adminThe slogan for this year was, “Stop TB in My Lifetime” while the theme was, “Call for a World Free of TB”. The national event was held in Bulawayo. As we move forward celebrating the tremendous progress made so far in addressing the TB menace within this universe, it is advised that we come up with strong strategies of combating MDR-TB which of late has become a major challenge.
MDR-TB is TB that is resistant to at least two of the best anti-TB drugs, isoniazid and rifampicin. These drugs are considered first-line drugs and are used to treat all persons with TB disease. Statistics show that the world has made headway in its efforts to reduce the burden of the disease, recording a marked decrease of 14 percent in TB prevalence between 1990 and 2009. There is also an emergence of new technologies and equipment to detect MDR-TB. Most major government hospitals in Zimbabwe have already received state-of-the-art machines that it now takes a few minutes for a person to know whether he or she has developed the disease or not. There is also a 35 percent decrease in mortality since 1990, which is encouraging.
Regardless of the progress, TB continues to be a major public health concern that adversely affects people living in poor, urban settings. And in a world that is urbanising at the rate of 200 000 people every day, there is need for aggressiveness and innovation to win this war against TB. Many cases of TB go undetected and untreated thereby fuelling new cases and deaths.
But with the speed we are moving at, it may remain a dream to achieve our target to halve the incidents of TB and deaths by 2015 unless we dramatically reduce the length of treatment regimens and devote our energies towards new research and technologies.
TB is spread through the air. When infectious people cough, sneeze, talk or spit; they propel TB germs into the air. A person needs only to inhale a small number of these to be infected.
In Zimbabwe, cases of pulmonary TB have risen, a phenomenon linked to the HIV pandemic as co-infection is common in patients infected with either of the two. That is why it is advised that anyone who is HIV positive should undergo TB test while those who test TB-positive should also be tested for HIV. Available information shows that every second, one person gets TB infection and that means overally, one third of the world’s population is infected with TB bacillus a pathogen that can lie dormant for years. If the person who is TB-positive is left untreated, he or she will infect an average of 10 and 15 people every year. People infected with bacilli like those with HIV will not automatically become sick with the disease.
According to the WHO’s Global Tuberculosis Control Statistical Report of 2009, Zimbabwe had an estimated 71 961 of new TB cases detected in 2007, with an estimated incident rate of 539 cases per every 100 000 people. The country was also ranked 17th on the list of high-burdened countries in the whole world. This is not good news for our health delivery system.
In the same report it is noted that the number of new reported TB cases in the country declined by 2,6 percent between 2006 and 2007.
However, there was a serious decline in the Directly Observed Treatment Strategy (DOTS) case detection rate. It decreased from 46 percent in 2002 to 2007 percent in 2007 with treatment success rate declining from 71 percent in 2001 to 60 percent in 2006.
DOTS is the name given to the WHO-recommended TB control strategy that combines five components:
o Government commitment (including both political will at all levels, and establishing a centralised and prioritised system of TB monitoring, recording and training)
o Case detection by sputum smear microscopy
o Standardised treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
o A regular drug supply
o A standardised recording and reporting system that allows assessment of treatment results
With the country having the second highest TB mortality and morbidity in the world, new strategies have to be taken to combat the double TB and HIV menace. This is because research has it that the former and the latter are inseparable.
More often than not a TB patient will be susceptible to HIV infection and vice versa. This means there is need for a twin strategy where the response to TB should be married with a robust response to HIV.
The TB-HIV co-infection rate is high. According to WHO, nearly 69 percent of new adult TB patients have tested HIV positive. National data suggest the actual estimate is slightly higher, around 80 percent, and there is increasing HIV observation in TB patients.
While the country continues to battle with the old TB cases an its more recent co-infection with HIV, MDR-TB has become a very big menace in the country’s quest to respond to this public health issue. MDR- TB may be as a result of patients who do not adhere to treatment regimens when they begin to feel better. The trend of MDR-TB is higher in areas like Matabeleland North where most people have migrated to neighbouring South Africa and Botswana, countries with higher HIV prevalence rates than Zimbabwe.
The Ministry of Health and Child Welfare should ensure that health services for TB prevention and control are adequate in terms of coverage, access and quality of care.
As it stands, the infrastructure that is there falls far too short of the need and there is also limited human capacity although the situation has slightly improved. The UN Global Fund programme has helped the ministry leading to an improvement of staffing levels in hospitals especially on TB, Malaria and, HIV and Aids. Cases of burn-out among healthcare workers will be reduced in hospitals and the quality of service will relatively improve if staffing levels increase.
Zimbabwe should look back at what we have done with antiretroviral therapy (ART) for Aids patients. The country should move with speed to nip the MDR-TB menace in the bud so that the 2015 target is met.
Let us all test for TB, for early detection will make life easier for the health personnel as well as helping you recover fast. TB can be successfully treated even if a patient is living positively with HIV, so get tested for TB and HIV today.
Online Reporter