8th April, 2011 : By Vicky Wandawa
WHILE it is already too bad that 100,000 Ugandans are contracting tuberculosis (TB) every year, much worse news has set in: A type of TB that is resistant to standard treatment has been spreading in the country and the treatment will cost sh11million per patient, enough to pay university fees for three years.
LIKE a common cold, TB starts with a cough, only that this cough cannot be treated by cough syrups and tablets bought over the counter.
“The cough usually lasts for more than two weeks and the patient produces sputum, sometimes laced with blood,” Henry Luzze, a medical officer at Mulago hospital’s TB unit explains. This could also be followed by excessive sweating at night and general body weakness.
Uganda is among the 22 countries in the world with the highest number of TB cases, with 100,000 new cases annually.
“These 22 countries carry about 80% of the world’s TB burden,” notes Dr. Joseph Kawuma, the executive secretary of Uganda Stop TB partnership.
Tuberculosis is caused by a species of bacteria known as Mycobacterium, which is spread mostly through the air, when an infected person coughs, spits, talks or even breathes around other people. There are other species spread through unboiled milk from infected cows.
Sadly, one cannot avoid the bacteria because they are everywhere. All that can be done to protect people from the virus is immunisation soon after birth. Even then, the immunization does not stop the TB germs from entering into your body. It only prevents the germs from making you sick.
According to the Ministry of Health, two thirds of all Ugandans have the TB germs in their lungs but they are not sick because they were immunised.
However, those with a weak body immunity are at risk of falling sick.
“In a lifetime, you have a 10% chance of contracting tuberculosis through inhalation but for one with HIV, the risk rises to 50%,” Luzze explains.
Meanwhile, Kawuma explains that 6 out of every 10 people with TB have HIV positive, and 3 out of 10 HIV patients have TB. The link between the two diseases is so strong that these days everyone with TB is advised to test for HIV and vise versa.
Besides HIV, Luzze explains that diabetes and malnourishment reduce one’s immunity, hence the risk of contracting tuberculosis is high. Poor ventilation and over exposure to the germs, also increases the chances of contracting TB.
Despite the risk, 10% of children born in Uganda do not receive the tuberculosis vaccine, BCG, which is supposed to be given free, immediately after birth.
Never the less, it is possible for a TB patient to heal completely. Luzze notes that TB requires a minimum of eight months treatment.
The first two months are referred to as the intensive phase of treatment. In Uganda, the treatment is free and can be accessed at all health centre IIIs, at the sub-county level.
However, even with the estimated 100,000 new cases annually, many miss out on the treatment. “There is evidence to show that we are treating barely half of these new cases,” Kawuma notes.
Many do not know they have TB, and do not go to hospital until it becomes worse. Even health workers sometimes take long to suspect that a patient has TB.
“Currently, there are numerous undetected cases of Tuberculosis in Uganda. Since the disease is airborne, wherever these patients breath, those around them are at a high risk of contracting the disease.” Kawuma says.
On average a TB patient can infect 10-15 other people in a year. The consolation is that once treatment has been started, patients cannot infect other people, if the medication is being taken as recommended.
An emerging challenge, however, is that the disease is becoming resistant to drugs. Doctors have noted a rise in the number of patients who do not heal when given the usual drugs.
In developed countries drug resistant TB (DR-TB) patients are being given drugs that are 15 times more expensive than the common ones. In Uganda, however, the drugs that treat DR-TB are not yet available.
The Ministry of Health has now created a coordination office to monitor the resistant strain of TB.
Dr. Samuel Kasozi, the coordinator for the DR-TB programme, says so far, 150 multi-drug resistant TB (MDR-TB) cases, have been detected from January 2008 to March 2011.
“The actual DR-TB burden in Uganda is not known but a survey to ascertain the burden is being carried out. MDR-TB occurs when the TB bacteria become resistant to the two most powerful first line anti-TB drugs,” Kasozi explains.
The emergence of Drug resistant TB is believed to be linked to poor adherence to prescribed TB treatment, social barriers such as stigma, discrimination, poverty, poor Direct Observation of Treatment (DOT) by treatment supporters and non compliance to the guidelines from prescribers partly due to drug stock-outs in some facilities.
The ordinary TB tests available at health centre IIIs cannot tell whether the infection is drug resistant or not. To detect drug resistance, sputum samples have to be tested from the national referral laboratory in Wandegeya, Kampala.
To do this, medics at the health centres seal a patients sputum in a box and send it to Kampala by post. The process is facilitated by the Centre for Disease Control.