Ending tuberculosis now is timelier than ever

Ekwi Ajide, CNS Correspondent, Nigeria
Nearly 4500 people die daily from tuberculosis (TB), the world’s deadliest infectious killer, and about 10 million people fall ill with this preventable and curable disease every year, which can infect any part of the body, but, more often than not, attacks the lungs. The symptoms of pulmonary TB include a cough that lasts for more than 2 to 3 weeks, weight loss, fever, night sweats, loss of appetite and coughing up blood, among others.

Experts say that when people with TB cough, sneeze or spit, they propel the germs that cause transmit TB into the air and another person can get infected latently by inhaling only a few of these germs. TB can also affect wild and domestic animals (zoonotic TB), and spread from animals to humans through airborne droplets or through products like undercooked meat, unpasteurised milk and cheese.

Most of the infected people may not develop active TB disease if their immune system can keep the latent TB bacteria under control. In fact, about one-third of the world's population is infected with latent TB. But when someone's immune system is weakened, the chances of becoming sick with TB increase. TB can be cured with medication, and treatment of drug sensitive TB usually takes up to six months. But if left untreated it can take the more serious form of multi drug resistant TB (MDR-TB) and can even become lethal. While the existing BCG vaccine protects children from TB meningitis, there is no known effective vaccine against all forms of TB for all age groups. The impact of TB on children is also enormous as half a million children become ill with TB every year and many more have been orphaned because a parent died of TB.

There has been a 47% decline in TB mortality rate and 42% decline in TB prevalence rate since 1990 and more than 60 million people have been documented as treated and cured since 2000. Nevertheless, worldwide TB is one of the top 10 causes of death. It is also the leading cause of death from a single infectious agent, ranking above HIV/AIDS.

The situation is worse in under developed climes, such as Nigeria, where the masses remain in denial and TB is still associated with witchcraft. Many Nigerians believe that their enemies and/or divine retributions are responsible for this ailment. This lack of awareness is increasing the spread of the disease. No wonder Nigeria is among the 14 high burden countries for TB, TB/HIV co-infection and for MDR-TB. The country ranks 7th among the high TB burden countries globally, while it bears the 2nd highest TB burden in Africa, next to South Africa.

Though treatment of TB is free in Nigeria, many still link the disease to witchcraft, thereby aiding the spread of the disease. According to Dr. Ijeoma Okosa, the burden of the disease in Nigeria is further worsened by the negative effects of the interactions between TB and HIV. HIV increases the risk of TB as people living with HIV (PLHIV) are about 37 times more likely to develop TB than people free of HIV infection. She says that TB is the leading cause of death among people living with HIV in Africa. Furthermore, MDR-TB is negatively impacting TB control efforts in the country.

Dr. Okosa believes that without treatment, the vast majority of people living with HIV who are sick with TB will die within a few months and the drugs can lose their power. According to her, if people do not take all their anti TB medicines regularly and complete the treatment, TB bacilli becomes resistant to the anti TB drugs and they can develop MDR-TB. MDR-TB takes much longer to treat and can only be cured with second-line drugs, which are more expensive and have more severe side effects. Sometimes, extensively drug-resistant TB (XDR-TB) can develop when people cannot or do not take all treatment with these second-line drugs. XDR-TB is very difficult, and sometimes impossible, to cure. Both MDR-TB and XDR-TB can spread directly from one person to another, she cautions.

In the opinion of homeopathic doctor, Professor Peter Katchy, the disease is  deeply rooted in populations where human rights and dignity are limited. “While anyone can contract TB, the disease thrives among people living in poverty, communities and groups that are marginalized, and other vulnerable populations, which include migrants, refugees, the elderly, marginalized women and children living in difficult settings.. Factors such as malnutrition, poor housing and sanitation, compounded by other risk factors such as tobacco and alcohol use affect vulnerability to TB care”, he says.

As per WHO Global TB Report 2018, an estimated 418,000 people in Nigeria got sick with TB in 2017, which includes 58,000 PLHIV co-infected with TB. Also an estimated 155,000 people (120,000 HIV negative people and 35,000 HIV positive people) died from it. It has been said that achieving the reduction in TB incidence rate for attainment of the 90-90-90 target of the END TB strategy will be a mirage, if something drastic is not done urgently.

TB care and control is largely dependent on timely diagnosis and treatment of individuals with the disease in order to cure them and render them non infections; detection of those who are infected with latent TB, and treating them so that they do not develop active TB. Then again, it is also important to immunize the newly borns in TB endemic countries with BCG vaccine. Hence the need for access to adequate and quality healthcare is very pertinent to effective control of TB.

Therefore, all hands must be on deck to involve political leaders and all other stakeholders to get rid of TB for good in Nigeria. If we do not act now, we never will, to deliver on the promise made by our government to end TB by 2030.

Ekwi Ajide, Citizen News Service - CNS
April 2, 2019