New Telegraph

Seeking effective TB intervention, treatment amidst COVID–19

Nigeria has the highest Tuberculosis (TB) burden in Africa, accounting for over 1.5 million deaths annually. In this report, experts highlight that with commitment to follow treatment plan through, the highly infectious disease is preventable and curable, reports APPOLONIA ADEYEMI

Aliya Yusuf, 16 years was still an adolescent when she married her heartthrob Azeez, a local musician in the Eyin-Igbale neighbourhood of Idiarere, in Molete Area of Ibadan. She conceived without delay and by the time she was celebrating her 18th birthday she has been delivered of twin baby girls, a development which became a source of joy in her family. That joy was however short lived. Less than nine months after the babies were born, Madam Yusuf became severely ill with fever.

She presented with weight loss and night sweats regularly to the extent that she was no longer able to care for the twins. Attending to the daily needs of the infants became an uphill task prompting her mother to intervene, hence assisting with caring for the kids and doing other domestic chores. Despite resorting to self-medication in managing her health condition, the fever, instead of abating became more severe.

To worsen her situation Mrs. Yusuf developed a very serious cough which made her condition to become noticeable by people around her. Rather than seek medical attention, the usual myth in her community was that the ailment was blamed on spiritual attack. Her regular coughing episode however became a source of serious concern to her husband and friends when the phlegm she often coughed out was sometimes tinged with blood stains.

At that stage most of the counsel to the young mother was to see doctors at the primary health care centre (PHC) in Molete. On her first visit to the PHC, however she was referred to the Oluyole General Hospital where laboratory tests conducted showed that tuberculosis (TB) was behind her health challenges.

TB, not a spiritual attack, caused mycobacterium tuberculosis

According to the World Health Organisation (WHO), TB is a contagious infection that usually attacks the lungs. It can also spread to other parts of the human body, like the brain and spine.

A type of bacteria called mycobacterium tuberculosis causes the infectious disease. Going by the treatment plan the doctors prescribed, Madam Yusuf was expected to be on TB drugs for an initial six months after which additional laboratory tests will determine if that treatment would be either conclusive or to continue. Although, she commenced the treatment, visiting the Oluyole General Hospital once weekly to obtain her medicines and using them as prescribed, by the end of the eight week when the obstinate cough had subsided and subsequently stopped.

Similarly, all the discomforts that were associated with the TB appeared to have ended; she was no longer coughing as usual and there were no fever symptoms any more. Based on what she perceived as the cure of the TB, the young mother abandoned the treatment.

Sadly, follow up telephone calls from hospital staff urging her to continue with the treatment did not persuade her to change her mind. More than six months after, she experienced a relapse that was more severe than the initial ailment, but then, other challenges have crept in; her husband and the twin girls have also become infected with the mycobacterium tuberculosis which causes TB.

Untreated TB spreads infection to others

Untreated TB in the communities such as that of mrs Yusu, could also spread the disease to others that are free from the ailment. Explaining how this comes about, the Director/Head, ACSM Unit at the National TB and Leprosy Control Programme (NTBLCP), Mrs Itohowo Uko said there was still 74 per cent undetected TB cases in Nigerian communities, going by the Global Report of 2019. That report shows that Nigeria is only able to identify or isolate 106,533 TB patients and put them on treatment, meaning that the country has 74 per cent TB cases as at 2018, that are yet to be notified.

Uko said, “As at 2018, we were expected as a nation to place over 409,000 TB patients on treatment but out of the over 409,000 patients we were able to get 106,533 patients notified and placed on treatment.”

She however lamented that one undetected TB case could spread to between 15 to 20 persons within one year. This is exactly what played out in the home of the Yusuf where two children and their father not only became infected but were subsequently diagnosed with the disease.

By the time, Mrs Yusuf got financial assistance and resumed treatment, the TB had impacted her lungs badly and consequently resulting in her untimely death. Sadly, just eight weeks after her demise the elderly twin, called Taiwo, that was barely two years old similarly succumbed to the ailment, to the shock of the community members.

Those who heard the news of the death of Mrs. Yusuf and her senior daughter, Taiwo were surprised to learn that TB could lead to fatality. To majority of the community people it sounded like a ‘cock and bull’ story.

“How possible,” were the words of the security guard in the house where the Yusufs live. Such is the perception that some Nigerians have of TB. Such people do not see TB as a killer disease; neither do they also view it as an emergency. It is worth stating here that all these experiences of the Yusuf family happened before the outbreak of the coronavirus. What some Nigerians that suffered TB during the coronavirus lockdown went through when most health facilities were not accessible due to the fear of contracting COVID-19, could be imagined. What this meant was that many TB patients then were not able to access care and some may have died needlessly from the preventable disease. On the contrary, during a recent media training by the Institute of Human Virology, Nigeria (IHVN) through the United States Agency for International Development (USAID) USAID/Breakthrough Action – Nigeria (BA-N), supporting the National TB & Leprosy Control Programme, experts at the meeting made it clear that Nigeria still holds the position of the country with the highest TB burden in Africa, accounting for over 1.5 million deaths annually.

During the training aimed to increase the knowledge of participants on the TB situation in Nigeria and empower them to increase the quality and number of TB reports; and also to create educative media content that will help audiences make informed decisions about their health and the health of those around them, experts said TB is a severe global threat that disproportionally affects the poorest and most vulnerable. For instance, a WHO ‘Overview- Progress Towards Achieving Global TB Targets and Implementation of the UN Political Declaration on Tuberculosis,’ stated that in 2019, about 10 million people fell sick with the disease globally and 1.4 million died, making TB the leading infectious killer worldwide and one of the top ten causes of death overall. Similarly, the data showed that one-third of deaths among people living with HIV are due to TB.

With close to half a million people developing drug-resistant TB annually, it is also a major contributor to antimicrobial resistance. According to the data, a quarter of the world’s population is infected with mycobacterium tuberculosis, which is an enormous human and societal toll for a curable and preventable disease.

WHO at a recent meeting recommended that TB services should be maintained and strengthened as essential during the current pandemic and other outbreaks. This includes, ensuring access to people-centered prevention and care services; effective infection prevention and control measures; proactive planning for procurement, supply and risk management and leveraging the expertise and experience of national TB programmes, especially in rapid testing and contact tracing, for the COVID-19 response.

On other measures to curb the disease and reduce unnecessary deaths, Dr. Olufemi Ayoola, deputy director, Health Orientation & Communication, National Orientation Agency (NOA), said changing the perception of the disease was key to fighting it. He said with the current poor perception of TB among the populace, many don’t take necessary measures to prevent themselves and their families from contracting the bacterial infection. However, Ayoola said it has become imperative to present TB in a way that would make the populace realise that it was still a big burden and that it can kill. He said, “We must change the perception of TB to show that it is still a problem; and that it can kill. It is as dangerous as COVID-19.”

He said, “Let TB be perceived as an emergency. “We must use established structures like the NOA to reach out to citizens in communities. We have to build trust among people in communities so that we can change their perception of TB.”

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