medical experts have, therefore, noted that TB cases have been on steady increase and there ought to be a mechanism to check the growth.
Medical statistics released by authorities show that no fewer than 207, 000 new cases of TB were identified in 2021, while there are almost 300,000 unattended cases of TB in the country yearly. The 300,000 cases are alleged not detected or reported and observers note that the carriers could be transmitting the disease to the society.
NTBLCP also cautioned that one un-intervened case of TB has the capacity to affect 25 other people, observing that only 27 per cent of Nigerians know that they have tuberculosis.
Medical sociologist note that TB spread by men is worrisome because of the fear of social stigma in the event of diagnosis that results in being positive. They note further that in some cases, “when married men test positive for TB, they may withhold the information from their family, increasing the rate of its spread.”
Healthcare practitioners Abatan Matthew and Ogunsakin Adesoji posit that in addition to men accounting for more than 60 per cent of those who developed TB, men also accounted for more than 63 per cent of TB deaths.
The National Tuberculosis and Leprosy Control Director, Dr Chukwuma Anyaike, notes that stigma can affect men’s health-seeking behaviour in the country and is a factor that drives the global burden of TB. He said stigma does not only harm the men affected by TB but reduces healthcare workers’ commitment to high-quality healthcare service delivery in the country.
Mr Isah Dogara, 39, a miner from Iowa community, about 35km from Gwagwalada in the Federal Capital Territory, said his belief in traditional medicine made him to infect his wife and late mother with TB because he feared that being diagnosed with the disease would make him vulnerable.
Dogara believed he was cursed when he started coughing and preferred to take traditional medicine.
He failed to recognise that the symptoms were due to TB because he called it an ordinary cough but had suffered from it for more than two years before he reported at the University of Abuja Teaching Hospital Gwagwalada.
According to him, it was after nine appointments with the doctors that he was finally diagnosed with TB.
He, however, said his cousins doubted the diagnosis and advised him to go for higher traditional medication apart from the one he took earlier.
Dogara said that his wife and his late mother became infected, but never showed any symptoms of TB, adding that his mother died from co-morbidity of diabetes and high blood pressure while being treated for TB.
The idea of men being more resilient to illness also appears to be linked to perceptions about illness and severity. Men described a pattern of waiting to see if their condition would improve before they sought care, and only going to formal healthcare when the illness was at an advanced stage.
This was the case of Mr Augustine Ogar, who works with a construction company in Masaka District of Karu LGA, Nasarawa State. He said he started coughing and was not able to sleep at night, and suffered from severe chest pain.
“It is better to do a test to understand the type of sickness you have. Before I did the test, I used to go to private pharmacies and spend a lot of money. I spent up to N80,000. They were treating just the cough, but I didn’t feel better.
“I’m now receiving free treatment through financial support from the Global Fund, at the Institute of Human Virology Nigeria (IHVN) in collaboration with the Leprosy Mission of Nigeria.
Buttressing this claim, Mrs Ekezie Eugenia, a focal person for drug resistance persons in Imo State, stressed there were differences in men’s health-seeking behaviour.
“Men have a higher prevalence of undiagnosed TB than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment.
“Health workers find it difficult to enroll men in treatment once they were diagnosed, even once some had enrolled, they would later abscond.
She said that men always complain about the duration of treatment and they easily believed that TB was not caused by bacteria, but poisoning and witchcraft.
“The consequence of men delaying seeking medical care, or keeping information from health workers, can be dire. This is the number one problem that leads them to miss the early warning signs of a more serious condition like TB, especially when it comes to ‘silent symptoms,” Eugenia stated.
Dr Akyala Ishaku, Senior Lecturer in the Department of Microbiology at Nasarawa State University, said that men who were diagnosed with TB at an early stage had a much better prognosis than those who show up too late to health facilities.
Ishaku stressed that first trying traditional healing also prevented many men from accessing health care facilities too.
On the other hand, some health experts believed that in terms of healthcare, women and children were given special treatment, while men are left out.
They believed that without the inclusion of men and boys in healthcare programmes, as well as greater recognition of how gender, a lack of awareness and poverty intersect to prevent diagnosis and treatment of TB, efforts to end this deadly disease will continue to be hindered.
Addressing the issue of why men became the biggest TB casualties in the country, the national director of NTBLCP, said they were mostly the breadwinners with the attendant exposure to environmental hazards that favoured TB infection. Anyaike added that “excessive stress, with probable under-nutrition, give room to TB infection”.
The director said creating awareness and improved laboratory networks encouraged health-seeking behaviour among men, thereby showing improved case detection.
(NANFeatures)