COMBATING TUBERCULOSIS (TB): NIGERIA AS A CASE STUDY

COMBATING TUBERCULOSIS (TB): NIGERIA AS A CASE STUDY  

by: Godday Ojore Aghedo

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Tuberculosis (TB) is an airborne clinical condition which is caused by bacteria called Mycobacterium tuberculosis. It is a poorly virulent organism that affects people of all ages all over the world. Dr Robert Koch stirred the tides in the worlds of science and medicine in 1882, by the discovering of the cure for TB. Since then, March 24th yearly, had been set aside to commemorate this landmark thunderstruck. The theme of the worldwide event this year is: WANTED: LEADERS FOR A TB-FREE WORLD. There are basically three (3) broad stages of TB infection:

(a) Latent TB (when it doesn't present with any serious signs and symptoms)

(b) Active TB (when clinical signs and symptoms begin to manifest, especially and often through cough)

 (c) Multi-drug resistant TB (when current treatment regimens start failing in combating the bacteria. This stage is usually difficult to cure).

The World Health Organisation (WHO) estimated that 10.4 million people were infected globally, in 2015; out of which 1.8 million deaths were recorded. It was recorded that over 400,000 deaths of the 1.8 million, were from TB/HIV co-infection. Note that death rate in TB/HIV co-infected patient is more than twice higher than that in TB alone. Sadly, 95% of TB deaths occur in low- and middle-income countries.

Nigeria is among the first 22 countries with highest global TB burden; and the fourth (4th) nation in the world with the highest annual TB cases. However, between 2000 and 2015, about 49 million lives have been saved globally through effective diagnosis and treatment.

The facts that about 500,000 Nigerians get infected with TB and about 170,000 of them die of the disease annually call for urgent public health attention. Case detection rate in Nigeria is still as low as 15%. In fact, this is reputed to be one of the lowest in the world. Undoubtedly, poor public sector management, limited number of Directly Observed Therapy Short-course (DOTS) centres and chest clinics have immensely contributed to the alarming all time low case detection rate of TB in Nigeria. The war against TB in Nigeria should be everybody's concern. All hands must be on deck in addition to the efforts of the government, international agencies, the Centres for Disease Control and Prevention (CDC) and the National TB & Leprosy Control Programme (NTLCP), to stamp out this vindictive disease called TB.

The 2015 - 2020 National TB Strategic Plan suggests the expansion of DOTS services to more facilities across the country. Nonetheless, as at 2015, only 200 centres in Nigeria provide Xpert MTB/RIF assay using GeneXpert machines. This machine is capable of detecting the Mycobacteria tuberculosis complex (MTBC) and the resistance to rifampin (RIF) in less than 2 hours. This is a breakthrough that the health sector should maximize in lifting the bar of case finding higher.

Early detection and treatment are key to scotching TB progression from the latent stage to active TB or becoming drug resistant. On the spread of TB, lack of basic health services, poor nutrition status, poor living conditions and HIV co-infection contribute monumentally to the spread of TB among people in a community.

SYMPTOMS AND SIGNS

About 95% of all TB cases are pulmonary and engender cough, while only about 5% is extra-pulmonary and do not manifest through cough. But the following experiences can be useful in clinically screening for presumptive TB.

1. Coughing for 2 weeks or more

2. Profuse sweating, especially at nights

3. Blood in the phlegm

4. Unexplained weight loss

5. Recurrent lymphadenopathy

6. Fever and/or internal hotness of the body, among others.

PREVENTION AND TREATMENT

First, it is paramount to note that TB IS CURABLE AND TB DRUGS ARE FREE, in all public health facilities. Just like other global public health diseases, prevention of TB starts with self before others. It adopts the inside-out principle. Adhering to simple cough etiquette, hygienic practices, enhancing case detection rates and curing diagnosed TB before it progresses to multi-drug resistant TB (MDR-TB), are very important medical approaches to preventing TB. Other preventive measures include but not limited to:

1. Closing your mouth with an handkerchief when coughing

2. GO for TB screening and test as soon as you notice any of the signs and symptoms above

3. Don't expose your handkerchief in public after use or waive it in the air while dancing

4. Don't just spit around, learn to bury your sputum

5. Ensure proper VENTILATION and ILLUMINATION of your dwelling places

6. When someone keeps coughing in a public vehicle, simply open the windows

7. Sensitization and campaigns about TB, down to students and pupils at schools, will help tremendously. At every point, education is vital.

8. Ensuring compliance to universal precautions and infection prevention and control (IPAC) standards

9. Intensifying case finding/detection efforts, through the development of innovative approaches to uncovering undiagnosed TB and MDR-TB cases

10. Improvement in clinical management practices

11. Strictly adhere to treatment plan, if you are infected.

12. Avoid overcrowded places where and when possible

13. Ensure you eat balance diet, to enhance your immune system

CONCLUSION

The best time to join in the fight against TB is NOW! The drugs for TB treatment have been in use for over 70 years till date. The CDC is leading the war against MDR-TB and poised to committing to the global sustainable development goal of exterminating TB by 2035. Hence, we must all join hands and efforts to: find, cure and prevent TB. This is a wake up clarion call to all Nigerians; let's STOP TB before TB stops us.

(c) Godday Ojore Aghedo, 2017 (AUTHOR: Healthy Life Compass)