Tuberculosis: Every cough, two weeks old, raises a red flag

When Moses, 40, began coughing last year, he thought it was just an ordinary cough that does not require going to the hospital. As weeks turned to months, his friends and family members recommended herbs, sweets and medicines, and the cough kept coming on and off, until he fell unconscious one day and was rushed […]

When Moses, 40, began coughing last year, he thought it was just an ordinary cough that does not require going to the hospital.

As weeks turned to months, his friends and family members recommended herbs, sweets and medicines, and the cough kept coming on and off, until he fell unconscious one day and was rushed to the hospital. He eventually lost his battle with the disease.

Babangida Shuaibu, 37, began to cough a few months after taking care of his younger brother Kabiru who suffered from tuberculosis at home. The father of three from Zamfara State said he immediately suspected the disease and kept a distance from his wife and children, and within a week he went to the hospital and commenced treatment. 

He took all the drugs prescribed during his 20-month treatment, which commenced in 2015 because he had the resistant type. Shuaibu said he was grateful to be alive today because he later lost his brother to the disease and witnessed the death of six persons while he was on admission.

 “I remember one man that died told us he sought treatment in a prayer house till it got worse. With the high level of tuberculosis I had, it was early treatment and care of the doctors that helped me. They give us medicines free. The treatment depends on your level of TB. Some of my colleagues were treated for six months. In my case I had one injection every day for eight months, that is 120 injections in all, sometimes on the lap, bottom, hand and even the head,” Shuaibu said.

While calling on government to support sufferers, he said some of those with high level of TB become a shadow of their former selves after treatment, and need to be empowered to take care of themselves and their families. 

Thirty-one-year old Elizabeth Oluwadare was first diagnosed of tuberculosis when she was 17 years old. She received treatment and stopped.  The disease resurfaced again when she had her first child in 2007. She abandoned her treatment regimen until the disease resurfaced last year, 11 years after.  She said it is important to follow prescribed treatments even when one felt better.

John Adeleke is a student of one of the private universities in the country, his bunkmate, had a chronic cough, and before long he started to cough too and came back to Abuja. He went to some health facilities but was mis-diagnosed for pneumonia.

He was given antibiotics that weren’t specific to tuberculosis and the case worsened. However, he finally went to a hospital where the Directly Observed Treatment (DOT) centre diagnosed that he had tuberculosis, placed him on medications, and his health improved and he went back to school.

Medical experts say persistent cough for two or more weeks could be tuberculosis and that people affected should see a healthcare provider.

Tuberculosis also known as TB still kills more people than any other infectious disease, and is the leading killer of people with HIV, according to the World Health Organization (WHO). It is an airborne disease that affects the lungs mainly and other parts of the body.

Dr. Ezie Patrick C, a physician and Publicity Secretary Nigerian Medical Association Federal Capital Territory (FCT) chapter, said tuberculosis is spread by droplet infection, meaning that it is contracted when a person infected with TB coughs, or sneezes into the atmosphere. 

“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; that is why outbreaks are fastest in prisons, buses, and overcrowded beaches, among others. One individual is enough to infected hundreds of people daily,” he said.

Dr Ezie said the damage caused by these bacteria is gradual and may take weeks or 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. 

Why are lots of Nigerians at risk of TB?

Dr Josephine Okechukwu, coordinator, Federal Capital Territory (FCT) Tuberculosis and Leprosy Control Programme said that only about 15 percent of people in Nigeria know the signs and symptoms of tuberculosis, meaning about 85 percent do not.  

She said to many Nigerians, coughing is normal, stressing that “Every cough is suspicious because there is something going on in the respiratory tract that irritates the system to create that cough. If someone has a cough that has lasted well over a week, he should go to the hospital and get tested for TB. Testing and treatment is free, everything we do about TB is free,” she advised.

Dr Ezie said Nigerians generally have poor health seeking behavior and only present at hospital when cases have defied all interventions from chemists, herbalists, prayer houses and spiritualists. This is a very troubling development, he said a person who is not diagnosed timely and referred to commence treatment risks spreading the bacteria to people each time he or she coughs, especially in crowded or overpopulated areas. 

