The Nation Newspaper

Tag: TB

  • Time to conquer TB

    Nigeria must re-strategize in its fight against this infection

    Nigeria’s successful conquest of the Ebola Viral Disease (EVD) has apparently had the paradoxical effect of blinding it to the importance of addressing other ailments, even more deadly when reckoned in terms of lost human lives.

    While the depredations of malaria are well-known, it appears that tuberculosis (TB) poses similarly crucial health challenges for the country.

    Nigeria was ranked third-highest in the world’s TB-prevalent countries in 2014, and the most heavily-infected in Africa. Some four million cases are expected to develop between 2015 and 2020, with a quarter of them co-occurring with Human Immuno-Deficiency Virus (HIV).

    A significant proportion of TB cases are of the version called Multi-Drug Resistant Tuberculosis (MDR-TB), which is harder to treat. About 170,000 of the current 570,000 TB cases occurring in the country are fatal.  That fatality is slightly more than one in every four cases.

    That would be a dire harvest in needless deaths, were Nigeria to get right the environment to prevent the disease; and the right medicare to treat and eventually cure it.  With the present parlous position, that appears a daunting challenge.  But it is not impossible to scale.

    The prevalence of TB in the country is due to several complementary factors: poor public sanitation, low levels of personal hygiene, overcrowding and poor immune systems.

    These factors become even more significant in the wake of the widespread social disruption caused by the Boko Haram insurgency, and communal clashes which occur across the country.

    If Nigeria is to properly come to grips with the TB challenge, it will first have to understand that it is facing a medical crisis that is as urgent as the one it encountered with EVD. Indeed, in some respects, the TB epidemic is far more serious.

    Ebola claimed eight lives, compared to TB which accounts for 0.17 million annually. Tuberculosis is far more insidious, and can manifest as the symptom-free latent TB that silently infects others. It can serve to accelerate the spread of HIV, and in its MDR-TB form, it can complicate treatment regimens and exponentially increase the cost of treatment.

    Besides, when HIV morphs into AIDS (but it need not, if the right counseling procedure and treatment regime are taken), TB is one of those virulent opportunistic infections that tears away at the patient’s body.  That explains why latter-day integrated HIV-AIDS preventive campaigns include TB and malaria.  It is dubbed HIV/AIDS, Tuberculosis and Malaria (ATM) prevention campaigns.

    A viable anti-TB campaign, therefore, requires a comprehensively integrated approach, which incorporates extensive immunisation, improved reporting systems and better nutrition, as well as education and enlightenment programmes, and, of course, better treatment.

    Since adolescents and children are disproportionately affected by TB in Nigeria, they should be given correspondingly greater priority. The country’s health system must return to its stress on primary health care, with emphasis on child immunization, that it enjoyed during the tenure of the late Professor Olikoye Ransome-Kuti as Minister of Health.

    Greater attention should also  be paid to school-feeding programmes to enable children obtain at least one nutritionally-balanced meal a day, thereby improving their immune systems. That means, even if to roll back TB alone, the Buhari presidency should urgently implement the nationwide schools feeding programme.

    Slum redevelopment and urban renewal are crucial to tackling the overcrowding and insanitary conditions that prevail in far too many of the country’s urban areas.

    Comprehensive enlightenment programmes must also be developed to show the citizenry how to avoid contracting the disease; and how to recognize its symptoms.

    The country’s healthcare facilities must give the anti-TB fight the same prominence that they currently devote to malaria. TB treatment should be heavily subsidised, if not completely free; drugs and therapies must be made widely available, especially in public health institutions. It is particularly important that patients be aware of the vital need to complete treatment regimes so as to avoid Multi-Drug Resistant TB.

    But none of these control measures will succeed without adequate funding. According to the WHO, the country’s national TB programme budget is put at US $228 million, of which 13 per cent is locally funded, 16 per cent internationally funded, while 68 per cent is unfunded.

    This a huge gap.  If over two-thirds of the anti-TB budget is not financed, very little progress can be made in combatting it. The Buhari administration must, therefore, ensure that the anti-TB campaign gets the money it needs in order to be effective.

