Curbing the scrooge of tuberculosis in Nigeria

The World Health Organisation (WHO) says that tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs.

The disease is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease, the organisation warned.

The report also says that in healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person’s immune system acts to ‘wall off’ the bacteria.

“However, the symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats,” it says.

Meanwhile, the World Health Organisation, in its Global Tuberculosis 2015 Report, says that TB remains one of the world’s biggest threats; killing 1.5 million people in 2014.

It says that TB is still a ‘major public health problem’ in Nigeria, with the country ranking fourth among the 22 high TB burden countries of the world.

“These 22 countries collectively bear 80 per cent of the global burden of TB,” it says.

The Webcam option

With one of the highest infection rates of tuberculosis (TB) in the country, King County, Wash., has enlisted technology to ensure that its patients take the required medication. The county, which includes Seattle, is using webcams to watch patients take the medication — the drugs must be taken exactly as prescribed and the treatment time can range from six to 12 months.

TB is a disease that often infects the lungs and can spread to other parts of the body, but it can be treated with a series of drug regimens, according to the Seattle and King County Public Health department. The county’s TB clinic started the webcam program a couple of months ago and about 10 patients are participating in it.

“TB is an extensive treatment regimen and it’s quite lengthy,” said Denise Genaro Wolf, the nurse manager for the county’s TB control program. “It’s a requirement to have the observed therapy because even for folks who are conscientious, it’s a difficult journey to stay compliant with taking all the medication and then for the length of time they have to take it, it assists them.”

As of 2010, King County’s health department had documented 114 cases of active TB in the county and provides treatment and/or evaluation to more than 1,100 county residents who have active or latent tuberculosis. According to the Centers for Disease Control and Prevention, if the medication isn’t taken correctly, the infection could become resistant to drugs.

“TB control is an essential investment in the health of our communities that helps us fight the local effects of this global disease,” said Dr. David Fleming, director and health officer for the county health department, in a statement.

Jasko Cokic, a county TB clinic medical assistant, said patients call the county’s TB clinic to alert clinic staff when they’re ready to take the medication. Once a staff member has been notified, an email invitation is sent to the patient to sign onto the clinic’s Microsoft Office Live Meeting video-conferencing tool. The patient then accepts the invitation and connects with the TB clinic.

Once connected, the patient takes the medication while a representative from the clinic observes that the accurate dosage has been taken. During the Web chat, patients also can talk to the TB clinic staff about possible side effects they’re experiencing or check in about the status of their treatment, Wolf said.

Cokic said the idea to provide live Web chat for TB patients to comply with taking their required medication stemmed from the patients. For some patients, medical staff must go to the patient’s home to observe that the TB medication has been taken. But with the webcam option, the patient won’t draw attention from his or her neighbors with medical staff from the county department on their property.

“The patients would say, ‘I don’t want you to come to my home,’ because there’s some stigma about the TB disease especially in the wealthy areas of King County,” Cokic said. “So they, for example, don’t want King County Public Health cars in front of their homes.”

To participate in the program, patients provide their own webcam equipment, but there’s no cost for accessing the video-conferencing tool. Once patients download the program onto their PC, they can access email invites for the Web chat meetings, Cokic said.

Before the webcam program launched, patients could borrow video phones from the clinic so they could call in for TB clinic staff to observe them complying with their treatment requirements. Patients can still borrow the video phones, however, Cokic said the phones are outdated and have trouble connecting back to the clinic.

While the new webcam program has produced positive results, according to Wolf, the TB clinic is the only section of the county’s health department that’s utilizing video-conferencing technology to observe patients taking medications and no plans have been made to expand the technology to other sections of the health department.

Meanwhile, a study by United States Agency for International Development (USAID) and KNCV Royal Dutch Tuberculosis Foundation says that the TB burden in Nigeria is further compounded by the current HIV/AIDS epidemic and the emergence of Multi-Drug Resistant Tuberculosis (MDR-TB).

Highlighting the prevalence of the disease in Nigeria, Dr Kuye Joseph, Monitoring and Evaluation Officer, Federal Ministry of Health, said that 330 persons, out of every 100,000 persons in Nigeria, were suffering from the disease.

