THE TUBERCULOSIS BURDEN

The health authorities could do more to contain the scourge

Tuberculosis still constitutes a major public health problem in Nigeria. A new report by the National Tuberculosis and Leprosy Control Programme has simply confirmed that the country has not made any progress in tackling the infectious but curable disease. The report ranked the country fourth with the highest cases of TB in the world, the same position it held in the World Health Organisation (WHO) 2016 “Global Tuberculosis Report.” Nigeria was ranked first in Africa and only came behind India, Indonesia and China in the total TB burden. The new report also said some 80 per cent of TB cases were undetected while some 1.5 million people died from TB annually.

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 was 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 were 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, better known as TB, 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. Indeed, Dr. Adebola Lawanson, National Coodinator of NTBLCPO said that the burden of the disease was often complicated by the drug-resistant TB, the Human Immune Virus and the Acquired Immune Deficiency Syndrome.

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, former 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.