    The battle against disease is a never-ending one. Nigeria’s globally-hailed victories over EVD and polio demonstrate that it has the capacity to win the current war against tuberculosis.  So, it’s time to attack and vanquished TB.  With determination and resolve, it can be done.

  • Children: the innocent victims of TB in vulnerable communities

    Children: the innocent victims of TB in vulnerable communities

    Each year on 24 March, WHO joins the rest of the international community to commemorate World TB Day. This year’s theme “Gear Up to End TB” is a continuation of the call to reach the missing cases, most of who live in the world’s poorest and most vulnerable communities, including those in the African Region.

    Tuberculosis (TB) is one of the world’s deadliest, yet preventable, communicable diseases and remains a significant problem in the African Region. Every year, there is an estimated 9 million new TB cases worldwide but consistently 3 million cases are either not diagnosed, not treated, or are diagnosed and not registered by national TB control programmes.

    These vulnerable populations include children and women, people living with HIV, people with diabetes, refugees, miners and ex-miners, prisoners and drug users whose access to basic health care services may be limited. The poor are also at risk, especially homeless persons and individuals living in densely populated communities.

    Among children, there were an estimated 550 000 new cases in 2013. Children with vulnerable immune systems, such as the very young, HIV-infected or severely malnourished, are at the greatest risk of falling ill or dying from TB.

    Children can get TB at any age, but the most common age is between one and four years. The source of infection is often an infectious adult that is in a child’s close environment. A TB infected adult often lives in vulnerable communities such as migrants, miners, prisoners, drug users and sex workers whose access to basic health care services may be limited.

    “Any child living in a setting where there are people with infectious TB can become ill with TB, even if they are vaccinated. If infected, TB is often missed or overlooked due to non-specific symptoms and difficulties in accurately diagnosing the condition. This highlights the urgent need to strengthen health systems to be able to manage TB and it’s other associated health conditions,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

    The HIV pandemic also threatens TB control efforts, particularly in sub-Saharan Africa. Wherever children are at risk of HIV infection, the HIV-infected children are at risk of TB. Overall, 34 per cent of TB cases are estimated to be co-infected with HIV in the African Region. In parts of southern Africa, more than 50 per cent of TB cases are co-infected with HIV.

    TB is a treatable and curable disease. Active, drug-sensitive TB is treated with a standard six-month regimen of four antimicrobial drugs that are provided with information, supervision and support by a qualified health care worker or trained volunteer.

    There has been continued progress in the implementation of collaborative TB/HIV activities but intensified efforts are needed, especially to ensure universal access to antiretroviral therapy (ART). In 2013, 70 per cent of TB patients known to be HIV-positive were on ART. This level, however, falls short of the 100 per cent target set for 2015.

    As a minimum, all HIV-infected children should be screened for TB and all children with TB should be offered HIV testing and counselling in high HIV prevalence settings. Irrespective of age, all HIV-infected children who are household contacts of infectious TB cases should be evaluated for TB disease and treated.

    For the first time in four decades, new TB drugs are starting to emerge from the pipeline, and combination regimens that include new compounds are being tested in clinical trials, but the funding required to rapidly evaluate whether these treatments are effective and ready for implementation is far from adequate.

    The end of 2015 marks a transition from the Millennium Development Goals (MDGs) to a post-2015 development framework. Within this broader context, WHO has developed a post-2015 global TB strategy (the End TB Strategy) that was approved by all Member States at the May 2014 World Health Assembly.

  • Research to save TB infected babies

    Research to save TB infected babies

    New research at the Desmond Tutu TB Centre at Stellenbosch University is studying the effects of tuberculosis (TB) drug therapy in children less than a year old. Children have traditionally been excluded from trials but research is needed to be able to adjust therapies according to body weight.

    Babies usually contract TB from their mothers or other infected adults, not from other kids. It most often infects the lungs, but it can also attack other parts of the body, such as the spine, kidneys and brain.