“In 2014, 330 persons were estimated to have TB disease among every 100,000 persons in Nigeria,” he added.

Joseph said that the rate of TB-induced deaths among persons who were not afflicted with HIV was 97 per 100,000 people, while the rate of TB-induced deaths among persons living with HIV was 44 per 100,000 people.

He reiterated that TB was the major cause of death among persons living with HIV/AIDS.

Joseph noted that the most common symptom of pulmonary TB was productive cough, spanning two weeks or more, which may be accompanied by other respiratory symptoms like shortness of breath.

“However, any person living with HIV is considered a presumptive TB case if he or she presents with cough of any duration,’’ he added.

Joseph explained that drug resistant tuberculosis occurred when strains of tuberculosis germs were able to grow in the laboratory in the presence of at least two most important first-line anti-tuberculosis drugs.

“It is a condition that happens when normal TB is not managed effectively or if a patient fails to take treatment on time,” he said.

Joseph, nonetheless, solicited the support of the media in disseminating information about TB service delivery points in Nigeria and the need for infected people to embark on early tuberculosis treatment.

Sharing similar sentiments, Dr Gidado Mustapha, Country Representative of KNCV Royal Dutch Tuberculosis Foundation in Nigeria, advised people living with tuberculosis to refrain from spreading the disease.

He said that the adoption of basic cough etiquette, such as covering the mouth when coughing, would go a long way in preventing the spread of the disease.

Mustapha stressed that TB was curable, adding that the diagnosis and treatment of the disease are free in Nigeria.

“People living with tuberculosis should ensure that they adhere to treatment. To prevent the spread of TB, ensure you obey simple basic cough etiquette: when you are coughing, cover your mouth.

“Do not throw your sputum all over the house because you have the responsibility to protect your family members and the community at large,’’ he said.

As regards TB diagnosis and treatment, Mustapha said that the Federal Ministry of Health and partners had established no fewer than 1,600 TB service delivery centres in Nigeria where people can be diagnosed and equally access TB treatment free of charge.

“In spite this, there is no good utilisation of these facilities, and, hence, Nigeria is not diagnosing and treating enough number of TB patients,’’ he said.

Mustapha blamed the shortcoming on the low community awareness of TB and available service delivery points.

He, however, urged TB patients to prevent the development of drug resistant TB by adhering to the treatment schedule religiously.

“Multi-Drug Resistant Tuberculosis (MDR-TB) occurs if one fails to manage the normal TB effectively, if patient does not take treatment on time,’’ he said.

Mustapha emphasised that the treatment of MDR-TB was always longer than the normal TB treatment because the patient had to undergo treatment for 20 months or more.

He said that during the period, the MDR-TB patient would be receiving injection on a daily basis for a period of eight months.

“We know it is a very difficult situation for the patient and it is also a heavy burden on the TB programme in general. Therefore, our role is to prevent drug resistant TB from occurring,’’ he said.

Nevertheless, UN Secretary-General Ban Ki- moon said that ending the TB epidemic by 2030 was one of the targets of the new Sustainable Development Goals (SDGs).

“Therefore, progress in ending TB must go hand-in-hand with other SDGs aimed at reducing inequalities, eliminating extreme poverty, ensuring social protection, achieving universal health coverage and ending HIV/AIDS,” he said.

Ban, nonetheless, emphasised that total victory over TB would require a united front, adding that ending the epidemic would require actions that were beyond those of ministries of health alone.

“We must also do more to engage affected persons and communities, as well as non-governmental organisations, researchers and the private sector.

“We need to eliminate stigma and ensure that all affected people have access to care. And we also have to be ready to keep people healthy in the face of complex emergencies and unprecedented movements of refugees and migrants worldwide.

On her part, Dr Margaret Chan, Director-General of WHO, said that given the prevalence of drug-resistant tuberculosis, ensuring high quality and complete care would also benefit global health security.

As part of efforts to draw global attention to tuberculosis, its diagnosis and management, the United Nations has designated March 24 as World Tuberculosis Day.

The day is designed to increase public awareness that tuberculosis today remains an epidemic in most parts of the world, causing the death of nearly 1.5 million people every year, particularly in developing countries.

In line with this, stakeholders call for intensified global solidarity and action in efforts to end tuberculosis.