As part of efforts to combat the spread of tuberculosis (TB), in society, a group, Agbami Co-Ventures, in partnership with Women’s Rights Advancement and Protection Alternative (WRAPA) and the Delta state government, has intensified its sensitisation programme across three council areas in the state.
The campaign, which aims to educate as well as care for persons suffering from the ailment, started in October last year and was scheduled in Warri South, Warri North and Ethiope East local government areas of Delta State.
Speaking during the exercise in Warri, Thursday, the WRAPA coordinator, Mrs. Edna Ohunayo, explained that “the project which started in October 2018 is to educate and sensitise the general public on prevention, care and control of Tuberculosis”.
She stated that the campaign also included training of care providers, peer educators community vanguards and advocacy visits to major stakeholders and also, community outreach programmes and rallies in the selected council areas.
The state Tuberculosis and Leprosy Coordinator, Dr. Alex Akpodiete had in December 2018, raised an alarm that about 12,000 cases of the disease are likely to occur yearly in Delta state alone.
Akpodiete stated this during a Tuberculosis Advocacy, Communication and Social Mobilisation Flag-Off Programme, adding that there is a possibility that two out of every family of six in Nigeria, would have the infection.
The National Tuberculosis and Leprosy Control Programme (NTBLCP) Department of the Federal Ministry of Health has said Nigeria has the highest number of people infected with tuberculosis (TB) in Africa.
Its National Coordinator, Dr. Adebola Lawason, made this known at a workshop organised in collaboration with Breakthrough Action and United States Agency for International Development (USAID) for health reporters in Nasarawa State.
She said Nigeria has the sixth highest burden of TB patients globally and the first in Africa.
Lawason, represented by Mrs. O. Shofowora, said tuberculosis is one of the top 10 causes of deaths, and that Nigeria is classified among 30 countries with high burden of TB, Multi-Drug Resistant TB (MDR-TB) and TB/HIV.
“Tuberculosis is caused by a bacterium known as mycobacterium tuberculosis, which affects mostly the lungs. It is called pulmonary tuberculosis. Our goal is to achieve a 50 per cent reduction in the TB prevalence rate and a 75 per cent reduction in TB mortality rate; that is, excluding those that are co-infected with HIV by 2025,” she said.
According to a 2017 global report by the World Health Organisation (WHO), it is estimated that two out of every 1,000 Nigerians have TB yearly. This is an estimated figure; the actual figure might be scarier. “In Nigeria, in 2017, out of over 407,000 people we are supposed to reach who have TB, we got only 104,000. The remaining 396,000 are still at large. Of the 104,000, we have recorded 10 per cent deaths. Most people who are infected the most with TB are within the reproductive ages of 15 years to 44 years.
“Also, one single person with pulmonary TB can infect between 10-15 people in a year. This is an estimate. At least, 18 people die every hour as a result of untreated and unattended cases of TB. The awareness of TB is very low, and some people don’t even want to know. TB bacteria can be suspended in the air for up to 8 hours; that is, between four and eight hours. The bacteria cannot strive under sunlight or in a place that is well ventilated,” Lawason said.
Officials attributed the high prevalence to low level of awareness, caused by insufficiency of funds for the programme at the national, state, and local government levels.
She urged the private sector and other public-spirited individuals to join the fight to end the spread of the disease, adding that the government cannot do it alone.
“TB is transmitted when an infected person coughs, sneezes, or spites into the atmosphere. Persistent cough of up to two weeks or more may be due to TB and may need further investigation. Our health-seeking behaviour is that we go to the chemist first before going to the hospital; we need to change this behaviour. Loss of weight, excessive sweat, and loss of appetite are part of the signs of TB.
“TB is curable and the patient is not infectious after two to three weeks of treatment. The test and drugs are also free at least in all public hospitals and some private hospitals. If anyone shows some of the signs of TB, all the person needs to do is subject himself to test. If it is confirmed to be TB, the drugs will be given to him for free.
“Once a patient is put under a medication, he or she must finish the drugs so that the bacteria are expunged from the body. Preventive measures are to avoid poorly ventilated and overcrowded environments; cover mouth properly when coughing and not spitting indiscriminately in the public; early detection of TB, diagnosed promptly, and early commencement of treatment will reduce the ability of the patient to infect others; also, eating a balanced diet to avoid malnutrition,” she added.
Patients share heartrending encounter with drug-resistant tuberculosis
The buzz about Bedaquiline
Tanimola begged her father to teach her to whistle. But much as he tried to teach her, she couldn’t. Her infant lips were too tender to hoot.
“She kept blowing air and bathing me with spittle,” said Folajimi David, her father.
Then, one Sunday evening, the five-year-old said, “Daddy, I can whistle with my chest.” To this, David responded with a smile, enthusing about how talented his little girl was.
He knew she couldn’t whistle with her chest. But “kids will always be kids,” thought the widower, craning his ear against her chest to hear it ‘whistle.’
All he could hear was the deep-seated wheezing that broke with her cough.
