Kakaire A. Kirunda
1 October 2008
opinion
Do you know what tuberculosis is, or what causes it or how you can suspect it is TB? And do you know what to do when you suspect TB?
The questions are many and if the dominant answer to most of the queries is no, perhaps this explains why there is only a 50.2 per cent detection rate of tuberculosis in Uganda, far below the World Health Organization's recommended 70 per cent.
This is happening in the midst of not so good statistics as far as tuberculosis is concerned.
Prevalence of TB infection stands at 600/100,000 people and incidence is 152/100,000 population. The highest affected age group is 20-45 years while the male to female ratio is not so different at 1:1. And the proportion of patients on Community Based-Directly Observed Treatment short course is below 30 per cent.
Yet in order to have a meaningful response to the tuberculosis crisis in the country, new cases need to be detected and successfully treated. Treatment success stands at 69 per cent short of the WHO standard requirement of 85 per cent. And according to the 2008 Global Tuberculosis Control Report, low cure rate and high default rate continue to hinder achievement of treatment success.
So, why is Uganda struggling with her response to tuberculosis, to such an extent that it ranks number 16 in the high burden countries?
Health workers failing to refer suspect cases to laboratories for evaluation, patients delaying to seek care, stigma associated with the diseases, the unfriendly services at public facilities that have made patients resort to traditional healers come to mind.
But Dr Francis Adatu, the manager of the National Tuberculosis and Leprosy Programme at the Ministry of Health, says the big picture is that Uganda just like other high burden countries has a weak Advocacy, Communication and Social Mobilisation (ACSM) component "and that is why we have been very slow in moving towards achieving targets."
He added: "And when it goes to the districts, the situation is even terrible. These Local Governments are simply not budgeting for ACSM activities."
An ACSM strategy involves three distinct sets of activities: advocacy aimed at changing the behaviour of leaders or decision-makers, communication channelled to individuals and small groups, and social mobilisation to secure support for efforts in TB control from civil society and the community as a whole.
At a regional ACSM workshop organised in early September in Kampala by the Eastern Central and Southern Africa Health Community with support from USAID and the Stop TB Partnership, it emerged that success in fighting tuberculosis would largely depend on ACSM.
For instance under funding the national TB programme in Uganda has variously been cited as one of the main barriers to success. However, it was observed that without advocacy, it would be hard to make decision makers put emphasis on tuberculosis.
"Unlike the case with HIV/Aids, there are few partners in the tuberculosis response to play an active advocacy role. Advocacy is needed to influence the decision makers at international level, regional and national levels," noted Dr Adatu during one of the discussions.
And citing the low index of suspicion among health workers of patients who appear with symptoms, the Uganda team noted a lack a communication initiative to educate clinicians on the need to intensify their vigilance.
Ignorance regarding tuberculosis, poor health seeking behaviour for those with symptoms, stigma and non-adherence to treatment, all of which communities can help overcome are thriving due to poor social mobilisation.
The 2008 Global Tuberculosis Control Report calls for a better understanding of how communities are currently involved in TB control to make full use of their potential contribution. "For example, despite the fact that 20 High Burden Countries report community involvement in TB care, little is known about the specific roles or functions for which communities have taken responsibility," reads the report in part.
Realising the importance of ACSM, using anticipated funds from the Global Fund to fight Aids, Tuberculosis and Malaria Uganda is now planning to support advocacy and community mobilisation over the next five years.
The grant proposal indicated that this will be through sensitisation meetings with 2,370 district officials in year 1 and again in year 3, sensitisation meetings with communities, school health talks (71,100 per year), dram shows (938 per year) and through mass media (2,880 radio jingles nationally per year as well as others at district level).
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