TB, the silent killer of women

Pretty Chavango, CNS Correspondent, Zimbabwe
TB, an airborne infectious disease, is the third leading cause of death in women worldwide. In 2013, there were 3.3 million new cases of TB among women and 510,000 deaths. Surprisingly, regardless of this impact on women, little attention is paid to the disease as a women's health issue.

Women are at increased risk of progression to disease during their reproductive years, between the ages of 15 and 44. TB in pregnant women puts them and their babies at risk. It has been associated with a six-fold increase in risk of perinatal death and a doubling of premature birth and low birth-weight. TB increases the risk of HIV transmission from infected mother to child. Moreover some studies show that in pregnant women living with HIV, TB increases the risk of maternal and infant mortality by almost 300%.

In Africa, TB rates are up to 10 times higher in pregnant women living with HIV than in pregnant women without HIV infection.  Facility-based studies in a number of high HIV burden settings found TB accounted for 15-34% of indirect causes of obstetric mortality.  Genital TB, which is challenging to diagnose, has been identified as an important cause of infertility in high TB-incidence settings.

The top three health threats facing the people of Zimbabwe are HIV/AIDS, TB and malaria. Three-fourths of all TB patients are co-infected with HIV/AIDS, a significant contributing factor to the TB caseload. Speaking at the World TB commemorations held last year (2014) Zimbabwean Minister of Health and Child care Dr David Parirenyatwa noted that although the Ministry has adopted an integrated approach to the management of HIV and TB co-infections the area still needs strengthening. “We continue to miss cases because of stigma and lack of awareness in the community and limitations in access to health services as well as the quality of health services”, he said.

According to the Ministry of Health and Child Welfare, cases of multi drug resistant TB (MDR-TB) nearly doubled from 156 in 2011 to 244 cases in 2013. This was despite the fact that notifications for ordinary TB drastically declined from 47,000 in 2010 to 38,367 in 2012.

Joshua Chigodora,  Southern Africa HIV & AIDS Information Dissemination Service (SAFAIDS) Zimbabwe resource centre programme officer while presenting a paper titled "Tuberculosis and HIV --a deadly marriage" said, "The 100-year old TB is now married to the young HIV and the honeymoon is causing a lot of death and misery.”  With the emergence of the multi and extreme-drug resistant strains of TB--both of which are far more challenging to treat than conventional TB-- there is much need to advocate greater awareness of the linkages between TB and HIV. According to the World Health Organisation people living with HIV have been, for instance shown to be twice as likely to have multi-drug resistant tuberculosis (MDR-TB) than HIV uninfected people.

In Zimbabwe women use biomass fuel (mainly comprising wood or forest residue) for cooking, both in urban and rural settings, as a result of erratic electricity supply. Studies show that women who cook with these fuels indoors in very confined spaces increase their chances of developing active TB disease.

Population growth, the HIV epidemic, increasing poverty and rising levels of drug resistance will inevitably increase the burden of this disease in women. Women often delay seeking medical care until the disease is so progressed as to become difficult to treat. They often go undiagnosed for a long time and/or lack access to effective treatment. At times they do not seek treatment even when diagnosed with TB for fear of stigma attached with the disease. The fear and stigma associated with TB have a greater impact on women than on men, often leaving them in a more precarious social and economic position.

TB screening, prevention, and treatment should be made part of HIV, reproductive health, and maternal and child health services. TB control programmes should be sensitive to the constraints faced by women in accessing health care. They must focus to remove barriers to access, reduce delays, and improve the diagnosis and treatment of TB in women. TB and infectious disease advocates and maternal and child health advocates must work better together on a common agenda to eliminate stigma, impact policies and programming, mobilize resources, and ultimately eliminate TB's impact on women.

As we celebrate International Women’s Day this month, as well as World TB Day, much needs to be done to ensure women do not keep losing lives to TB but are able to easily access quality and affordable health care. Awareness programmes should sensitize communities and encourage people to improve their understanding of the disease, share key preventive measures, encourage testing and reduce stigma.

I would like to quote here Paula Fujiwara, Scientific Director and Riitta Dlodlo, Director, Department of Tuberculosis and HIV at the International Union Against Tuberculosis and Lung Disease (the Union)- “We call for a permanent end to the stigma and abuse that women with TB routinely endure on top of the pain and suffering they experience from the disease itself. We call for access to quality TB treatment for all women. We must all recognize TB as an important women’s health issue that demands urgent attention and work together for its elimination.”

Pretty Chavango, Citizen News Service - CNS 
7 March 2015