Only one in six Tuberculosis (TB) cases in Nigeria is detected raising the need for a national emergency on a disease that kills 250,000 Nigerians yearly, writes ISAAC ANYAOGU.
Today is World Tuberculosis Day, a time set aside to highlight why a disease that killed 250,000 Nigerians out of 1.4million people globally in 2015 require urgent attention.
Tuberculosis is a disease caused by bacteria that are spread through the air from person to person through coughing, sneezing, speaking and singing. If not treated properly, it can be fatal says the United States Centers for Disease Control (CDC).
The World Health Organisation (WHO) says one –third of the world’s population has latent TB and those with compromised immune systems, such as people living with HIV, malnutrition or diabetes or use tobacco have a much higher risk of falling ill. The disease affects the lungs.
March 24 1882, was the day, 39 year old Robert Koch, German physician and microbiologist, announced the discovery of TB Bacillus, as the cause of Tuberculosis in the midst of an epidemic killing one out of every seven people in Europe and America.
But that is not the only debt the world owes Robert Koch. The pioneering microbiologist and Nobel Prize winner in Medicine, discovered the specific causative agents of cholera, and anthrax while improving laboratory technologies, techniques and public health.
Every year since 1997, the World Health Organisation (WHO), with principal funding support from the United States Agency for International Development (USAID), publishes a global TB report to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels.
The report for 2016 which highlights activities in 2015 would have been sufficiently terrifying if the world hasn’t become sated with terrors. 1.4million deaths, 10.4million new cases, and the majority of these in only a handful of countries.
Nigeria as a global concern
Nigeria is currently ranked 4th on the list of countries with the highest cases of tuberculosis worldwide along with India, Indonesia, China, Pakistan and South Africa
Nigeria and India accounted for 48 per cent of global TB deaths among HIV-negative people and for 43 per cent of the combined total TB deaths in HIV-negative and HIV-positive people.
While TB is treatable and curable, many still die from the disease largely because it is not treated on time. Nigeria is among the ten countries that accounted for 77 per cent of the global gap in TB case finding and was responsible for less than 20 per cent of the total TB cases estimated for that year.
80 per cent of TB cases in the country are undetected so a lot of undiagnosed TB cases in the country serve as a reservoir for continued transmission of TB.
On a visit to sensitize the Internally Displaced Peoples (IDPs) on TB prevention methods and conduct free screening in the new Kuchingoro IDP camp on March 20, Adebola Lawanson, national coordinator of National TB and Leprosy Control Programme (NTBLCP) said, “while Nigeria has about 600,000 suspected TB cases, only 100,000 or 1 out 6 come forward to get tested and get treatment.”
Gidado Mustapha, country director of KNCV Nigeria, a non-governmental agency which partners the federal health ministry in TB control, treatment and prevention, added a disturbing dimension when he said at a recent press conference that only 52 % of health workers in Nigeria have knowledge of TB.
Ayodele Awe, WHO medical officer in charge of TB at a conference last year said that Nigeria’s 500,000 detection gap exist because of inadequate facilities and knowledge gap among health workers.
“There is also a coverage gap, how many facilities are actually providing effective TB service in Nigeria? There are still less than 70%, and several health facilities do not have effective TB service,” he said.
Nigeria has over 1,700 points for diagnosis and more than 5,000 points for treatment of the disease but only about 20% of Nigeria’s TB burden gets detected.
In 2014, Nigeria developed a national strategic plan for TB control which it planned to run between 2015 – 2020 to provide citizens with universal access to high-quality, patient-centered prevention, diagnosis and treatment services for TB, TB/HIV and drug-resistant TB by 2020 but the programme has recorded only modest success.
The WHO 10 year strategy (2006-2015) to cut down the burden of TB in the world gained traction in other countries preventing loss millions of lives but this is not the case in Nigeria.
Strides in treatment yield modest results
In 1995, the WHO advocated the use of Directly Observed Treatment Short Course (DOTS) strategy which was designed to ensure that a trained health worker or supervisor provides the prescribed TB drugs and watches the patient swallow every dose. Nigeria adopted the DOTS strategy nationally following the Abuja Declaration in 2001.
DOTS include delivering the prescribed medication, checking for side effects, watching the patient swallow the medication, documenting the visit, counselling and answering patient questions.
In 2006, WHO developed a new six-point Stop TB Strategy which builds on the successes of DOTS with the goal of dramatically reducing the global burden of TB by 2015 in line with the millennium development goals.
Some components of the Stop TB strategy include addressing TB-HIV, Multidrug Resistant to TB (MDR-TB) in vulnerable populations, contribute to health system strengthening based on primary healthcare, engage all care providers, and promoting research.
WHO is currently implementing End TB strategy which aims to end global TB epidemic, with targets to reduce TB deaths by 95%, and to cut new cases by 90% between 2015 and 20135 and to ensure no family is burdened with catastrophic expenses due to TB in with the UN sustainable development goals.
Research and development of new antibiotics to tackle the threat of tuberculosis and build on the success already recorded is now important. Between 2000 and 2015, an estimated 49million lives were saved through TB diagnosis and treatment.
Margaret Chan, director-general of WHO has said that in the past 50 years, only two new antibiotics addressing drug-resistant tuberculosis have made it to the third phase of trials.
This indicates a critical need for more research and development of new antibiotics to tackle diseases especially as over 480,000 people have developed multidrug-resistant TB in the world.
Chan said that these medicines were now being tested on patients to assess efficacy, effectiveness and safety, and would still have to pass the final stage before they could be sold.
“More than US$800 million per year is currently necessary to fund badly needed research into new antibiotics to treat tuberculosis,” said Chan.
According to Chan, drug-resistant tuberculosis, a condition in which the disease causing organism was resistant to at least Isoniazid and Rifampin, the two most effective tuberculosis drugs is a growing threat.
In a country were healthcare is abysmally poor with unmotivated practitioners and a poorly funded sector, regular check-up for large swathes of the population is a rarity. Nigeria requires a radical approach to contain the disease and India may just provide a fine model.
A radical approach
Like Nigeria, India has a disturbing TB rate. The number of new cases every year has risen to 2.8million. However, the country is serious about tackling it by proposing a countrywide scale up of Badequiline and Delamid, drugs meant for people who do not respond to any anti-TB medicine, says The Hindu online.
India also wants to increase active case finding to 100% by 2020. First it is increasing funding to the relevant agencies working to combat TB.
The government is encouraging small businesses to improve drug compliance, incentivising and private doctors to notify cases and providing free medicines to patients, including financial support, rewarding states performing well in controlling TB, and using management information systems to monitor all aspects of TB Control.
India is not waiting for the patient to come to the hospitals, rather it has identified trouble spots and is sending healthcare workers to go after the most vulnerable in shanties and slums, cases that often go undetected.
These actions are also required in Nigeria especially funding. Largely, donor agencies are leading the drive to halt TB in Nigeria whereas the government has devoted less than 5 per cent of the total budget to health. This strategy is not sustainable.
The theme of today’s World TB day is ‘Unite to End TB: Leave no one behind.’ The WHO is placing a special focus on uniting efforts of leave no one behind, including actions to address stigma, discrimination, marginalisation and overcome barriers to access care.
For policy makers and healthcare workers in Nigeria, leaving no one behind has never become more urgent.
(Published in print on March 24, 2017)