    “Immunity is very weak in a small child and even more so in an infant. They can get seriously ill. If the mother is not treated for TB or has only recently started treatment, it poses a high risk to her newborn baby. We also need to find better ways to treat babies with TB,” says Adrie Bekker, lead researcher and neonatology specialist.

    One million children every year contract TB, according to World Health Organization (WHO) estimates, and 400 000 of them die from it. Bekker says without proper preventive therapy, up to 50 per cent of babies infected with TB will develop TB disease.

    “We need to know if we’re treating babies with TB correctly. The study is important to determine whether new guidelines are appropriate to also treat the youngest and most vulnerable TB patients. This research also paves the way to evaluate new TB drugs and treatment regimens in babies,” says Anneke Hesseling, Director of the Paediatric TB Research Programme.

    Bekker’s research is also looking at the intimate relationship between maternal and infant TB, particularly if the mother is HIV positive. TB is second only to HIV/AIDS as the greatest killer worldwide that is caused by a single infectious agent. HIV and TB form a lethal combination causing one fifth of all deaths of people living with HIV.

    “A mother with TB or HIV is twice as likely to have a premature and low-birth weight baby and for a tiny baby, the risk of contracting TB and severe forms of TB is much higher because they have less immunity,” adds Bekker.

    The new research comes at a critical time in the global fight against TB. Last week, in Geneva, the 67th World Health Assembly (WHA), the WHO’s highest decision-making authority, approved the “Post-2015 Global Strategy and Targets For Tuberculosis Prevention, Care and Control”.

    The new Post-2015 Global Strategy for Tuberculosis emphasises the importance of early diagnosis of the disease and of new research and development for life-saving medicines. With this new strategy in place, governments are working to end the TB epidemic and achieve a 95 per cent reduction in TB deaths by 2035.

    According to the Stop TB Partnership, the upcoming five-year Plan to Stop TB (2016-2020) will set the direction to achieve these international goals. The strategy is built on the three pillars of integrated, patient-centred care and prevention; bold policies and supportive systems; and intensified research and innovation.

    WHO states that they will promote research and development for new or improved diagnostics, treatment and preventive tools, efficient vaccines, and stimulate new innovations to fight the TB epidemic and save lives.

     

    Dr Couillard is an international health columnist that works in collaboration with the World Health Organization’s goals of disease prevention and control. Views do not necessarily reflect endorsement. He can be reached via: Facebook: Dr Cory Couillard, Twitter and DrCoryCouillard

     

     

     

  • Nigeria’s long search for TB cure

    Nigeria’s long search for TB cure

    The World Tuberculosis (TB) Day is a global effort to create awareness on the disease’s eradication. The day was celebrated worldwide yesterday. OYEYEMI GBENGA-MUSTAPHA examines why TB is still prevalent in Nigeria.

    This year’s World Tuberculosis (TB) Day theme: “Find TB. Treat TB. Working together to eliminate TB” encourages local and state TB programmes to reach out to their communities to raise awareness about the disease.

    According to the Centres for Disease Control (CDC), countries do not have to fight TB alone; but should partner with others that are also caring for those most at risk of TB such as people with HIV infection, or diabetes, and the homeless. Everyone has a role in ensuring that one day TB will be eliminated.

    The Nigeria Institute of Medical Research (NIMR) is one of the centres dedicated to the research and treatment of TB in the country. A senior researcher, Dr Dan Onyejekwe while commenting on the institute’s experiences at a forum, said: “While great strides have been made to control and cure TB, people still get sick and die from this disease in our country. Much more needs to be done to eliminate this disease. TB is still a life-threatening problem in Nigeria, despite the declining number of TB cases. Anyone can get TB, and current efforts to find and treat latent TB infection and TB disease are not sufficient. Misdiagnosis of TB still exists and health care professionals often do not “think TB”.

