… Loses 170,000 out of 570,000 patients
Despite a remarkable reduction of tuberculosis, often referred to as TB, around the world, latest report by the World Health Organization (WHO), has shown Nigeria still retaining its slot as one of the five countries with the highest number of cases, recording no fewer than 170,000 people dying every year out of an estimated 570,000 people living with disease.
The 2015 Global TB report which was released few days ago also indicates that more than half of the world’s TB cases (54%) occurred in China, India, Indonesia, Nigeria and Pakistan with an estimated 3.3% of new cases globally having the more fatal multidrug-resistant TB (MDR-TB), a level that has remained unchanged in recent years. This is even as TB mortality witnesses a 47 per cent global reduction since 1990, with nearly the entire improvement taking place since 2000, when the MDGs were set.
From the report, Nigeria’s disease burden of 322 for every 100,000 more than doubled the global average of 133, with 2.9 per cent of new cases having MDR-TB. The Nigerian tuberculosis situation which is almost the same as the previous year, indicates an increase in death from the disease, from 160,000 in 2013 to 170,000 in 2014, while the people living with TB and HIV slightly increased from 85,000 in 2013 to 100,000 in 2014. The report also indicates gains have been made in terms of treatment in the country, with 86 per cent of new cases registered in 2013 and 80 per cent of HIV-TB cases also registered same year.
However, despite these gains, a Professor of Microbiology and chairman National Committee on Control of Multi-drug Resistant TB, MDR-TB, Oni Idigbe, says TB still remains a health emergency in Nigeria. This is because many TB patients are living in communities with no access to any form of TB care. “Many TB cases are located at the community where poverty level is high and where people believe the myth that it is caused by a witch in the village. Most hospitals in the communities are not equipped with TB care and that is where you have most of the cases. Now some of these communities, not only are they poor, they are hard to reach and healthcare facilities are far away from them. The services are supposed to be available at the primary health centres, PHCs, at the various local government areas but if you see
some of our PHCs, they are not really what you can call a care centre”, he said.
According to Idigbe, TB is 98-99 per cent curable when the right combination of drugs are used and if the patient adheres to treatment, but sometimes, he said, the disease can develop resistance (MDR-TB cases).
“Somewhere along the line, the correct combination of drugs may not be prescribed or the patient is not adhering to treatment. The result of this is that somewhere along the line, the organism (TB bacillus) develops resistance”, he further explained. On solution to the MDR-TB cases, Head of TB research, Nigerian Institute of Medical Research, NIMR, Yaba, Lagos, Dr. Dan Onwujekwu, said MDR-TB cases need to be found out and treated so as to control more spread of TB among the populace.
“Despite governments effort in addressing the issue of MDR-TB treatment, detecting and controlling the spread of MDR-TB is still a major problem. But, we are happy that the second line drugs for the treatment of MDR-TB are currently available at special treatment centres such as Mainland hospital Yaba, University of Port Harcourt Teaching hospital, University College Hospital (UCH), Ibadan and other places. ”
However, he said these drugs are costly and the treatment involves the patient being hospitalized for about 8 months with daily dose of injection.
“Not only is this form of TB expensive, it takes 24 months to treat, 8 months as an inpatient at the facility and 12months as outpatient. It is therefore preferable if TBs are cured with the first line drugs without developing into MDR –TB”,
Dr. Onwujekwu however said there is hope for those with MDR-TB because the drugs and labs for the treatment are available now. He noted that some patients, when diagnosed with MDR-TB do not want to stay the complete eight months on admission or complete the treatment they require to get cured. This he said is one of the challenges facing the control of TB in the country.
Also, a chest physician at Lagos University Teaching Hospital (LUTH), Dr. Cyril Chukwu, explains that many TB cases are still largely undetected because an immune -strong person will not necessarily become sick when infected with TB.
“The TB can stay dormant in the person for years. In this case, the TB becomes latent; meaning that the person has TB but is not yet sick with the disease so cannot transmit it. The bacteria becomes active in cases such as; HIV positive cases, advancing age or some medical conditions which can reduce the persons immunity”, he says.
This year’s TB report indicates that The MDG target to halt and reverse TB incidence has been achieved on a worldwide basis, in each of the six WHO regions and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases. Globally, TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000.
The report describes higher global totals for new TB cases than in previous years, “but these reflect increased and improved national data rather than any increase in the spread of the disease. Despite these advances and despite the fact that nearly all cases can be cured, TB remains one of the world’s biggest threats. In 2014, TB killed 1.5 million people (1.1 million HIV-negative and 0.4 million HIV-positive). The toll comprised 890 000 men, 480 000 women and 140 000 children. TB now ranks alongside HIV as a leading cause of death worldwide.”
By: Franka Osakwe
National Mirror News
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