Tuberculosis: Time to defeat deaths, concerns around illness

“My wife Asiya suffered from persistent cough and chest pain for about seven months before she died last year,” Hassan, 45, told Daily Trust Saturday. “We initially managed it with home remedies and drugs from pharmacy shops but she continued to grow weak. Later, we went to a clinic and the doctor referred her to […]

“My wife Asiya suffered from persistent cough and chest pain for about seven months before she died last year,” Hassan, 45, told Daily Trust Saturday.

“We initially managed it with home remedies and drugs from pharmacy shops but she continued to grow weak. Later, we went to a clinic and the doctor referred her to the District Hospital and some tests were done. However, she died shortly after test results revealed she had tuberculosis,” he said.

Tuberculosis is an airborne disease caused by a bacteria called mycobacterium tuberculosis, which mainly affects the lungs and other parts of the body.

According to Dr Ezie Patrick C, a physician, tuberculosis also known as TB 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. That is why outbreaks are fastest in prisons, buses, and overcrowded beaches among others.

The physician said the damage caused by this bacterium 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 and AIDS, diabetes, individuals on steroids, pregnant women, and children especially those under five. TB can be found in the vertebra column commonly referred to as hunch back. It has also been found as swellings in the neck, in the ovaries, intestines, and disseminated around the body in forms we refer to as military tuberculosis. However, the TB that affects the lungs is the commonest presentation of the disease,” he added.

Some symptoms of tuberculosis include cough lasting longer than two weeks in normal individuals, and any current cough in People Living with HIV and AIDS, weight loss, night sweats, and persistent fever. These symptoms may be masked by other illnesses and will defy other treatments.

TB is the world’s top infectious disease killer and remains a major public health problem in Nigeria. The country is classified among countries with high burden for TB, TB/HIV and Multi-Resistant Tuberculosis (MDR-TB).

The 2017 WHO Global TB Report shows that the incidence of all forms of TB in Nigeria is 219/100,000 population. This means that for every 1,000 Nigerian, two are likely to have TB.

National Coordinator of the National Tuberculosis and Leprosy Control Programme of the Federal ministry of Health, Dr Adebola Lawanson said Nigeria has the highest TB burden in Africa and ranks 6thglobally. Till date, tuberculosis is estimated to kill 18 Nigerians every hour. Forty-seven Nigerians develop active TB every hour, with seven of them being children.

She said persistent cough for two or more weeks could be TB and any affected person should see a healthcare provider. Dr Lawanson said diagnosis and treatment, including tuberculosis drugs, are available free of charge in all Directly Observed Treatment (DOTS) centres nationwide and that the disease is curable.

As the country joins the rest of the world to commemorate this year’s World TB day today, it behoves on government at all levels, stakeholders, as well as the general public to accelerate efforts in tackling the disease.  This is in line with the theme of this year’s commemoration of the day ‘It’s time to end TB’.

It is time to find and treat every TB case, address all concerns related to the disease and end it for good in Nigeria.

Poor knowledge

Many Nigerians still have poor knowledge about the disease thereby putting lots of them at risk.

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.”

Dr Ezie Patrick C said it is important to see a doctor once you have cough to discern what kind it is. He said that  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.

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.

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

Missed cases

The country urgently needs to tackle the issue of undetected or missed TB cases.

Dr Lawanson said a large number of TB cases are still undetected/missing thereby constituting a pool of continuous transmission of the disease in the community.

“The country contributes 9% to the global 3.6million missing TB cases after India and Indonesia with 26% and 11% respectively. An estimated 418, 000 new TB cases occured in Nigeria in 2018 and the country notified 104, 904 ( 25%) and 106, 533 cases of TB in 2017 and 2018 respectively giving a gap of 314, 712 and 319, 599 cases yet to be notified respectively,” she said.

Minister of Health, Prof Isaac Adewole, said only 2,286 of the estimated 20,000  drug resistant (DR-TB) cases in 2017 were diagnosed with about 17,000 missing DR-TB cases. “I must inform you that the missing TB cases continue to fuel the transmission of the disease in the community, in fact one undetected TB case is able to infect 10 – 15 persons annually,” he added.

There is need to scale up national efforts at detecting all the missing TB cases and achieving the set national and global targets.

Rising drug resistant cases

The increasing pool of drug resistant tuberculosis in the country is a major threat to the country’s efforts in controlling the disease, Dr Lawanson said.

Speaking during the Pre-World TB day media conference organised by USAID, KNCV and other partners in Abuja, she said Nigeria was among the six multi-resistant TB burden countries globally,  and that it is also among the 10 countries that accounted for 75% of the incidence treatment enrolment for drug resistant TB globally.

Babangida Shuaibu, who suffered from the drug resistant TB type, called on the government for more funding and expansion of services for TB. He also  called on government to support sufferers, saying 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.

Gaps in care and financing

Tackling the epidemic requires action to close gaps in care and financing. It is important for government at all levels to improve funding for control of tuberculosis in the country.

Prof Isaac Adewole said that in 2017, only 36% of the total funding required for TB control was available, which is grossly inadequate to make the desired impact.

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

Innovation:

There is also need to take the fight against TB to the next level by harnessing the power of innovation. Some of these innovative approaches include using digital technologies.

Recently, a Dutch company – Delft Imaging Systems, in a statement said the organisation has developed vibrantly coloured mobile clinics powered by the sun that can quickly and efficiently diagnose TB in the remotest areas of the world; and if necessary, enable treatment to be started the very same day. This is a major step in the fight against the disease in the country.

The statement said: “Delft Imaging Systems has developed brightly coloured and solar powered mobile clinics that are self-sufficient and can drive to the remotest areas in the bush, the desert or the countryside in order to screen the local inhabitants for tuberculosis. The cheerful design of the clinics, which don’t suggest they are associated with TB in any way, shape or form, helps make diagnosis and treatment more accessible and acceptable.

“Screening can be conducted in less than a minute thanks to digital X-ray scans and the TB detection software CAD4TB, and no radiologist is required as the software’s artificial intelligence can immediately indicate whether or not the person’s lungs may be infected with TB.  If this is the case, the GeneXpert GXP lab test can provide a definitive diagnosis within two hours. All of these advancements enable the clinics to screen up to 300 people a day anywhere in the world,” the statement said.

Guido Geerts, CEO of Delft Imaging Systems, said “In many places, especially remote areas, TB is a major taboo and because people don’t want to be associated with the disease in any way, they often only see a doctor once they really have to. As a result, these people could be walking around with the illness for months or even years, unwittingly infecting the people around them.

“Our mobile clinics can help to counteract this taboo and diagnose TB anywhere in the world, which will be a major step forwards in our struggle to wipe out TB once and for all.”

The World Health Organization (WHO) has also issued new guidance to improve treatment of multidrug resistant TB (MDR-TB). A statement from WHO headquarters on Tuesday said WHO is recommending shifting to fully oral regimens to treat people with MDR-TB. This new treatment course is more effective and is less likely to provoke adverse side effects. WHO recommends backing up treatment with active monitoring of drug safety and providing counselling support to help patients complete their course of treatment.