He said it is not advisable to treat cough yourself  because though tuberculosis presents as cough, it is a unique cough and its tests and confirmatory test could not be confirmed in laboratories without proper technology either gene expert test or AFB microscopy investigations. “So it is important to see a doctor once you have cough to discern what kind of cough it is.”

Dr Ayodele Awe of the World Health Organization  (WHO) Nigeria office, and Chairman 2018 World TB Day Planning Committee explained that the gene expert machine is a revolutionized molecular diagnosis  machine that can diagnose tuberculosis with precision in 110 minutes, “ When the sputum is collected and put in the machines, within 110 minutes you get the result ,” he said.

According to Dr Ezie Patrick, some of the following ways to prevent tuberculosis are:

Cough Etiquettes: The current cough etiquette advocates that coughing individuals should not use handkerchiefs. Tissues are recommended as they are used and discarded. “The correct coughing etiquette is to cough into a tissue which is promptly discarded or the inside surface of your arms. This is because the bacteria that causes TB is very reactive to sunlight and is rapidly destroyed in a matter of minutes when exposed to sunlight,” said Dr Patrick.

– Immediate and prompt referral of anyone with chronic cough or cough lasting longer than two weeks.

– Ensuring that your houses are not overcrowded and that adequate sunlight and cross ventilation are allowed into the environment.

– Ensuring vaccination of all children with Bacillus Calmette-Guerin (BCG) vaccine at birth. However, it is important to note that BCG does not prevent children from acquiring TB, it just prevents them from acquiring the malevolent forms of TB.

– Avoid self-medication; promptly see your physician for management of chronic cough.

-Avoid unnecessary use of steroids except when prescribed by a physician.

– Individuals with chronic illnesses such as diabetes, cancer and HIV should present to their physician on the occasion of any current cough.

Missing cases

Many TB cases in the country are not detected. The National coordinator of the National Tuberculosis and Leprosy Control Programme of the Federal Ministry of Health, Dr. Adebola Lawanson, said that in 2017 Nigeria notified a total of 104, 904 TB cases which is 26%  of the estimated 407, 000 TB cases in the country in the same year. 

“This huge gap in TB case filing is much higher among children aged zero to 14 with a child proportion of 7% for 2017,” she said while briefing newsmen ahead of the World TB Day organized by the Stop TB Nigeria Partnership and KNCV/Challenge TB in Abuja.

Where can you access treatment for TB?

The first thing is to present yourself at a hospital where referral could be made if need be. 

Also, the National Tuberculosis and Leprosy Control Programme said members of the public can call this toll free number for directives 08002255282 on closest TB treatment centre nearest to them. 

In the FCT, Dr Okechukwu said the University Teaching Hospital Gwagwalada, National Hospital Abuja and all the general hospitals have centres for TB treatment.  

Drug resistance

Some tuberculosis are resistant to drugs. 

Dr. Vivian Ibeziako, Programme Manager Drug Resistant TB, Institute of Human Virology Nigeria (IHVN) said the organization has diagnosed about four per cent of  drug resistant TB in Nigeria, adding that no fewer than 1000 drug resistant TB were detected in 2017.

She urged government, partners and other key stakeholders at all levels to scale-up commitment and services for drug resistant tuberculosis detection in Nigeria.

Sixty patients are being managed with multi-drug resistant tuberculosis in FCT, according to the FCT TB and Leprosy Control Programme.

Stigma

Mrs. Itowo Uko, Head advocacy committee of the social mobilization unit of the National Tuberculosis and Leprosy Control Programme of the Federal Ministry of Health advised people to stop stigmatizing people who have suffered or are suffering from tuberculosis.

Babagana Adams, national coordinator of the Civil Society for the Eradication of Tuberculosis in Nigeria network called on the federal government to increase funding, saying that donors majorly fund it presently.