Nigeria’s ongoing initiative of a house-to-house search for new cases of tuberculosis marks the beginning of a major offensive against the dreaded disease that should be sustained until it is either wiped out or reduced to the barest minimum. In a country where scant attention is often paid to issues of public health, this survey surely represents a significant paradigm shift.
The objective of the exercise, according to the Programme Coordinator, Association of Reproductive and Family Health, Queen Ladipo, is mainly to identify new cases of TB and immediately place them on treatment. It is also meant to raise greater awareness among Nigerians about the deadly disease. This is central to any programme that is designed to successfully tackle it.
The main advantage of conducting a house-to-house search is that it helps to give a true picture of the burden of TB in the country, unlike in the past when health officials had to wait for patients to report at the hospital. Since it is not likely that everybody suffering from TB will seek medical attention at the hospital – many may not even be aware that they have the disease – it has meant that health authorities gathering information on Nigeria’s TB burden have had to rely purely on projections, which could be quite misleading.
For instance, it is difficult to say with exactitude the number of Nigerians that are living with TB infection. But, generally, the country is said to have the third highest TB burden in the world, next only to India and Indonesia. By virtue of her ranking globally, Nigeria remains the leading country in Africa and one of the 22 notoriously identified by the World Health Organisation as the highest TB burden countries. These countries accounted for 83 per cent of TB cases in the world in 2014, according to TB FACTS.ORG.
Data gathered from the house-to-house search will provide the basis for any information needed about the scope of the disease and the amount of funding that would be required to mount a formidable and sustained challenge against a disease which, according to the Minister of Health, Isaac Adewole, claims an estimated 250,000 lives in Nigeria every year. Another report quoting the Association of Public Health Physicians of Nigeria put the number of Nigerians that have died of TB since 1990 at 4.5 million. For a disease that is curable, the casualty figure is quite alarming.
Reports say preliminary work carried out between January and June in 22 states has already thrown up 50,000 new cases of the disease. It follows that, if thoroughly done, it should not be surprising that, at the end of the day, it would be discovered that there are many more people with the disease than were previously thought. This may also alter Nigeria’s position in the infamous list of highly burdened countries. As Ladipo said recently, the country’s first ever prevalence survey had shown that “Nigeria is three times what the WHO (thought it) used to be.”
TB, a bacterial infection that most often affects peoples’ lungs, is caused by Mycobacterium tuberculosis. Since infection is by mere inhalation of the air contaminated through coughing, spitting and sneezing by an infected person, personal contact is not necessary for infection to occur. Symptoms of TB include fever, night sweat, cough with sputum and sometimes blood, weakness of the body and weight loss. Barring a situation of compromised immunity, only 10 per cent of infected people with latent infection — that cannot transmit the disease because they are yet to fall ill — have a “lifetime risk of falling ill with TB”.
In recent years, TB has emerged as the leading infectious killer disease, according to reports quoting WHO. It has become an epidemic, especially in low income and Third World countries. In fact, USAID says 98 per cent of all TB deaths occur in developing countries. Figures released by the global health authorities indicate that in 2014, TB was responsible for 1.5 million deaths, trumping HIV/AIDS which accounted for 1.2 million deaths the world over.
A deadly alliance between both diseases has also resulted in more fatalities. When there is a co-infection of HIV/AIDS and TB, it increases the possibility of death. TB has been implicated in 25 per cent of AIDS deaths and is “the most common causes of morbidity in people living with HIV and AIDS,” according to a USAID report. In sub-Saharan Africa, it is estimated that 80 per cent of people with active TB are also HIV-positive.
While Nigeria’s TB survey could be considered bold and commendable, it is also pertinent to state that the initiative will come to naught if the health authorities do not build on it by providing the necessary treatment, which can only be reached through government subsidy. Cost of TB treatment is prohibitively high and is not affordable to many of the patients. The government, which is providing the treatment free, also has to ensure that it is accessible.
At the last World Tuberculosis Day, the health authorities blamed Nigeria’s inability to meet the Millennium Development Goal targets of TB on shortfall in funding. Adewole said, “For instance, in 2015, only 32 per cent of the $228 million required was released, leaving a funding gap of $155 million.” He, however, gave an assurance that the anomaly would be corrected as the money has been appropriated in the 2016 budget.
By tackling TB forcefully, the government is actually not doing anybody any favours. TB is a deadly disease that is no respecter of persons. As long as there are cases of the disease in the country, there is a threat to everybody.
