Reducing the TB burden in Nigeria

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Presently, the World Health Organisation (WHO) ranks Nigeria as having the highest tuberculosis (TB) prevalence rate in Africa and 11th among the 22 high burden countries in the world that account for 80 per cent of global TB burden with a total of 180,000 cases occurring annually in Nigeria.

The burden of the disease in Nigeria is further worsened by the negative effects of the interactions between TB (an air-borne infectious disease) and HIV, leading to the deaths of 27,000 persons annually. On the link between TB and HIV, Dr Sunday Amosun, a Consultant with the Psychiatric Hospital, Aro, Abeokuta, stated: “Tuberculosis is caused by micro bacteria and it is common among those whose immunity is down; that is why it is common among those who have HIV because what HIV does is to knock out all the immune system.”

Indeed, TB has been variously described as the most common life-threatening disease and the number one killer among ‘people living with HIV’.

Due to the seriousness of the disease, the World Health Organization (WHO) declared tuberculosis (TB), a global emergency in 1993. It remains one of the world’s major causes of illness and death.

In Nigeria, tackling the disease by health authorities to reduce the TB burden in the country, has been a herculean task. Several factors mitigate against curbing the disease, which include unhygienic environment, lack of drugs, stigmatization, poor health facilities among others. While decrying the TB prevalence in the country, the Nigerian Medical Association (NMA), last year in a statement blamed the high rate on the unavailability of drugs and modern treatment facilities to treat the disease in the country.

“It’s due to poor availability of microscopy (smear), culture, drug susceptibility centre and presence of only one national reference laboratory at the national tuberculosis and leprosy control programme headquarters in Kaduna,” it stated.

Statistics show the disease mostly affects those between 25-34 years (36.6 per cent) with Lagos, Kano, Oyo and Benue states being the states with the highest level of infections. Ekiti and Bayelsa States have the least cases of infections.

People with HIV/AIDS are mostly vulnerable to the disease with 26 per cent of them infected with 3.1 per cent of this number infected with the Multi Drug Resistant Tuberculosis (MDR-TB).

The TB burden is compounded by a high prevalence of HIV in the country which stands at about 4.1% in general population.

The prevalence of HIV among TB patients increased from 2.2 per cent in 1991 to 19.1 per cent in 2001 and 25 per cent in 2010. This indicates that the TB situation in the country is HIV-driven.

Benue for instance, has a high TB burden which is attributable to a high HIV prevalence.

Poor hygiene, overcrowding

Many reasons have been adduced by health experts for the high TB rate in Nigeria. Speaking on this, Dr Dan Gadzama, Consultant, Primary Health Board, Abuja, said:

“It is commonly and easily transmitted in overcrowded environment where people have no proper ventilation, poorly ventilated areas. A bacterium causes the disease known as tuberculosis. It is a lung disease just like others. There are infective and non-infective lung diseases. There is asthma, bronchiolitis and others. Tuberculosis is very common and comes about through micro bacteria.

“The commonness symptom is whooping cough; it is common in children and elderly because of their low immunity and people with it tend to sweat quite a lot in the night even when the weather is cold. And then there is also weight loss.

The elderly for instance, their immunity is low and for those in prison too, it is easy for them to contact it because of poor ventilation and overcrowded living conditions.

Symptoms of TB include night sweats, chronic cough, weight loss among others according to Amosun: “If someone also have chronic all night sweat with chronic cough for like three months and within that period loses weight seriously, then he or she has likely contacted tuberculosis. Those are the pointers. At such time, tests must be done immediately.”

To prevent TB, he advises people to avoid, “overcrowded places, stop sharing of utensils, discourage people from coughing and spewing sputum all over the place because the bacteria is normally inside sputum. When it dries up, the wind blows it everywhere. And then someone else may inject it.”

“Many people may actually have contacted it, but it is not active because the body immunity is high.

“Tuberculosis was almost eliminated but because of HIV, it became more common, noted Gadzama, adding: “That is because, HIV enhances tuberculosis; what happens usually is that when someone is infected with tuberculosis, it goes into the system and becomes dormant for sometime. But once immunity is low either due to HIV, malnutrition or cancer, the tuberculosis will then come up strong.”

Presently, despite some efforts being made to curb the disease, there are fears in some quarters that Nigeria is lagging behind in all areas of rolling back the disease and there are doubts that the country will be unable to achieve the goal of 50% reduction in the prevalence and death from TB compared with the 1990 baseline by 2015 and eliminating TB as a public health problem by 2050.”

WHO estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population.

There were an estimated 320,000 prevalent cases of TB in 2010, equivalent to 199/100,000 cases. There were 90,447 TB cases notified in 2010 with 41, 416 (58%) cases as new smear positives, and a case detection rate of 40 per cent.

83% of cases notified in 2009 were successfully treated.

The main goal of Nigeria’s TB program is to halve the TB prevalence and death rates by 2015.

TB death rates have however, declined from 11 percent in 2006 to 5 percent in 2010.

 

Credit: The Nation

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