The World Health Organisation (WHO) observes that Nigeria is one of the countries with the highest TB caseloads globally and number one in Africa.
Also, the National Tuberculosis and Leprosy Control Programme (NTBLCP) expressed concerns about the high burden of TB in the country.
Worried by this, NTBLCP has declared that Nigeria is sitting on a keg of gunpowder with 440, 000 new infections recorded yearly.
Medical experts have, therefore, noted that TB cases have been on steady increase and there ought to be a mechanism to check the growth.
Fearful statistics
Statistics released by authorities show that no fewer than 207, 000 new cases of TB were identified in 2021, while there are almost 300, 000 unattended cases of TB in the country yearly.
These 300,000 cases are alleged not detected or reported and observers note that the carriers could be transmitting the disease to the society.
NTBLCP also cautioned that one unintervened case of TB has the capacity to affect 25 other people, observing that only 27 percent of Nigerians know that they have tuberculosis.
Medical sociologist note that the prevalent rate of TB spread by men is worrisome because of fear of social stigma in the event of diagnosis that results in being positive.
According to them, most men delay getting tested for the disease or refuse to go for test even when the symptoms are evident.
They note further that in some cases, when married men test positive for TB, they may withhold the information from their family, increasing the rate of its spread.
Experts note that the bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.
The bacteria are spread when an infected person coughs or sneezes.
The symptoms include cough (sometimes blood-tinged), weight loss, night sweats and fever.
From a health practitioner’s point of views
Healthcare practitioners Abatan Matthew and Ogunsakin Adesoji posit that in addition to men accounting for more than 60 percent of those who developed TB, men also accounted for more than 63 percent of deaths among people who had TB.
The NTLC director, Dr Chukwuma Anyaike, notes that stigma can affect men’s health-seeking behaviour in the country and is a factor that drives the global burden of TB.
Anyaike believes that stigma does not only harm the men affected by TB but reduce healthcare workers’ commitment to high-quality healthcare service delivery in the country.
“Excessive stress with probable under-nutrition gives room to TB infection,” he noted.
However, experts say the ailment is curable in most cases if the right treatment is available even as drug-resistant TB is becoming more prevalent and can be fatal.
The lack of knowledge of health care workers in managing TB cases and poor interpersonal relations and communication with people who have TB have negative effects on men who are expected to adhere to the long treatment schedule for TB.
Victims speak
Mr Isah Dogara, a 39 year-old miner from Lowa community about 35km from Gwagwalada in the Federal Capital Territory, said his belief in traditional medicine made him to infect his wife and the late mother with TB because he feared that being diagnosed with the disease would make him vulnerable.
Dogara believed he was cursed when he started coughing and preferred to take traditional medicine.
Even though the cough became worse, he delayed seeking hospital care because he was told to give the medication some time to cure his uncontrollable cough.
He failed to recognise that the symptoms were due to TB because he called it an ordinary cough but had suffered from it for more than two years before he reported at the University of Abuja Teaching Hospital after a prolonged period of self-medication.
According to him, it was after nine appointments with the doctors that he was finally diagnosed with TB.
He, however, said that his cousins doubted the diagnosis and advised him to go for higher traditional medication apart from the one he took earlier.
“What my cousin claimed worked for other colleagues, that were also coughing, almost ended my own life, when I saw myself in the hospital,” he said.
Dogara said his wife and his late mother became infected, but never showed any symptoms of TB, adding that his mother died from co-morbidity of diabetes and high blood pressure while being treated for TB.
Another TB victim, Mrs Paula Bitrus, 54, who was a teacher, said she was diagnosed with multi-drug resistant TB (MDR-TB) and HIV and spent more than 21 months caring for her late husband who was paralysed and down with TB but refused to go to the hospital because of the stigma associated with it.
Bitrus noted that she contracted the disease from her husband, whom she said hid his diagnosis from her and never sought medical attention, because he was an elder in the church and concerned about possible loss of status.
