Catching up with global TB targets – Punch

With mortality rate still so high and the number of fresh cases soaring, rather than dipping, there seems to be no respite from the destructive impact of tuberculosis in Nigeria.  At the current rate,  there is very little prospect of the country ever meeting the target of 2030 set by both the United Nations Sustainable Development Goal and the World Health Organisation for ending the global TB epidemic.

It may seem a pessimistic view, but it would come as no surprise to those familiar with the country’s health sector; Nigeria has fallen behind in practically every health target set by the global agency, including that for the eradication of the crippling child killing disease, polio. Nigeria remains one of only three countries in the world still actively transmitting the polio virus.

Through its End TB Strategy, the WHO is trying to see if, compared to the situation in 2015, both global TB deaths and incidence (new cases) could be scaled down by a massive 90 per cent and 80 per cent respectively by 2030. This seems like a tall order, considering the fact that the disease is adjudged the ninth leading cause of death globally and the leader among infectious diseases, including HIV/AIDS. In 2016, 1.3 million people died from TB, while 10.4 million fell ill with the disease.

But the prospect for Nigeria looks really disturbing. Fresh facts presented by the WHO indicate that no fewer than 18 Nigerians die every hour as a result of the deadly disease, making it 432 deaths every day. This cannot be permitted for a disease that can both be cured and prevented. “This is not simply statistics behind these figures; they are humans,” said the WHO’s Acting Coordinator, Non-Communicable Diseases Cluster, Linda Ozor.

Unfortunately, in a country where health matters are treated with levity, there may be no relief in sight for those infected. In this year’s budget, the provision for health was not more than four per cent. But the fact remains that anybody could be infected by TB, since the causal organism is usually released into the air through the sneeze, cough or spit of an infected person. This could then be inhaled by anybody within that vicinity. If released in a room, for instance, the microorganism could remain in the air for as long as possible, until blown away by either natural or artificial ventilation.

Nigeria’s health infrastructure is in such a dire state that those who can afford it do not hesitate to fly abroad for treatment for any minor ailment. In fact, the President, Muhammadu Buhari, like his predecessors, is most guilty of this. In 2017, he spent 49 days in the United Kingdom with his spin doctors trying hard to justify his long stay. However, the country needs to find a way to contain TB, a disease caused by bacterial microorganism called Mycobacterium Tuberculosis.

It is not as if nothing is being done to combat the killer disease, it is just that whatever is being done is not far-reaching enough. As far back as June 2006, TB was declared a national emergency in Nigeria and a plan was developed for its control. But two years ago, the Minister of Health, Isaac Adewole, complained about the shortfall in funding TB containment. According to him, of the $228 million needed, the funding gap stood at $155 million.

Yet, while globally, mortality rate and incidence have fallen by three per cent and two per cent respectively, Nigeria is still grappling with the basics of how to detect new cases. It is said that five in every six TB cases in Nigeria are undetected, which poses a serious problem for the treatment and control. Ozor describes such cases as “a pool of reservoir for the continuous transmission of the disease”. She said, “Each undetected TB case has (the) potential of infecting 10 to 15 persons in a year.” This is why efforts should be intensified to discover most of the undetected cases. Aside from helping in the containment of the disease, early detection offers higher chances of cure.

Other areas of difficulty in dealing with TB arise from the emergence of multidrug resistant strains of the bacteria and the growing co-infection in HIV positive patients. Due to the compromised immune system of people living with HIV, they contract TB more easily. Other risk factors include smoking, diabetes and malnutrition. Generally, TB is described as a disease of poverty as it mushrooms in poor and overcrowded areas; it has also emerged as the leading killer of HIV-infected people. “Without proper treatment, 45 per cent of HIV-negative people with TB, on average, and nearly all HIV-positive people with TB will die,” WHO said of the two killers also referred to as the “cursed duet”.

For Nigeria to make a reasonable impact in the fight against TB, there has to be availability of drugs and access to treatment by those who are suffering from TB. The treatment of patients with the right antibiotics for a minimum of six months can render a patient infection-free and halt the spread of the disease. It is advised that whenever symptoms such as the coughing out of blood, chest pains, pain in breathing, fatigue, night sweats, loss of appetite, among others, are noticed, the person should approach a doctor for TB test. Failure to follow strictly the treatment regime could result in a resurgence of drug resistant TB.

According to the WHO, improved basic sanitation and living conditions have led to a decrease in the impact of TB in developed countries. For, instance, if people feed well, their immune system can suppress the development of latent TB into the full-blown disease. The United States Centres for Disease Control and Prevention advises that latent TB should be treated to forestall a graduation to TB.

For effective result, the WHO recommends the Directly Observed Treatment, Short Course strategy, combining five elements of political commitment with increased and sustained funding; case detection through quality-assured bacteriology; standardised treatment with supervision and patient support; effective drug supply and management system; and monitoring and evaluation system and impact measurement. Nigeria stands to gain a lot by adopting the WHO strategy.