Surviving the ordeal of tuberculosis

Normal treatment should have taken six months, but without supervision, monitoring, and strict compliance to the guidelines for treatment, the infection recurred at the end of five months, Adebambo recalls.Her words, “Unknown to me, my ordeal had just begun, my TB status changed and I suffered a relapse because I was later diagnosed to have […]

Normal treatment should have taken six months, but without supervision, monitoring, and strict compliance to the guidelines for treatment, the infection recurred at the end of five months, Adebambo recalls.
Her words, “Unknown to me, my ordeal had just begun, my TB status changed and I suffered a relapse because I was later diagnosed to have Multi Drug Resistant.
The second line of drugs she needed were not in the country, she recalls, but she didn’t want to wait. She returned to University College Hospital, Ibadan, for a host of drugs “but there wasn’t much improvement.”
Eight years later and surviving what is perhaps her biggest health battle, Adebambo has become a poster child for the tortuous journey with tuberculosis, to emphasise that TB can be cured, if diagnosed early.
Last year’s global report on TB noted 27,000 people died from TB, out of which 190,000 new cases were reported in 2011. Some 97,799 cases were reported last year out of a possible 190,000.
Among more than 81,000 tested for HIV, 26% were positive for TB.
“The burden of TB in Nigeria is further made worse by the challenges of HIV co-infection, Multi Drug-Resistant TB and TB among children,” says Health Minister Prof. Onyebuchi Chukwu.
This worry is also being expressed by one of the Implementing Partners of the Global Fund, Institute of Human Virology in Nigeria (IHVN) whose major function is to address issues of Multi Drug Resistant which is on the rise.
Speaking on the prevalence of MDR TB, the executive secretary of IHVN, Dr Patrick Dakum in an interview with Daily Trust said, “The burden now is estimated at almost 3,000 people living with the multi drug resistant strain of mycobacterium TB. The prevalence among TB cases is about three and five percent, and varies.
“But 3,000 is quite a lot, because right now we have less than 400 people on treatment. The gap is quite wide, and so we are looking forward to getting additional resources to ensure we have additional diagnostic centres.”
 A cocktail of challenges
More cases coming to light are thanks to newer technologies available to screen for TB. Some detection is possible using acid-fast smear, a procedure for which the federal health ministry says it has trained 400 laboratory personnel in 2012. Treatment should almost be immediate, using WHO-recommended DOTS [Direct Observed Therapy Short-Course], lasting six months.
DOTS services are available in 332 centres, commanding the attention of a combined 664 health workers, using first-line drugs as isoniazide, rifampicin, ethambutol and pyrazinamide.
The cocktail of drugs target the Mycobaterium bacilli, which cause TB, when they are still drug-susceptible. But unsupervised regimen, lapses in treatment could encourage the organism to become resistant and there lies the problem: when the TB becomes resistant to either a single drug or a combination of them.
“Treatment for Multi-Drug Resistant TB (MDR-TB) requires more expensive and toxic drugs and may last for 20 months,” said the Nigeria Medical Association.
TB centres use the GeneXpert for rapid diagnosis of susceptible TB as well as TB that has become resistant to rifampicin. So far, 32 such machines are in the country, up from 24 last year.
Chukwu also said that, “Commitment has been received to increase the number to 60 by the end of the year across all the states of the country.”
Drug-resistant TB is a big worry for Nigeria but the centres that actually handle it are few and inadequate to the chagrin of the medical establishment. From 2 centres last March, there are now 8:  University College Hospital, Ibadan; Jericho Chest Hospital, Ibadan; Lawrence Henshaw Hospital, Calabar; University of Port Harcourt Teaching Hospital; National Tuberculosis and Leprosy Programme Training Centre, Zaria; Infectious Diseases Hospital, Kano; and Mainland Hospital, Lagos.
Two more centres-at Federal Medical Centre, Owerri and Nnamdi Azikiwe University Teaching Hospital, Nnewi-set up this March are expected to begin recruiting patients by May.
Only 72 health workers have trained in managing drug-resistant TB, health authorities admit.
Since 2010 when TB treatment started, only 231 persons have been placed on treatment-171 of these persons were put on treatment last year alone.
Federal government approved N297.8 million to buy second-line drugs to treat 500 patients with Multi Drug-Resistant TB last year-the first in history wherein such approval was made since the programme started.
More funding is expected from grants from Global Fund and partners like US Agency for International Development, which sponsors treatment sites in 18 states and recently donated $126,000 worth of microscopy equipment and reagent.
“Not easy”
A survey of Nigeria’s present  prevalence of drug-resistant TB is yet to be released, but an estimated 3000 persons are said to be suffering from it, however this figure is being debated by several agencies who fear the figures might be much more than it is being predicted.
Dakum noted that data collection has always been Nigeria’s greatest handicap, when it comes to evaluating progress or lack of it during monitoring and evaluation.
He expressed hope that in most of the centres sponsored by implementing partners, data collection is top most on the agenda, as according to him that fuels the intervention, and ensure provision of care.
A major problem with drug-resistant TB is keeping to regimen to avoid relapse.
Adebambo battled it for more than a half decade. She had lost 42kg to her illness but in the first-seven month window, she has gained 20kg.
“After I was discharged, I had the challenge of going to the hospital everyday for my drugs. Because I knew where I was coming from and the seven months of my treatment wasn’t easy, I just had to comply. I had to encourage myself,” she remembers.
The 24 months of treatment weren’t easy, she says. “There were side effects. Sometimes I would have tingling sensations, blurred vision, memory loss. After a while, those things thinned out and here I am now.”
Adebambo is now married and expecting a baby, and finally okay.
But she recalls, “It’s quite easier to treat TB than Multi Drug Resistant TB, but the best is to rush to the hospital so that your symptoms can be diagnosed early enough and put on treatmen”t.
“It’s not easy  taking the drugs neither is it easy keeping to the routine, but its better to start the treatment and finish it.
“When you have TB, it is not the end of the world. Life goes on. Just get your treatment and be encouraged. Fine, there can be stigma here and there, but just look at the goal and everything will bow and work out,” she said.