    “This World TB Day, we call for further collaboration to find and treat TB. By working together to raise awareness that TB still exists and sharing the personal stories of those people affected by TB, we can bring attention to this public health problem. This year’s World TB Day theme encourages local and state TB programmes to reach out to their communities to raise awareness about TB. We don’t have to fight TB alone; we should partner with others who are also caring for those most at risk for TB such as people with HIV infection or diabetes, and the homeless. Everyone has a role in ensuring that one day TB will be eliminated. NIMR and our partners are committed to a world free of TB,” he said.

    Dr Onyejekwe said: “The fight to eliminate TB will only be successful if local, state, national, and international partners from all sectors of our society join resources and collaborate to find solutions. “Our united effort is needed to reach those at highest risk for TB and to identify and implement innovative strategies to improve testing and treatment among high-risk populations.”

    Highlighting some of the challenges in treating TB, Dr Onyejekwe said: “Progress towards the achievement of global targets for TB control remains slow. The control and prevention of Tuberculosis in contemporary times have many faces and challenges. These among others include the impact of HIV/AIDS and the emergence of multi-drug resistant tuberculosis (MDR-TB). The HIV/AIDS pandemic is not only fuelling the burden of TB but also poses great challenge to its diagnosis and management. People living with HIV or AIDS who are also with TB, due to stigma do not always want to come for TB treatment.”

    According to the Federal Ministry of Health, Department of Public Health National TB and Leprosy Control Programme (NTBLCP), Workers’ Manual (Fifth Revised Edition), the recorded HIV prevalence among TB cases in Nigeria is estimated at 27 per cent according to the World Health organisation (WHO, 2009).

    “Apart from the HIV/AIDS situation, the emergence of MDR-TB not only presents additional burden to the control of TB, but is capable of obliterating all the gains of TB control over the years. Although the current burden is currently unknown, the WHO estimates MDR-TB rates of 1.8 per cent of the new TB cases and 9.4 per cent among re-treatment cases. Institution-based reported from 2006 to September 2009 showed that 97 MDR-TB cases have been notified so far in the country. This is certainly a tip of the iceberg and it is hoped that the on-going TB drug drug resistance survey (DRS) will establish exactness in the burden of MDR-TB,” the manual stated.

  • WHO: Three million miss TB diagnosis

    ABOUT three million people do not recieve tuberculosis (TB) diagnosis yearly, the World health Organisation (WHO) has said.

    According to a WHO report, about three quarters of the cases are in 12 countries. The report was released by the WHO in London and Geneva.

    About 75 per cent of the estimated 2.9 million missed cases, that is, people who were either not diagnosed or diagnosed, but not reported to National TB Points (NTPs) – were in 12 countries. They are India (31 per cent of the global total), South Africa, Bangladesh, Pakistan, Indonesia; China, Democratic Republic of the Congo (DRC), Mozambique, Nigeria, Ethiopia; the Philippines and Myanmar.

    According to WHO Director of the Global TB Programme, Mario Raviglione, “Quality TB care for millions worldwide has driven down TB deaths. But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they received is unknown.”

    WHO estimates Global tuberculosis report for this year that the three million people who are currently undiagnosed by health systems account for one third of all those falling ill with TB yearly.

    According to the report, reaching the missed cases is among the five priority actions to accelerate progress towards 2015 Millennium Development Goals (MDGs).

    Other areas include: addressing multi-drug-resistant tuberculosis (MDR-TB) as a public health crisis; accelerating the response to TB/HIV; increasing financing to close all resource gaps and ensuring rapid adoption of innovations.

    The report said the response to testing and treating all those affected by multi-drug-resistant TB (MDR-TB) is inadequate. WHO estimated that 450,000 fell ill with MDR-TB last year alone, with China, India and Russia carrying the highest burden of the disease.

    Other key findings of the report point out that by last year, TB mortality rate had been reduced by 45 per cent since 1990, making the MDG target to reduce deaths by 50 per cent by 2015 achievable.

    “The Global TB Report highlights the very big gains the global community has made in the fight against tuberculosis,” said Head of the Strategy, Investment and Impact Division of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Osamu Kunii.

    He said: “We are now at a crucial moment where we cannot afford to let these gains go into reverse. We need the commitment of the international community to address a significant funding gap to fight this disease.”