He blamed it on her inability to pass out the phlegm that was stuck in her chest. It’s one of the things she inherited from him, he thought; “I have never been able to cough out phlegm no matter how hard I tried,” he said.
Thinking she got that from him too, along with her looks, he gave her cough syrup, and then, a tincture of honey, bitter kola and mint.
But neither the cough syrup nor the potion provided relief to the five-year-old. She couldn’t sleep and she coughed through the night. By dawn, David noticed a spatter of blood on the bed sheet, at the spot she rested her head.
“Her symptoms got worse and she wheezed for breath like an asthmatic. But she had never been diagnosed of asthma. In the morning, she complained of fatigue, and collapsed on the way to the bathroom. That day, she didn’t go to school. I took her to a neighbourhood clinic from where she was referred to the Lagos teaching hospital,” he said.
Early diagnosis indicated that Tanimola had pneumonia and typhoid fever, for which she was treated. But her symptoms persisted.
“I became very scared when her teacher called, urging me to come for her; she said her cough had aggravated, and droplets of blood stained her teeth at every expiration,” said David.
Thus precisely eight days after she was treated at the teaching hospital, Tanimola was rushed to a private hospital, where lab tests and analysis revealed that she was infected by the Multi Drug Resistant strain of tuberculosis , widely known as MDR-TB.
David was diagnosed with the same disease, and father and daughter were advised to commence treatment at the state’s MDR-TB centre.
“We received the result late in the day, around 6.25 pm. There was no way we could report for treatment at that hour. I intended to take her to the clinic the following morning, which was a Tuesday,” said David.
But Tanimola would not make the trip with him. Seventeen minutes past midnight, she died in his arms.
David should have paid good mind to his daughter. Contrary to his belief, that, the five-year-old suffered a mild cough, she was in the advanced stages of MDR-TB. It wasn’t until she died, that, he understood the reason for her protracted cough and tiredness.
Today, David is “almost rid” of the disease. But he would never be rid of guilt.
The bereaved widower and his late daughter, however, represent a fraction of the country’s missing MDR-TB cases.
•An MDR-TB patient using his medication on the watch of a health officer at a DOT centre.
An awful way to die
Each year, nearly one and a half million people die from tuberculosis, that, for many years, has been treatable and curable. More than 30 million people have died since the World Health Organisation (WHO) declared TB as a global emergency in 1993.
The devastation wreaked by the disease is best captured in the anonymous quote: “When TB wakes up and gets into the lungs, it eats them from the inside out, slowly diminishing their capacity, causing the chest to fill up with blood and the liquid remains of the lungs.
“A wet, hacking cough is evocative of TB. The lungs, now in liquid form, are sloshing around in the chest. Cough that up, even in microscopic, impossible-to-see droplets, near other people, and they have a very good chance of getting TB too.
“Eventually, liquid replaces the lungs; the suffering patients cannot get enough oxygen, and respiratory failure occurs. They can no longer breathe and they drown. It’s painful. It’s drawn out. It’s an awful way to die. But before any of this happens, the disease weakens you. It diminishes your capacity for work, and puts your family and friends, and anyone else you come into contact with at risk. Individual death is only part of the problem.”
The bereaved family often inherits death from the deceased too. Or vice versa. In the case of the Davids, for instance, the father infected his daughter with the disease “because her immune system was very low, compared to his own,” said one of the doctors that attended to the deceased.
The typical pathway of the infection according to health experts is as follows:
When somebody coughs, it spreads through the sputum and then a susceptible host inhales it. If the person’s immune system is intact, the TB stays dormant in the lungs, without causing any harm to the body. But if the body’s immune system is compromised, the bacteria mutates aggressively in the body, corrupting and totally overwhelming the host’s immune system as a full blown infection. From a single host, TB can spread to infect between 10 and 12 people.
The progression is worse where the hosts dwell in a slum. It spreads rapidly, and assumes the state of a pandemic.
According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and MDR-TB. The country is also among the 10 countries that account for 64 percent of the global gap in TB case finding. India, Indonesia and Nigeria account for almost half of the total gap.
Nigeria is also ranked 7th among the 30 high drug-resistant tuberculosis (DR-TB) burden countries and second in Africa, with an estimated 4, 700 patients with multi drug-resistant-TB (MDR-TB) in 2015.
•A shanty kid picks her way through a river of filth in Makoko. The Lagos slum is widely known as a cesspit of diseases like tuberculosis.
Why TB persists…
Tuberculosis, widely adjudged to be a disease of the poor, is endemic in urban slums and communities, where the poverty level and population density is high.
“Most hospitals in the communities are, however, not equipped with TB care and that is where you have most of the cases. Also, most of the affected areas are hard to reach,” said Dr. Babawale Victor, a Senior Health Officer with the The National Tuberculosis and Leprosy Control Program (NTLCP), in a chat with The Nation.
Further findings revealed, that, while TB care services are supposed to be available at the Primary Health Centres (PHCs) across the country’s 774 local government areas (LGAs), they are absent in most of the target coverage areas.
