Nigeria’s response to TB, leprosy

The WHO country representative in Nigeria, Dr Rui Gama Vaz, who was speaking at the just concluded TB day world celebration said that 15% of the three million people undiagnosed for TB around the world were in Nigeria, most of them women and children in slum neighbourhoods where poor ventilation and squalour aids the spread […]

The WHO country representative in Nigeria, Dr Rui Gama Vaz, who was speaking at the just concluded TB day world celebration said that 15% of the three million people undiagnosed for TB around the world were in Nigeria, most of them women and children in slum neighbourhoods where poor ventilation and squalour aids the spread of the disease.
“If you don’t reach those women and children infected, they continue to spread TB in their communities,” said Vaz.
Nigeria has the highest TB burden in Africa, the WHO said in its 2014 Global TB Report.
But according to Dr Gabriel Akang, national coordinator of NTBLCP the saving grace for the management of Tuberculosis or TB, is that it is now categorised with AIDS and Malaria, following the HIV/AIDS pandemic.
TB is an infectious bacterial disease caused by mycobacterium tuberculosis, which most commonly affects the lungs.
It is transmitted from person to person via droplets from the throat and lungs of people with active respiratory disease. Nigeria ranks 11th among the 22 high burden countries that account for 80 percent of the Global TB burden, the World Health Organisation (WHO) in the 2013 Global TB Report estimated that a total of 180,000 TB cases occur annually in Nigeria.
Dr. Akang said a collaborative effort between the three levels of government has ensured that Nigeria effectively combats the disease. Now Nigeria has an estimated four thousand ‘DOT’ centers where TB is managed.
He also explained those with multi-drug resistant TB need not lose hope as government has what it takes to provide second line treatment for TB.  
 He said: “What happens in our DOT centers is that health workers give the patients their drugs and they observe them taking the drugs and the patient makes a daily visit to the clinic so that he can be properly monitored. On the issue of diagnosis, we have what we call ANP microscopy and in hospitals/medical centers as well as health centers in the country, we have where the sputum can be taken for the ANP microscopy test.
 “We’ve had successes with managing multi-drug resistant TB, but with a lot of challenges. But I must tell you that it can be quite challenging for a patient to go through a one year-eight month treatment which includes taking injections for eight months”.
Even then the National Tuberculosis and Leprosy Control Programme launched its first-ever electronic information system to capture and map data on TB and patients diagnosed or being treated for the condition.
The first, e-TB manager, allows health workers keep track of any new patient diagnosed, their treatment and possible side effects to drugs.
The second tool, GxAlert, links with existing GeneXpert machines and cut time for testing and report TB test results by sending same results to patient managers via emails and SMS.
Health minister Khaliru Alhassan, who launched the programmes, spoke of possible installation of more GeneXpert to increase nationwide capacity for diagnosis from the current 98—18 of them donated by the Agbami Partners.
But anti-TB programme contends with difficulty getting people from urban slums with high chances of exposure into TB test and treatment, which are free.
Already, some TB cases resistant to common drugs have emerged, and 922 people with drug-resistant TB have been put on treatment, according to the minister.
Treatment centres for drug-resistant TB patients have grown from one in 2010 to 12 last year and five more could be opened this year, said Alhassan.
Some 15 states have initiated treatment of drug-resistant TB patients in their communities, and the use of e-TB and GxAlert could make tracking them more effective, according to Dr Gabriel Akang.
The strategy, which will involve combing through urban slums, need civil society groups to mobilize residents, but CSOs say they have been left out of TB control programmes and are not experiencing great support from government,” according to Abba-Gana Adam, national coordinator of Civil Society for the Eradication of Tuberculosis in Nigeria.
Leprosy
Recent reports released have shown that Anambra State recorded 14 new cases of leprosy. With an estimated 3800 Nigerians infected with the disease, experts have warned that many more people are suffering in silence as adequate statistics on leprosy cannot be collated due to the high level of discrimination and stigma attached to it.
 They call leprosy the neglected disease, as it is a contagious disease that affects the skin, mucous membranes, and nerves, causing discoloration and lumps on the skin and, in severe cases, disfigurement and deformities. Leprosy is now mainly confined to tropical Africa and Asia.
 In April 2014, stakeholders further warned that the stigma suffered by people affected by leprosy is causing under reporting of new cases among people living with the condition, thereby preventing them from seeking treatment until it is too late.
According to the National Director of the Leprosy Mission-Nigeria (TLM), Dr. Sunday Udo, more Nigerians need to be enlightened that leprosy infection is curable and there is no reason to stigmatise those infected with the disease.
He said: “The last fight against leprosy is the stigma. It is a very deep issue that we need to find a way to break the reign of stigma”.
A further look at the statistics released by TLM showed that Grade-2 disability—the deformities that set in when leprosy is untreated—rose to 14 percent in 2012, up from 12 percent in 2010. Also, the proportion of children affected rose to nine out of every 10.
But the National- Coordinator of the National TB, Leprosy and Buruli Ulcer Control Programme, Dr. Gabriel Akang said: “We are the custodian of the country’s data on leprosy. We are saying that Nigeria was able to meet the target of 1/10,000 cases of leprosy. This is the elimination target. But the fight is not over especially as we have been able to identify cases of child leprosy and this means, we have transmission of the disease going on in some communities.
So we have to get to these communities and start treatment early to cut the spread of infection. We have started our community outreach and we will continue with awareness campaigns so that once people feel the symptoms of leprosy, they will come out for treatment. You might see people whose fingers and toes are already gone, but they have been treated and cured of the disease”.
Speaking on how stigma has led to people not coming out for treatment and the state of treatment centers, he said things were looking up. “Most of the people who have been treated, government tries to settle them in rehabilitation centers. I know that in Edo State, government even provide feeding and give them stipends. But one person sneaked to the road side and by the time he came back, he had more money than what he gets from government. So others joined him on the street to beg.
“In different states, people affected by leprosy have been rehabilitated, some taught skills and even given special shoes but they want to fend for themselves on the streets. Apart from government our partners too have been involved with assisting them”.