GLOBAL TUBERCULOSIS SCOURGE: THE NIGERIA PANORAMA

BY: Aghedo Ojore Godday (AMIIM, HRMA)

Nigeria joins the rest of the world every March 24^th, to commemorate the World Tuberculosis (TB) Day. It is important for everyone too to take cognizance of this day and ensure a renewed commitment to protecting one’s family and indeed neighbours from the devastating health, social and economic consequences of this highly infectious disease. Over 95% of TB related morbidity and mortality occur in low-income and middle-income countries especially in Africa. This means a lot to us in the public health sector.

Despite being curable, World Health Organization (WHO), states that TB kills 18 Nigerians every hour and 4,500 people globally per day. 407,000 HIV negative persons and 63,000 HIV positive persons in Nigeria are estimated to have TB every year. While mortality in TB/HIV co-infected persons stands at 39,000 annually, TB related death in HIV negative persons is projected at 115,000 persons annually.

For the records, Nigeria is now ranked 6th globally and 1st in Africa among the 30 high burden countries and sadly among the 14 high burden countries for TB infection prevalence, TB/HIV co-infection and Multi-Drug Resistant (MDR) TB cases (Global TB Report, 2017).

CHALLENGES…

Major challenges faced in the fight against TB in Nigeria include but not limited to:

1.      Low TB case finding both in adult and children.

2.      Poor knowledge about TB.

3.      Poor health seeking behaviour of Nigerians, and

4.      Low TB treatment coverage.

5.      Escalating number of MDR-TB cases

Away from the aforementioned challenges, another threat is that, about one-third of the world’s population has latent TB (according to WHO). Latent TB means, people have already been infected by “mycobacterium tuberculosis” without morbidity and capability of transmitting the disease. However, latent TB carriers do have a 10% lifetime risk of TB morbidity or developing active TB, while persons with compromised immune systems have a much higher risk of falling ill. Compromised immune system is common with people living with HIV (PLHIV), patients of various viral infections, diabetic persons, people who use tobacco or suffer malnutrition.

THE WAY FORWARD…

1.    In addressing the setbacks around case finding, the World Health Organization (WHO) has engaged 12,000 persons to report cases suspected to be TB in about 12 high burden states in Nigeria. While this is an effective and laudable step, that number is not enough; therefore we can volunteer to report TB suspected cases to relevant health professionals in our community health facilities offering TB services. According to Dr Emperor Ubochioma, an estimated 418,000 new TB cases occurred in Nigeria in 2018 but the country was notified of only 106,533 (25 per cent). This leaves us with a gap of over 311,000 (75 percent).

2.    In addressing challenge number four above, Dr Adebola Lawanson and National Coordinator of the National Tuberculosis, Burulli Ulcer and Leprosy Control Programme (NTBLCP), had said through Dr. Emperor Ubochioma, “The Federal Ministry of Health with support from partners is rapidly expanding TB diagnostics and treatment services to more sites across the country.” This is critical because the undetected TB cases constitute a puddle for incessant transmission of the disease in Nigeria. I must commend the FMoH and NTBLCP for the much incentive given to MDR-TB patients, in ensuring adherence to TB treatment.

3.    Ongoing and unalloyed sensitization of the public about TB will enhance case finding and demystify TB treatment myths, which have prevented TB infected persons from seeking professional care and treatment in the past. TB is a bacteria disease, it is curable and it is not a sign of witchcraft. People must know this truth and that is where the media comes in. Medical journalists, researchers and health educators must rise up to this challenge and wear TB a human face like we have done to HIV. “Prevention” they say, “is better than cure.” Preventive measures such as isoniazid preventive therapy (IPT), intensified case finding (ICF), nutrition intervention services, infection control in health facilities and even ART initiation have documented records of effectiveness.  ART significantly but not entirely reduces the risk of TB disease in PLHIV. Some common signs and symptoms of TB are: fever, persistent cough (especially for about two weeks), night sweating and sometimes, lymphnoadenoparthy.

4.     Poor health seeking bahaviour is an endemic problem in Africa, especially among the masculine gender. Female are twice more proactive about their health than the males, but it high time we changed this ugly thread. Regular routine medical checkups can be lifesaving and highly economical. It is always best to seek professional medical advice rather than resorting to self-medication when we feel unwell. In my book: Healthy Life Compass (Aghedo, 2017), I dealt exhaustively with the health consequences of self-medication. While the government is making unpretentious efforts to expand the coverage of health services in Nigeria, Nigerians must make themselves available to access such services.

5.    Right policy formulation – Nigerian government should come up with favourable policies that will enhance smooth intervention of both corporate and private performers towards curbing the TB scourge.

CONCLUSION

Health is Wealth! Health is Priceless!! Health is Life!!! Taking issues of your health seriously is beneficial, because a compromised health can amount to a crumbled life and destiny. TB is curable, yet it is claiming scores of life every single day. This is a cause to worry. While we acknowledge the previous and ongoing efforts of individuals, relevant agencies of the government and global partners/donors on TB programmes in Nigeria and Africa at large, it is obvious we still have much to be done in achieving the 90-90-90 target by 2020 and ending TB by 2030. Just 11 days ago, precisely on March 14^th, 2019, the President announced the latest national HIV prevalence to be 1.4%, a laudable decline from 3.1% in 2015. We must commend the FMoH, NACA, NCDC, other stakeholders and global partners for the success of the Nigeria AIDS Indicator and Impact Survey (NAIIS) – one of the largest HIV/AIDS surveys in the world. Of course, I am glad to be part of that project. So, if we could bring down HIV to this point, then I believe we can eliminate TB in record time. This is a herculean task before us but it is not impossible. The end of TB was made visible when Dr Robert Koch found its cause in 1882, March 24^th. The 2019 World TB Day theme is: “IT IS TIME!” Indeed, it is time for action… It is time to End TB in Nigeria and Africa in general. It is time for the young, old, men, women and all stakeholders concerned to join hands together in making Nigeria a TB-free country. YES, IT IS TIME! Keep the promise, find TB and treat TB!

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© Aghedo Ojore Godday (AMIIN, HRMA)