The WHO’s alarm over TB increase

JOHN NWOKOCHA, in this analysis evaluates the recent report by the World Health Organisation (WHO) on the alarm over rising cases of Tuberculosis, TB epidemic in the country, as well as challenges to end the killer disease

Grim report Tuesday September 18, the World Health Organisation, (WHO), gave a grim picture of the state of Tuberculosis, commonly called TB in the country.
The WHO made a shocking disclosure on the alarming increase of the disease, saying an estimated 10 million people developed TB in 2017, adding that the epidemic is far from being tackled.
Raising the alarm over rising cases of the deadly disease the WHO, disclosed that TB is one of the top 10 causes of death globally and killed an estimated 1.6 million people worldwide in 2017.
The report stated that WHO recorded 6.4 million cases of TB officially, but estimates the number of people who developed the disease was as high as 10 million due to under reporting and under diagnosis.
Sadly, Nigeria is on the list of countries that have high cases of TB.
The report stated: “but two-thirds of cases were in eight countries: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa”.
Currently, Nigeria is ranked first in Africa among countries with high prevalence of the killer disease.
For Nigeria to rank fourth among the countries with the global burden of TB is worrisome.
Unfortunately, what constitutes the major challenges for Nigeria have been the inability to detect cases and the battle against drug resistant variants of the ailment especially among people living with HIV/AIDS.
Equally disturbing about the development is, according to WHO, “For most countries, however, the ‘end’ of TB as an epidemic and major public health problem remains an aspiration rather than a reality”.
It would be recalled that in 2016, TB bacteria was reported as the top infectious killer and was also the main cause of deaths related to antimicrobial resistance as well as the leading killer of people with HIV.
Similarly, according to the National Tuberculosis and Leprosy Control Programme, over 80 per cent of TB cases were still undetected.
Highest burden cases Still saddening, WHO in its 2016 TB prevalence statistics for Nigerian estimated 322 tuberculosis cases per 100,000 people.
It revealed that the bacteria are commonly found in slums, among refugees, prisoners, people with poor income, among others.
At the time Sokoto state was identified as high prevalence areas in the country.
Hear the Minister of State for Health, Osagie Ehanire, “Nigeria is one of the highest burdened countries.
Currently Sokoto has the estimated highest prevalence cases in Nigeria with 127 TB cases per 100,000 in 2016.” 87 million Nigerians live below poverty line The recent damning remark by Mrs Theresa May, British Prime Minister, about Nigeria being a miserably poor country, also has implication for the TB threat that should be viewed as a major problem, because having been rated as a poor country, Nigeria is vulnerable to TB bacteria.
It would be recalled that the British Prime Minister, May, while speaking in Cape Town, South Africa, noted Nigeria was the home of the highest number of poor people in the world.
She said while observing that Africa was home to a majority of the world’s fragile states, and a quarter of the world’s displaced people, “Much of Nigeria is thriving, with many individuals enjoying the fruits of a resurgent economy, yet 87 million Nigerians live below $1 and 90 cents a day, making it home to more very poor people than any other nation in the world.” In other words, May said 87 million Nigerians were living below the poverty line of $1 and 90 cents per day.
And by implication, about 87 million of the entire population of the country is at risk of TB.
Besides poverty, other factors that have compounded the problem according to experts are underre porting and under-diagnosis, as well as large unregulated private sectors and weak health systems.
As they put it: In tackling the epidemic especially in subset of high TB burden countries; as under reporting and under diagnosis of TB cases continue to be a challenge, especially in countries with large unregulated private sectors and weak health systems.
To the experts, progress in reducing the epidemic is stalling and not fast enough to reach global targets or close persistent gaps in TB care and prevention.
Government’s action Speaking during the recent World Tuberculosis (TB) Day commemoration in Abuja, the Minister of Health, Isaac Adewole, said the Federal Ministry of Health took step in partnering with international donors as a way of achieving the year’s TB Day theme, tagged “Accelerating TB case findings in Nigeria”.
He said this administration has taken some bold steps to control tuberculosis in Nigeria.
“Some of these steps we embarked on is introducing the use of the Gene-Xpert MTB/ RIF technology as the primary diagnostic tool for TB among all presumptive TB cases in the country including People Living with HIV/ AIDS (PLWHA).
