Although there has been a significant decline in the incidence of TB in the last decade, it continues to be one of the biggest health issues mainly in developing countries. The World Health Organization (WHO) reports show that around 1.5 million people die annually of TB. The main reasons for its continued prevalence is poverty and societies' low awareness about its prevention methods.
World 2024 TB Day for 2024 has been held under the theme 'Yes! We can end TB!' to put across message of hope that getting back-on-track to turn the tide against the TB epidemic is possible through commitment, increased investments and faster uptake of new WHO recommendations. To accelerate progress to end TB, this year's focus has shifted to turning these commitments into tangible actions. Although TB has for a long time been one of the prevalent diseases afflicting Eritrea, the government has, since independence, been working to stop it from being a major health threat. It has established a TB monitoring and control unit under the Communicable Diseases Control Unit.
According to Mrs. Hiwet Nigusse, head of the TB Monitoring and Control Unit, their unit is attempting to stop TB from becoming a public health threat in Eritrea by controlling and monitoring its prevalence. The vision is to reduce the spread and fatality of the disease. The main task of the unit is to change the way the disease is handled -- its diagnosis, its treatment and its strategic prevention methods - and the society's attitude toward the disease.
The prevalence of TB in Eritrea has been steadily decreasing due to the Ministry of Health's (MoH) work in collaboration with other organizations and stakeholders. The prevalence decreased from 2095 in 2015 to 1616 in 2020. And the treatment of more than 93% of those diagnosed with TB in the last five years has been successful.
Prior to 1996, the treatment of people suffering from TB was not efficient because it lasted for two years and there was no monitoring mechanism. After 1996, however, treatment was made efficient with the introduction of the Directly Observed Therapy (DOT) strategy, a treatment that lasts for six months and that includes monitoring and direct observation of the diagnosed person. This has helped prevent instances of patients that stop treatment prematurely.
Another important progress made in dealing with TB is the improvement of the diagnostic mechanism. TB screening, which in the past was limited to big hospitals, is now available at community hospitals and health centers. The types of screening available at healthcare facilities include X-ray, gene expert and culture, and they are given free of charge.
Mrs. Hiwet is concerned that the reduction in the prevalence of TB in Eritrea might cause people to be negligent, and this may result in the spread of the disease. That is why the MoH has established community DOTS promoters to monitor the spread of the disease. The main task of DOTS promoters is to inform the community, to organize sanitation campaigns and to monitor progress of patients under treatment within their community. Community based health service is one of the most effective strategies the MoH promotes to take care of the health of citizens. This approach ensures that people with TB have the best possible treatment, which also helps protect the wider population.
Existing conditions that can increase a person's risk for TB include diabetes, weakened immune system (as in people with HIV/AIDS), being malnourished and tobacco use. Moreover, people who live in densely populated areas, boarding schools and detention and rehabilitation areas are vulnerable to TB. Continuous surveillance and screening are done for those who are at high risk because the presence of even a single person with TB can be deadly for people in the whole environment. Upholding the motto "No one is safe until everyone is safe," the MoH has been fighting against the spread of the disease. It provides treatment to those diagnosed with TB and gives preventive treatment to those who are around them but haven't shown any symptoms.
One of the major challenges being faced is the emergence of drug resistant TB due to patients' behavior, such as using the prescribed medicines inappropriately or stopping their use prematurely. The most frequently occurring type of drug resistant TB is the Multidrug-resistant tuberculosis (MDR-TB), which is caused by bacteria that do not respond to isoniazid and rifampicin, the two most effective first-line TB drugs. TB caused by bacteria that do not respond to the most effective second-line TB drugs can leave patients with very limited treatment options though this is rare in Eritrea.
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While technology is playing a significant role in the diagnosis and treatment of TB, research, both nationally and internationally, is playing a role in improving control and prevention methods. WHO recommends the use of rapid molecular diagnostic test as the initial diagnostic test in all persons with symptoms of TB. Rapid diagnostic tests recommended by WHO include the Xpert MTB/RIF Ultra and Truenat assays. These tests have high diagnostic accuracy that lead to major improvements in the early detection of TB and drug-resistant TB.
Technology has been introduced to facilitate the struggle against TB and to achieve the WHO sustainable development goals in 2030-2035. For the 2020's, the MoH has succeeded in achieving 90% of the goal of identifying and treating the disease, 90% of the goal to reach out groups that are highly exposed to TB, and 90% of the goal of proving full treatment and cure. The MoH is committed to further achieve SDG goals by bringing about 90% reduction in the prevalence of TB by 2030- 2035.