    Two-thirds of international donor financing for TB is provided by the Global Fund. By July this year, Global Fund financing has cumulatively supported detection and treatment of 11 million smear-positive cases of TB, up from 9.7 million at the end of last year. The number of people treated for multi-drug-resistant TB grew to 88,000 from 69,000 through Global-Fund supported programmes, he added.

  • WHO: Three million missTB diagnosis

    he World Health Organisation (WHO) has said about three million people do not recieve (TB) diagnosis yearly.

    According to a report by the body, about three quarters of the cases are in 12 countries. The report was released by the WHO in London and Geneva.

    About 75 per cent of the estimated 2.9 million missed cases, i.e people who were either not diagnosed or diagnosed but not reported to National TB Points (NTPs) – were in 12 countries. They are India (31 per cent of the global total); South Africa; Bangladesh; Pakistan; Indonesia; China, Democratic Republic of the Congo (DRC); Mozambique; Nigeria; Ethiopia; the Philippines and Myanmar.

    According to WHO Director of the Global TB Programme, Mario Raviglione, “Quality TB care for millions worldwide has driven down TB deaths. But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they received is unknown.”

    WHO estimates Global tuberculosis report for this year that the three million people who are currently undiagnosed by health systems account for one third of all those falling ill with TB yearly.

    According to the report, reaching the missed cases is among the five priority actions to accelerate progress towards 2015 Millennium Development Goals (MDGs).

    Other areas include: addressing multi-drug-resistant tuberculosis (MDR-TB) as a public health crisis; accelerating the response to TB/HIV; increasing financing to close all resource gaps and ensuring rapid adoption of innovations.

    The report said the response to testing and treating all those affected by multi-drug-resistant TB (MDR-TB) is inadequate. WHO estimated that 450,000 fell ill with MDR-TB in 2012 alone, with China, India and Russia carrying the highest burden of the disease.

    Other key findings of the report point out that by 2012, TB mortality rate had been reduced by 45 per cent since 1990, making the MDG target to reduce deaths by 50 per cent by 2015 achievable.

    “The Global TB Report highlights the very big gains the global community has made in the fight against tuberculosis,” said Head of the Strategy, Investment and Impact Division of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Osamu Kunii.

    He said: “We are now at a crucial moment where we cannot afford to let these gains go into reverse. We need the commitment of the international community to address a significant funding gap to fight this disease.”

    Today, two-thirds of international donor financing for TB is provided by the Global Fund. By July this year, Global Fund financing has cumulatively supported detection and treatment of 11 million smear-positive cases of TB, up from 9.7 million at the end of 2012. The number of people treated for multi-drug-resistant TB grew to 88,000 from 69,000 through Global-Fund supported programmes

  • Why PLWHA don’t get TB treatment

    Why PLWHA don’t get TB treatment

    Why have people Living with HIV/AIDS (PLWHA) not been accessing tuberculosis treatment at Directly Observed Treatment Short Course (DOTS) centres?

    It is because they do not want their identities revealed, says a clinician, Dr Dan Onwujekwe, of the Nigerian Institute of Medical Research (NIMR).

    He said PLWHA were not using the DOTS centre, which is the global standard for tuberculosis treatment because of the stigma associated with their status. He enjoined the centres to come up with new methods of managing their patients to achieve impressive treatment results.

    According to him, self stigma, whereby HIV/TB co-infected patients fear loss of confidentiality of their HIV status in centres near their homes; rejection of referred HIV/TB patients due to fear of HIV infection and drugs out of stock; coupled with increasing numbers returned to NIMR ART site demanding other options all amount to factors and challenges of the success of DOTS at the treatment centre.Hence, NIMR was permitted to use innovative approaches to implement DOTS, whereby a weekly monitoring was devised: “and the outcome of the implementation study showed that a weekly DOTS can achieve high cure and treatment rates to a daily DOTS.