“We have scaled up the number of facilities providing GeneXpert services from seven health facilities in 2011 to 318 facilities in 2016; and efforts are still ongoing to scale up more facilities in 2017 to achieve the target of having one machine per LGA across the country,” he added.
Urging the federal government to get more involved in the awareness campaign on tuberculosis in order to be able to locate the missing cases in the country for treatment, Clement Adesigbin, a medical expert on TB at the National Tuberculosis Leprosy Centre Zaria, said there is a need to do more in searching out new TB cases in the country.
He said, “The mandate given to us as a centre is to search for new TB cases and we have been doing so but we can’t say we have recorded much success because most of these cases are yet to be detected”.
To John Osho, Programme Manager, TB Global Fund project of the Association of Reproductive and Family Health, ARFH, there is a need to do more in the search for unreported TB cases in Nigeria, so as to prevent a possible spread.
Osho said “Detection is very low, we had about 15 per cent.
Out of the 36,000 PHC’S in Nigeria we have DOT centres in 6,000 across the country.
What we are currently doing is house to house campaign and screening of people for TB and we are currently working in 187 slums in Nigeria”.
In his view, the awareness and funding of the epidemic is lower, stating that “HIV and TB are conjoin twins with TB more deadly.
The government should get more involved in the campaign against the disease especially in terms of screening as this will help curb the menace from spreading”.
Experts lament Early this year, concerned professionals in the nation’s health sector converged on Lagos and lamented what they called lack of prompt action on the part of the federal government towards addressing the threat of TB in the country.
It seemed to them that while the rest of the world is committed to ending the TB epidemic by 2030, actions and investments by the federal government do not match the political statements.
The experts lamented the country’s dependent on international donors for its TB programmes, saying such attitude shows that the government has not demonstrated commitment to tackle tuberculosis spread.
They disclosed that: ”funding gap of about 35 per cent; 60 per cent of TB funds used in the country are donated by international partners”.
Further revelation is “despite the National Strategic Plan for TB 2015-2020 which stipulates that the government will ensure universal access to high quality patient centre for TB prevention, diagnosis and treatment services for Nigeria with all forms of TB, many cases are yet to be detected and many unsuccessfully treated”.
Bad still, “There is a huge resource gap, many of the laboratories that can be used to detect the cases are not functional.
Most health workers do not have the adequate knowledge to diagnosis or detect the disease even when presented early.
There is a need for re-training of most of the health workers and this would be easy for the system if there is adequate funds allocated to the programme”.
The way forward is for the federal government to improve its domestic funding to curb Tuberculosis in order to reduce the burden of the disease in the country.
The government must go beyond propaganda, show political will to embark on intervention programmes, and awareness campaigns to drive home the message of how the killer disease spread as well as achieving the goal of reducing the epidemic.
Facts about TB Although TB test and treatment in Nigeria is free, there are facts the public should know about Tuberculosis.
These include: Tuberculosis is partly preventable by vaccine.
The bacteria that cause TB are spread when an infected person coughs or sneezes.
Most people infected with bacteria that cause tuberculosis do not have symptoms.
When symptoms do occur, they usually include a cough, sometimes blood-tinged, weight loss, night sweats and fever.
Treatment is not always required for these without symptoms.
Patient with active symptoms will require a long course of treatment involving multiple antibiotics.
If you do not take the drugs correctly, the germs that are still alive may become difficult to treat with those drugs.
It takes at least six months and possibly as long as one year to kill all the TB germs.
If you have TB, don’t drink alcohol — it can add to the risk of liver damage from some of the drugs used to treat your TB.
Tuberculosis is curable and preventable.
About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease.
People infected with TB bacteria have a lifetime risk of falling ill with TB of 10 per cent.
You cannot get TB germs from: Sharing drinking containers or eating utensils.
TB is NOT spread through shaking someone’s hand, sharing food, touching bed linen or toilet seats, or sharing toothbrushes.
However, it should be stressed that the federal government needs to focus more on funding of programmes to end the killer disease before 2030.


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