APRIL 7, 2013 BY EDITORIAL BOARD
IT is alarming that health authorities have yet to effectively address the rising incidence of tuberculosis infection in Nigeria. The emergence of drug-resistant strains of the bacterium that causes the disease and the high incidence of reduced immunity caused by HIV/AIDS are usually quoted for this worrying upsurge. Every year, about nine million people worldwide develop the active disease, which is spread through the air by coughing and sneezing; and one in five will die as a result. Globally, the deadly curable infectious disease kills 1.4 million people annually and costs the world about US$20 billion a year. Stop TB Partnership, a non-profit organisation, cited figures from the World Health Organisation showing that 600,000 people died from tuberculosis in Africa alone in 2011, which was 40 per cent of the world’s total.
Although Nigeria dropped from fourth to 10th among the 22 countries of the world with a high TB burden, the 2012 figure of 97,799 infected persons, which was given last month by the Federal Ministry of Health during this year’s World TB Day, is a wake-up call to the Federal Government — and indeed every Nigerian — to develop an effective antidote to the killer disease. Not only is this figure high, the country is also said to harbour the more deadly multi-drug resistant TB strain, which is not treatable with the first line drugs, with a prevalence of 2,400 people, of which only a paltry 23 are undergoing treatment with the second line drugs. It is said that, although curable and preventable, TB requires a carefully followed regime of medication over a period of six months. Anything less leads to drug-resistant strains. One undiagnosed TB-infected person can infect 10 others in a year.
According to figures from WHO and the United States Embassy in Nigeria, states such as Lagos, Benue, Oyo and Kano have the highest rate of prevalence in the country. While this development is not comforting, the uncommonly high rate of prevalence in the states listed above can be attributed to the high population density in Lagos, Kano and Ibadan, the Oyo State capital. The disease, a bacterial infection of the lungs (Tubercle Bacillus), is easily spread in crowded environments, which are commonplace in those states.
TB in Nigeria is also driven by the high prevalence of people living with the Human Immunodeficiency Virus, with the country having a national HIV prevalence rate of 4.1 per cent. TB, an airborne communicable disease, spreads rapidly among the poor, especially in Africa and Asia. Health expert, Dr. Kevin Kelleher, says, “It is important to be aware of the symptoms of TB, which include fever and night sweats, cough (lasting more than three weeks), weight loss and blood in the sputum (phlegm) at any time.”
TB also successfully attacks “people with weakened immune systems due to disease or medication, people who have been in contact with a case of TB and those who for other reasons may be at high risk, for example, the homeless and intravenous drug users.” According to Akudo Anyanwu-Ikemba, the CEO/Founder of a health advocacy group, the Global Fund Africa, other factors aiding the spread of the disease are “drugs adulteration, patients’ preference for alternative or spiritual treatment and inaccessibility to treatment.”
Nigeria must remedy its current 10th position. The National Tuberculosis and Leprosy Control Programme is making some impact, but this is not enough. A study by Intergender Development Centre, Jos reports that health service providers as well as consumers lack knowledge about TB. It says stigma, discrimination, gender differences and cultural and religious beliefs affect TB control. Accurate diagnosis of the disease remains one of the biggest obstacles to global tuberculosis control. Experts say there are still unanswered medical questions: What is the best way to screen for TB? How can TB programmes best use this valuable new tool for detection and management of drug resistant strains? How can tests be effectively evaluated?
But there are no easy answers. The health authorities need to take a holistic look at the way the disease is being managed, and build upon what is on the ground. Since treatment is, officially, free in the country, sufferers should be encouraged to go for early treatment, while a multi-pronged national awareness campaign should be launched immediately.
The sensitisation campaign should focus on the ways the disease can be prevented: living in houses with well-ventilated rooms; neat environments; and early screening for those suspected to have the TB symptoms. Furthermore, the Federal Government and its partners need a sustained, vigorous enlightenment campaign among those being treated, which is that they must complete their drugs’ regimen that lasts for six months or risk developing the MDRTB, which could take up to two years to treat.
Since our prisons and detention centres are overcrowded and dirty, the Federal Government has to take its campaign to these vulnerable areas. Inmates have to be screened and those infected treated so that they not only avoid infecting their fellow inmates, but when they serve out their terms, and re-join the larger society, they would not infect others. With TB now a public health issue in Nigeria, the federal and state health authorities must move in unison to tackle the scourge, which is said to “pose significant challenges to developing economies as it primarily affects people during their most productive years.”
The enlightenment campaign should be sustained so that Nigerians can be aware that TB can lead to deadly complications for people who are suffering from diseases such as diabetes mellitus, a combination of which health experts see as a “marriage made in hell.” TB is preventable and curable, so, no effort should be spared in significantly reducing the incidence of the disease in Nigeria. We should take a leaf out of the book of Ireland, which had one of the lowest incidences of only 368 infections in 2012 among its citizens. In tackling the dreaded phenomenon, which was discovered by Dr. Robert Koch in 1882 when he announced Tubercle Bacillus as the cause, Ireland instituted a national awareness campaign, and did not relent in taking measures even when the rates of infection had dropped considerably.