    “It is imperative that National TB control programs that are challenged with a high burden should adopt innovative ways to reach more patients with effective treatment. As a well managed once a week health worker observation of treatment, backed by strong laboratory component can produce cure rates as high as DOTS. This may be a useful way to improve towards achieving the Stop TB targets of halving Nigeria’s TB burden by 2015,” he stated.

    Dr Onwujekwe said other reasons why DOTS  was worked on to once a week health worker observed treatment approach was because, “most patients cannot afford daily cost of transportation to clinic; cure rate for smear-positive TB of 96.9 per cent and treatment success rate f 75 per cent compare favorably with those reported from other treatment sites in Nigeria and settings where daily DOTS is supposedly the standard practice.

    “Treatment success rates for HIV co-infected patients was 69 per cent. This compares favorably with reports of 56 per cent obtained in similar clinics in South Africa.”

    Director General, NIMR, Prof Innocent Ujah, said NIMR serves as a reference Centre for the training and quality assurance of staff and Laboratory tests for the TB Laboratory Network, and in doing so, provides specialized diagnostic strain identification and resistance testing.

    ”NIMR also conducts training programmes in specialized areas of TB and TB/HIV diagnosis and management. It is important to state that NIMR provided the laboratory support and back up services for the first ever Nigerian National Survey on Multi drug resistance TB as well as the first national survey of the prevalence of TB in Nigeria.

    “NIMR acts as the National TB Reference Laboratory and currently, it is being upgraded to bio-safety level 3 Laboratory (BSL-3), courtesy of FHI360. NIMR has high level man power and infrastructure capacities to conduct research, provide clinical and laboratory services to patients. Our finding showed that at HIV clinic, 27 per cent of PLWHA and accessing anti retroviral treatment (ARV) in our clinic have TB

    “Due to effective counseling by our committed staff, the default rate among TB patients has been reduced from 22 per cent to six per cent. Our target is zero default rate and I am sure that we can achieve the target.

    “TB needs to be prevented and we call on all stakeholders to redouble all effort to bring the prevalence of TB in Nigeria to an acceptable level. Unfortunately, the dangerous triad of poverty, ignorance and illiteracy will be our greatest challenge. Therefore, we can stop TB in our life time if we improve the socio-economic circumstances of our people, by reducing poverty through income generation, ignorance and illiteracy through formal education, sustained awareness creation and childhood immunization of new born babies with BCG,” stated Prof Ujah.

  • Nigeria, nine others to receive UN treatments on HIV, Tuberculosis

    Nigeria, nine others to receive UN treatments on HIV, Tuberculosis

    The Executive Director of United Nations Programme on HIV and AIDS (UNAIDS), Mr. Michel Sidibe, said Nigeria and nine other countries will be the focus of a new UN-led preventative treatments of tuberculosis (TB)/HIV infection.

    Other beneficiaries are Ethiopia, India, Kenya, Mozambique, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

    The UN Correspondent of the News Agency of Nigeria reports that the initiative was inaugurated on Tuesday as part of a wider effort to accelerate the global fight against the highly fatal co-infection.

    Sidibe urged the scaling up of services in affected countries through concerted and joint efforts.

    He noted that the agreement between UNAIDS and the Stop TB Partnership would seek to achieve the 2015 goal of reducing deaths from TB among HIV patients by 50 per cent, or the equivalent of 600,000 lives.

    “TB/HIV is a deadly combination; we can stop people from dying of HIV/TB co-infection through integration and simplification of HIV and TB services,’’ Sidibe said.

    He said that at the 2011 UN high-level meeting on AIDS, member states agreed on the ambitious objective of reducing by half the TB/HIV deaths by 2015.

    “TB is preventable and curable at low cost, yet we still have one in four AIDS-related deaths caused by TB, and this is outrageous,’’ Dr .Lucica Ditiu, the Executive Secretary of the Stop TB Partnership, also said at the inauguration.

    Ditiu said that in spite of increased access to antiretroviral therapy for patients and a consequent 13 per cent reduction in the numbers of TB-associated HIV deaths over the past two years, the pulmonary disease remained the leading cause of death among HIV patients.