As the world continues to witness significant progress in the United Nations campaign for the global eradication of tuberculosis by 2030, Nigeria remains a miserable straggler among her peers, with little or no hope of meeting the set target. Currently accounting for the highest burden in Africa, the country’s response to the TB epidemic is hobbled by a dysfunctional health care system, which is also poorly funded, massive corruption and increasing cases of drug-resistant strains of the disease.
Without a doubt, Nigeria needs to step up efforts to close the funding gap, increase the level of surveillance and raise awareness among the people so that they can take advantage of all opportunities on offer to roll back the spread of a deadly disease that, fortunately, is not only preventable, but also treatable and curable. It is an irony that a disease that is capable of being controlled has become the leading infectious disease killer globally, claiming about 1.6 million lives annually.
Regrettably, Nigeria contributes handsomely to this repugnant record. Aside from the 407,000 people that are infected with TB every year, it is estimated that 63,000 HIV-positive others come down with the disease yearly, says TB FACTS.ORG. Besides, about 154,000 TB deaths are recorded in the country every year, out of which 39,000 are of HIV-positive persons. Due to the compromised immunity of HIV-infected persons, it is difficult for them to fend off TB infection.
Needless to say, the dangerous mix of HIV and TB turns the situation into a public health crisis. This portends danger to the economic life of the country, as people are forced to spend their disposable income on the treatment of a deadly disease, thus deepening the poverty level. At the same time, the effect of the disease on the labour force impacts negatively on productivity. Although treatment is supposed to be free, access to free treatment does not come easy to many and paying for it could be quite exorbitant.
A bacterial infection that often affects people’s lungs, TB is caused by Mycobacterium tuberculosis. By merely inhaling the air polluted by a sneeze, cough or spit of an infected person, an infection can occur. While everybody, irrespective of age or status, could be infected by TB, children and those with compromised immunity are mostly at risk. Experts say, with the exception of those with compromised immunity, only 10 per cent of infected people have a “lifetime risk of falling ill with TB.” But as many as a third of the global population have latent TB infection that can only be transmitted when a person falls ill.
The crisis in Nigeria is made worse by the prevalence of the drug-resistant strain, which does not respond to first-line TB drugs. This is primarily because patients do not follow through with their medications, particularly when they discontinue because they feel they are better. According to Olukemi Longe-Peters, the Coordinator of the Lagos University Teaching Hospital’s Directly Observed Treatment Short-Course, the Multi-Drug Resistant strain of TB has become very common in the country. Unlike the situation 10 years ago, she said “… now we are seeing fresh cases that have MDR, which means it is spreading.”
In recognition of the global threat, the first ever United Nations High-Level Meeting on TB took place on September 26 last year, where heads of government across the world pledged to fund the treatment. In 2015, the Minister of Health, Isaac Adewole, put the gap at $155 million as against the funding requirement of $228 million. The Country Director (Challenge TB Programme), KNCV, Nsa Bassey, faulted the government’s funding attitude. He lamented, “Government put in about four per cent of 15 per cent supposedly set aside as TB commitment. Partners put in about 60 per cent. That means we have about 64 per cent funding. There are still funding gaps that need to be filled.”
President Muhammadu Buhari, who attended the UNHLM in New York last year, has to go beyond pledges and take concrete steps to ensure that everybody infected with TB has access to a well-funded treatment. Doing so will, however, start with identifying new cases of TB for commencement of treatment. Right now, Nigeria still has a huge gap in terms of detection, let alone treatment.
According to TB FACTS.ORG, only 104,904 cases of TB were detected out of an estimated 407,000, leaving a gap of 302,096. The Minister said, “Our national TB treatment coverage for 2018 was 26 per cent.” Failure to carry out a diligent house-to-house search for new cases would further worsen Nigeria’s situation, especially as the World Health Organisation says that each patient not identified and treated could infect between 10 and 15 persons each year.
Although the country has made some progress by increasing her centres for Directly Observed Treatment Short courses — an internationally recommended, highly efficient and cost-effective strategy for TB control — from 3,931 in 2010 to 6,753 and microscopy centres from 1,148 to 2,650, a lot more still needs to be done to catch up with the rest of the world. The increase in Gene-Xpert coverage, a first line test for TB diagnosis, from 32 in 2012 to 390 in 2017, is still grossly inadequate. Only 26 per cent of our health facilities can treat TB, which is not good enough.
For Nigeria to meet the 2030 WHO and UN Sustainable Development Goals target, the government would have to show sustained political and financial commitment, increase people’s awareness level, carry out a detection campaign, especially in places like the prisons, schools and other places that attract large gatherings. Health facilities need to be upgraded, while the people should endeavour to live in well-ventilated houses under good hygienic conditions.
It is achievable if the will is there. That is how the world was able to save 43 million lives between 2010 and 2014, which exceeded the Millennium Development Goals target.
