The high incidence of tuberculosis-related deaths reported in Nigeria yearly makes it mandatory for an urgent and rigorous response by the government to contain the spread of the disease. There is hardly anybody who values human life that would not wince at the news that nearly 250,000 lives are lost in the country every year to the deadly disease. Yet, it is preventable and, with the right medical intervention, curable.
While joining the rest of the world to mark this year’s World TB Day on March 24, Isaac Adewole, the Minister of Health, rightly described the disease as an epidemic, not only because of the deaths it causes in Nigeria but the threat it poses to the entire world. The country is adjudged to have the third highest TB burden globally, next only to India and Indonesia. The minister has to go beyond mere platitudes to take concrete actions.
As usual, at the root of Nigeria’s poor showing is the lack of commitment by the government to funding the programme of detection and treatment of TB. The same attitude of indifference that has hampered the fight against the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome has also been transferred to the TB containment, allowing the disease to take advantage of the disinterest to flourish in Nigeria even when the incidence globally has witnessed a drastic decline over the past 15 years.
Adewole, a professor of gynaecology and obstetrics, put the funding gap at $155 million out of the $228 million needed to tackle TB last year. Doubtlessly, this has affected the number of people undergoing treatment, as corroborated by the National Coordinator, National Tuberculosis and Leprosy Control Programme, Gabriel Akang, who was quoted as saying that only about 91,354 cases were on treatment in 2014. This lack of sufficient interest in public health issues constitutes a trend that should be reversed in the overall interest of the country, not forgetting that, as a communicable disease, TB can be easily passed on from one person to another, regardless of age or status.
It is not surprising that TB has struck a deadly alliance with HIV/AIDS, unleashing a mutually destructive force that claims lives in millions; each speeding the progress of the other. According to the World Health Organisation, people living with HIV/AIDS are more susceptible to TB infection because of the compromised state of their immune system. Other risk factors include smoking, diabetes and malnutrition. But TB remains 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.”
Globally, TB has emerged as the leading infectious disease killer, according to a report quoting WHO. In 2014, TB was responsible for the deaths of 1.5 million people, topping HIV/AIDS, the hitherto unchallenged leader, which accounted for another colossal 1.2 million deaths. About 9.6 million people worldwide became sick with TB the same year.
However, due to concerted efforts by countries to meet their Millennium Development Goals target, the world was able to save an estimated 43 million lives between 2000 and 2014. But while the world met the MDG target of halting and reversing the TB epidemic by 2015, Nigeria only climbed to third position among the 22 countries with the highest prevalence of the disease in the world. This calls for urgent government measures to buck the trend.
TB, a bacterial infection that most often affects people’s lungs, is caused by Mycobacterium tuberculosis. Personal contact is not necessary for infection to occur, as merely inhaling the air polluted by the sneeze, cough or spit of an infected person is enough. It is estimated that a third of the global population has latent TB infection but cannot transmit it because they are yet to fall ill. 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.”
The disease affects people of all ages and the symptoms include cough with sputum and at times blood, fever, night sweats, weakness and weight loss. However, with the right medical attention, TB patients are being treated and the infection cured. But the treatment has to be properly monitored and the medication strictly followed. Failure to follow strict medication – especially when patients discontinue treatment because they feel better or a wrong treatment regime is prescribed or the supply of drugs is unreliable – could lead to a drug resistant strain, which poses greater challenges both to the patients and the medical personnel.
In Nigeria, due to stigmatisation, many people with TB do not come out openly to seek treatment; and for those who do, lack of resources to pay for the treatment, which could be prohibitive, discourages them. The government has a duty to enlighten the people about the need to seek treatment at properly designated places.
It is for this reason that WHO recommends the Directly Observed Treatment, Short Course strategy. The strategy combines 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. Although the government has ensured the expansion of DOTS to all the states of the federation and established 969 TB microscopy centres in 494 local government areas, according to the National Strategy Plan for TB and Leprosy Control, these have to be made to work to reduce the incidence of infection and death.
WHO, in its World Tuberculosis Day celebration, chose “Unite to End TB” as its theme. The DOTS strategy, as attested to by experts, has produced cure rates of up to 95 per cent, even in very poor countries. Besides, the way it is structured, it cannot succeed without government backing, no matter the role of the international partners. Nigeria has to key into the global vision of ending TB by 2030, which is also a component of the Global Goals of Sustainable Development. Early detection and treatment are paramount, given the WHO position that each patient not properly handled could infect between 10 and 15 people in one year.
