Nigeria’s Tuberculosis Burden

The nation faces an uphill battle to reach the global targets for tuberculosis

Tuberculosis, better known by its acronym, TB, still constitutes a major health problem in Nigeria. This much was recently brought to the fore by the World Health Organisation (WHO) in its 2016 “Global Tuberculosis Report” which ranked Nigeria fourth behind India, Indonesia and China as one of the six countries which accounted for 60 per cent of the total TB burden. Some 1.8 million people died from TB in 2015, of whom 0.4 million were co-infected with HIV. The report urged the affected countries to “move much faster to prevent, detect, and treat the disease if they are to meet global targets.” It is a call we must heed.

The WHO 10-year strategy (2006-2015) to cut down the burden of TB in the world worked elsewhere as it reportedly saved some 37 million lives while some countries halved the prevalence of the disease. But in Nigeria, the reverse is the case. According to the National TB and Leprosy Control Programme (NTBLCP), over 600,000 new cases of tuberculosis occurred in Nigeria from a global report conducted in 2014. It is even more worrying because substantial numbers of the people infected in the country are unreported or undiagnosed, most of them women and children in neighbourhoods where poor ventilation and squalor abet the spread of the disease. “If you do not reach those women and children infected”, said Dr. Rui Gama Vaz, WHO representative in Nigeria, “they will continue to spread TB in their communities.”

Tuberculosis is perhaps the single leading cause of death from any infectious agent. It is caused by a bacterium which most commonly affects the lungs and transmitted from person to person through air droplets. TB affects all species of vertebrates and though control measures had reportedly limited the spread through animals, they (particularly cattle) still constitute a significant source of risk in countries like Nigeria where meat and milk inspection by health officials are often overlooked. Globally, TB was one of the top causes of death in 2015, responsible for more deaths than HIV and malaria.

However, tuberculosis is a curable disease. But that is dependent on early detection and correct diagnosis aided with proper treatment. Many patients afflicted with TB do not complete the TB therapy and even worse, many do not make themselves available for treatment. Failure to complete the treatment and the mismanagement of drugs had led to the death of many patients and an increase in variants of the disease that are drug-resistant.

Ironically, current efforts are not enough to find, treat and cure people suffering from the ailment even though treatment centres for drug-resistant TB have grown from one in 2010 to 12 in 2014. Some 15 states are said to have initiated treatment of drug-resistant TB patients in their communities. Dr. Gabriel Akang, National Coordinator, NTBLCP said the directly observed treatment short course (DOTS) services are currently provided in about 6000 health facilities in the country, and diagnosis in 1515 microscopy laboratories. DOTS is said to be an efficient and cost effective strategy that consists of physically observing patients as they take the TB medications to ensure treatment compliance.

Unfortunately, all these still fall short of what is expected to contain the epidemic. “We face an uphill battle to reach the global targets for tuberculosis,” said Dr. Margaret Chan, WHO Director General. “There must be a massive scale-up of efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.”

What this means is that the relevant agencies have to put in more effort to achieve the global target of 90 per cent reduction in TB deaths and an 80 per cent reduction in TB cases by 2030. It is, no doubt, an uphill task.

QUOTE: Ironically, current efforts are not enough to find, treat and cure people suffering from the ailment even though treatment centres for drug-resistant TB have grown from one in 2010 to 12 in 2014