Godwin Haruna
23 March 2008
Lagos — The World Health Organisation (WHO) Tuberculosis (TB) Report for 2007 says Nigeria has the fourth largest TB burden in the world and indeed, the largest in Africa.
According to statistics obtained from the Nigerian Institute of Medical Research (NIMR), tuberculosis remains a serious public health problem in Nigeria. An estimated 390,000 Nigerians are infected with active TB yearly and over 107,000 people die from the infections annually. Expectedly, this has placed a huge burden on the shaky public health index in Nigeria.
As World Tuberculosis Day is being marked across the world today, many agencies and development partners working on the control of the deadly disease in Nigeria, say a lot still requires to be deployed to tame the epidemic. With the WHO theme: "I am Stopping TB", individuals are required to work collectively to checkmate the enormous human and material resources lost to the pandemic annually. It commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus.
What really is tuberculosis? Dr. Daniel Gobgab, director, Public Health Programme, Christian Health Association of Nigeria (CHAN) says it is a contagious disease. He adds that like the common cold, it spreads when people cough, sneeze, talk or spit; they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected, Gobgab states. Left untreated, each person with active TB disease will infect on average, between 10 and 15 people every year. He states further that people infected with TB bacilli will not necessarily become sick with the disease. "The immune system 'walls off' the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater", he says.
Dr. Jonah Okesola describes the onset of the disease to THISDAY thus: "When the disease becomes active, 75 per cent of the cases are pulmonary TB. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily"
Okesola says treatment for TB is the use of antibiotics to kill the bacteria. The two antibiotics most commonly used are rifampicin and isoniazid. However, he says instead of the short course of antibiotics typically used to cure other bacterial infections, TB requires much longer periods of treatment (around 6 to 12 months) to entirely eliminate mycobacteria from the body. "Latent TB treatment usually uses a single antibiotic, while active TB disease is best treated with combinations of several antibiotics, to reduce the risk of the bacteria developing antibiotic resistance. People with these latent infections are treated to prevent them from progressing to active TB disease later in life', he adds. However, he says treatment using Rifampin and Pyrazinamide is not risk-free. The Centers for Disease Control and Prevention (CDC) notified healthcare professionals of revised recommendations against the use of rifampin plus pyrazinamide for treatment of latent tuberculosis infection, due to high rates of hospitalization and death from liver injury associated with the combined use of these drugs.
WHO estimates that the largest number of new TB cases in 2005 occurred in the South-East Asia Region, which accounted for 34 percent of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region, at nearly 350 cases per 100 000 population.
It is estimated that 1.6 million deaths resulted from TB in 2005. Both the highest number of deaths and the highest mortality per capita are in the Africa Region. The TB epidemic in Africa grew rapidly during the 1990s, but this growth has been slowing each year, and incidence rates now appear to have stabilized or begun to fall.
In 2005, estimated per capita TB incidence was stable or falling in all six WHO regions. However, the slow decline in incidence rates per capita is offset by population growth. Consequently, the number of new cases arising each year is still increasing globally and in the WHO regions of Africa, the Eastern Mediterranean and South-East Asia.
According to Mr. Ben Nwobi, national coordinator, National Tuberculosis and Leprosy Department of Public Health, Federal Ministry of Health (FMOH), those within 15-35 age brackets are the most vulnerable in the country. Nwobi says the significant impact on the TB epidemic is evidenced by a drift to the younger age groups, who have higher HIV sero-prevalence, which Nigeria ranks second largest in Africa.
He says to address this situation; the FMOH adopted the Directly Observed Treatment Scheme (DOTS) strategy for TB control with the assistance of German Bank for Reconstruction. He adds that by 2000, only 50 per cent of states in the country were implementing the DOTS strategy. The slow pace, he stressed, necessitated the development of a five-year strategic plan for DOTS expansion by the National Tuberculosis and Leprosy Control Programme (NTBCCP) of the ministry of health covering the period 2001-2005.
Nwobi said the plan received the support of the Canadian International Development Agency (CDA) and the United States Agency for International Development (USAID). The 100 per cent coverage is to be achieved for the entire country in consonance with attaining the global target for TB control and to abide by the Federal government policy of giving TB treatment to Nigerian patients free of charge.
Also speaking on the problems of accessing the needed resources to control TB, Mr. David Omorebokhae, director of advocacy, CHAN, said the national budgetary allocation to health has remained at about six per cent of the national budget. This, Omorebokhae says, is a far cry from the WHO recommended minimum allocation to health and Abuja 2001 agreement by 40 African Heads of State to allocate 15 per cent of their annual budget to health.
"This has created a big vacuum in the effort to effectively fund the treatment of TB in the country. It explains the partnership of CHAN, NTBLCP and other foreign organizations in submitting proposals to Global Fund in 2005 to access the Global Fund Round 5 TB Grant worth about $68,000 for five years. The project with CHAN commenced on January 1, 2007 with NTBLCP as a major sub-recipient", Omorebokhae stated.
Also speaking on TB control in the country, Mr. Patrick Kwakfut, secretary general, CHAN, says the Global Fund grant has really scaled up control activities in the country. Before the grant, Kwakfut says the statistics on case detection showed that it stood at 26 per cent, but today, it has increased to 31 per cent.
According to the secretary general, the programme, whose rating by Global Fund stood at B2 by middle of last year, has moved up to B1 by the beginning of 2008. However, he says despite the above increase in TB scorecard of Nigeria, the target for the country is to increase case detection from 26 per cent to 70 per cent.
"We have not reached even 35 per cent case detection. Many Nigerians are still suffering from TB undetected when the services/treatment and drugs are free. This is the challenge before CHAN and NTBLCP and others, who are the major drivers in the process of stopping the onslaught of TB in the country.
"We should not forget that in the projection to treat at least, 85 per cent of detected cases, we have only achieved 79 per cent. We need to improve on logistics and supervision to make Nigeria TB free", Kwakfut says.
According to Mr. Louis James de Viel Castel, President of World Lung Foundation, beyond the proven economic returns, TB control programmes have an obvious impact on each individual's well being and his or her ability to contribute to society in many other positive ways. Better health, he adds, yields many more intangible returns than are capable of being measured.
"The World Lung Foundation strongly urges all governments and public health agencies to make a stronger financial commitment to global TB control, not just because of the proven returns on such an investment but for the improved health and welfare of each citizen whom they serve", Castel said in a published report on the dangerous disease.
Be the first to Write a Comment!
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