She said her husband died because of ‘what people would say.
“The bacteria induce fevers and sweats, particularly at night. We suffered. No drug was working; accessing TB drugs without being registered in any of the health facilities was not possible.
“Eventually, blood vessels feeding the lungs rupture, further diminishing functions and contributing to increasing anaemia. He suffered before he finally died.”
Mr Khali Adamu of Bwari Area Council in the FCT narrated his experiences as an ex-convict. “I remember how I broke down coughing, accompanied by catarrh and high fever which ended up to be TB infection. In spite of the availability of free treatment, I ran away from the Dantsoho Memorial Hospital Kaduna to Abuja just because of isolation and maltreatment from health workers.
“I was poorly counselled on TB and my treatment ended up with poor outcomes because the health workers would throw my drugs at me and place my food by the door. I was not examined while I was there; they only ask me how I was feeling from afar and they do so by speaking through the window.
“Such experiences never made me to have hope in the treatment, so I stopped. Sometimes, I can’t speak because of the pains I felt around my neck to my chest.
“They kept on telling me to be a man that I was acting like a woman inside the labour room; this was why I ran away.
“When I got to Abuja, I met an NGO that gave me a better understanding of what I was feeling and how important it was for me to seek medical attention,” he added.
Adamu, who had already been diagnosed with sickle cell disease, had fluid building up in his lungs, a symptom typically associated with severe and long-term TB infections.
Mr Augustine Ogar worked with a construction company in Masaka District of Karu local government area of Nasarawa state. He started coughing and was not able to sleep at night and suffered from severe chest pain.
Ogar, who is now a TB survivor, said that before he was diagnosed with the disease, he felt his problem was due to the harmattan season and that it was the weather.
“It is better to do a test to understand the type of sickness you have. Before I did the test, I used to go to private pharmacies and spend a lot of money. I spent up to N80,000. They were treating just the cough, but I didn’t feel better.
“I’m now receiving free treatment through financial support from the Global Fund at the Institute of Human Virology Nigeria (IHVN) in collaboration with the Leprosy Mission of Nigeria.
“The two organisations are supporting the private health facility where I receive treatment in Alheri Ifeoluwa Medical Centre in Masaka. I must say I am now feeling well,” he said.
Men at higher risk than women
Buttressing this claim, Mrs Ekezie Eugenia, a focal person for drug resistance persons in Imo state stressed that there were differences in men’s health-seeking behaviour.
“Men have a higher prevalence of undiagnosed TB than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment.
“Health workers find it difficult to enroll men in treatment once they were diagnosed, even once some had enrolled, they would later abscond.
“Health outcomes are often worse for patients with TB living in informal settlements, especially men,” Eugenia said.
She said that men always complain about the duration of treatment and they easily believed that TB was not caused by bacteria, but rather caused by poisoning and witchcraft.
“The consequence of men delaying seeking medical care, or keeping information from health workers, can be dire. This is the number one problem that leads them to miss the early warning signs of a more serious condition like TB, especially when it comes to silent symptoms,” Eugenia stated.
Caution against traditional medication
Dr Akyala Ishaku, senior lecturer in the Department of Microbiology at Nasarawa State University said men who were diagnosed with TB at an early stage had a much better prognosis than those who show up too late to health facilities.
“A major challenge that stops some men from visiting hospital is their belief in traditional medicines. Some men trust traditional medicines and oppose seeking treatment from healthcare facilities,” he said.
According to the country director of the KNCV Tuberculosis Foundation Nigeria, Dr Bethrand Odume, there is a need for the government to improve men’s pathways to care.
Odume said this would require interventions that consider contextual issues by addressing individual-level socioeconomic factors, but also broader structural factors of gender-related social dynamics and the health system environment throughout the country.
Any measure that would enhance universal access to treatment and drugs for TB patients should be pursued.
NAN
