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TUBERCULOSIS: The Alarming WHO report By Dr Murtala Muhammad Umar The World Health Organisation (WHO) has earmarked every 24th of March as world stop TB Day, a day meant to reflect on the prevalence of TB, success achieved on control, and restrategise an effective mode of prevention of the disease. The report released by WHO on this year’s World Stop TB Day leaves much to be desired in Africa. While other regions of the world are celebrating success, the 47 countries in Africa south of the Sahara are still battling with increasing prevalence and morbidity and mortality. The Global Tuberculosis Control Report for 2005 finds that global TB prevalence has declined by more than 20% since 1990 and that incidence rates are now falling or stable in five of the six regions of the world. The glaring exception is Africa, where TB incidence rates have tripled since 1990 in countries with high HIV prevalence and still rising across the continent at a rate of 3-4% annually. This report is quite alarming for a continent that currently habour the highest HIV prevalence in the world. In fact before the advent of HIV/AIDS some significant achievements were recorded in the control of TB but because HIV destroys the body defence mechanism required to protect against TB, the later has continued to multiply in triple as confirmed by the recent alarming WHO report. Nigeria, an African country, has the fifth highest TB prevalence in the world been led by China, India, Indonesia and Bangladesh in decreasing order. China and India, which account for one-third of the global TB burden have made significant progress in the control of the disease. The African continent has continued to provide enabling environment for the spread of TB. This disease which is caused by mycobacteria and associated with productive cough, sometimes with blood, loss of appetite, weight loss, generalized body weakness e.t.c. is transmitted through contact (coughing, sneezing, spitting) especially in an overcrowded environment. Poverty which has remained endemic with us has helped in the propagation of predisposing factors for TB such as malnutrition, urban slums, illiteracy, low socio-economic status etc. Directly Observed Treatment Short (DOTS) is the internationally recommended strategy for controlling TB. It consists of five elements: (1) Government commitment to TB control (2) Diagnosis through bacteriology and an effective lab network (3) standardized short-course chemotherapy with full patient support throughout treatment (4) uninterrupted supply of quality-assured drugs (5) Recording and reporting to measure patients and programme outcomes. Since the introduction of DOTS, progressive achievements have been recorded. 17 million people have benefited worldwide since 1995. The Nigerian Minister of Health as reported by Daily Trust of Tuesday 29th March, 2005 said the country has recorded 80% success rates.. Happily, Nigeria is one of the countries that currently provide free drugs to TB patients with DOTS centres spread all over the nation. The challenge here is for the government and health workers to create awareness in both print and electronic media and be committed and honest in dispensing the drugs to patients. The control of TB cannot be effective unless TB patients who serve as reservoir for spread of the disease are promptly and properly treated. Vaccination against TB is an important control measure especially to infants who are most vulnerable. The BCG vaccine (Bacilli, Culmette, Guerin) protects for 7yrs and efficacy is around 80%. Most importantly vaccination protects from complications such as TB meningitis, milliary tuberculosis and TB adrenal glands. In Nigeria, it is a routine for babies to be given BCG at birth but the compliance rate due to probably ignorance or inaccessibility is still low. The National Programme on Immunisation (NPI) should within its limitations provide vaccines to all nooks and crannies of the country in addition to health education on the benefits of BCG vaccination. As part of preventive measures individuals who are in close contact with TB patients (especially those coughing with sputum) and infants of infected mothers need to be given chemoprophylaxis regardless of having received BCG at birth. The chemoprophylaxis is also recommended for people who are immunocompromised e.g. those with malnutrition and HIV/AIDS. The advent of HIV/AIDS has reduced the commitment of the international community to fighting TB. For example the number of drugs developed in less than 20 years to fight HIV/AIDS have outnumbered the drugs available for treating TB. Like Nelson Mandela rightly put forward. “We can’t fight AIDS unless we do much more to fight TB.” For HIV/AIDS and TB are twin brothers, the existence of the former almost always presupposes that of the later. This column calls on China and India to lead the African countries so that new, effective drugs that can be used for a shorter duration rather than what obtains now, can be discovered and produced en masse. The United Nations Millennium Development Goal aims at reducing the prevalence of TB to half by 2015. Although the HIV/AIDS, TB co-epidemic in Africa has been an obstacle, it is still possible with strong commitment to approximate the goal. With strong political commitment, matching words with actions, the prevalence of TB can be significantly lowed. Let us pray that by March 24th 2006, Africans would have survived their present mourning state and join the other continent in celebrating progress in the area of control of tuberculosis. Amen! Amen!! Amen!!! By Dr Murtala Muhammad Umar , General Hospital ZURMI, Zamfara State
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