Where PHCs are present, they are ill-equipped and understaffed to contain and treat TB patients, let alone MDR-TB sufferers.
Victor argued that prohibitive cost of treatment also delays and prevent individuals from initiating TB treatment after diagnosis. The dearth of paediatric TB specialists in areas most affected by the disease also poses an impediment to containment efforts, he said, stressing that, delay in reporting cases for treatment and lack of point-of-care laboratory capacity also hinder treatment and containment efforts, especially for multi drug-resistant TB.
A nurse at a Lagos based directly observed treatment (DOT) centre revealed, that, in order to encourage patients to complete the full course of treatment, they are provided some token for transport fare and meals. After the intensive phase, patients are allowed to return home for the continuation phase of treatment.
Why paediatric TB goes neglected
Until very recently childhood TB has not been a priority in public health and has remained essentially a hidden pandemic. All too often, paediatric TB goes undiagnosed in children.
While high-income countries now use sophisticated molecular tests to detect the disease, most developing countries, Nigerian inclusive, still use the method developed 130 years ago: the patient must cough up a sample of sputum, which is then checked under the microscope for the bacteria that causes TB.
Young children, generally, are unable to produce a sample. Even if a child with active TB succeeds in providing a sample, it often contains no detectable bacteria.
Compounding difficulties with diagnosis is the fact that children with TB have families that are poor, lack knowledge about the disease and live in communities with limited access to health care.
•TB bacteria inside the human body.
The burden of stigmatisation
Isa Mahmud, 35, was forbidden from using the same cutlery with his parents and siblings, soon after he was diagnosed with TB.
“Even after I started treatment, they kept their distance from me. My brothers stopped sleeping in the same room with me and my mother turned her face away from me whenever she had to talk to me, even after using a nose mask. I have been treated like a leper. They don’t even tell me sorry anymore, when I cough. Instead they frown and hiss. Sometimes, I feel like killing myself,” he said.
Experiences like Mahmud’s have often led to non-disclosure of illness by TB patients. Even while the chronic cough persists, some simply explain it away as “chest problem.”
Patients also dread being quarantined in the hospital, often likening it to a jail cell.
“They will make you feel like a condemned prisoner. The nurses are particularly careless in thought and speech. They shout at you and treat you like a hardened criminal. They make you feel like you are doomed for death,” said Gladys Onuh, who quit treatment at a Lagos Direct Observation Treatment (DOT) facility to patronise a herbal doctor.
The ugliness of hospital based care
A typical ward in Nigeria would contain 24 patients with MDR-TB, who should be cared for by 10 specially trained nurses running shifts, where they provide 100 per cent of their time for this service. Additionally, doctors attend to patients for about 15 minutes weekly. This depicts an ideal situation.
In reality, patients complain of stigmatisation by doctors, nurses and other health officers. Princewill Okeh, an outpatient in a treatment facility in the southern part of the country, complained that many TB sufferers are reluctant to come forward due to the hostility they might experience from public health officers.
“It’s one thing to be maltreated by your family but when government doctors and nurses also treat you badly, you lose hope in the system. This disease (MDR-TB) will make nurses and doctors avoid you. My girlfriend also has TB, but she would rather treat it from home. She has witnessed my experience with family and doctors and nurses. They all treat me like a demon. This is why she will never come to DOT for treatment. She is using home remedy and antibiotics,” he said.
Further findings revealed that some public health workers avoid the wards of MDR-TB patients thus leading to a fragmented bedside interaction and hindered service delivery.
In a recent Focused Group Discussion (FGD) conducted by health researchers, some participants recalled that healthcare providers in other facilities, which they visited for specialised services such as audiometry and chest X-ray avoided contact with MDR-TB patients and were more resentful than the healthcare providers at the
treatment centre.
They also stressed that it was disparaging and unfair for patients to use an inferior quality face mask while healthcare providers used a superior type.
“It is an inferior face mask. It is not a good type. It is the type they are selling in the market that they brought to us. They were using the better type. You see Nigerians! I argued with them seriously. They said, I argue too much because I am educated,” said a 54-year-old male patient.
The cost factor
Management of identified MDR-TB cases is based on a standardised WHO approved treatment regimen of 20 months, consisting of an eight-month intensive phase and a 12-month continuation phase.
Patients are placed on Pyrazinamide and four second-line anti-TB drugs namely Levofloxacin, Kanamycin (replaced by Capreomycin when indicated), Prothionamide
and Cycloserine. The five drugs are used for the eight-month intensive phase, at the end of which Kanamycin (or Capreomycin) is discontinued for the remaining 12-month continuation phase.
A recent study revealed that three models of MDR-TB care were utilised in Nigeria between June 2013 and December 2014, and differed only in their eight-month intensive phase.
Patients treated under Model A, were hospitalized for the complete duration of the intensive phase; patients in Model B were hospitalised for a duration of five months in the intensive phase while patients treated under Model C received the complete
intensive phase treatment as ambulatory care in the community.
The estimated total cost of providing diagnostic and treatment care as outlined in the Nigerian MDR-TB guidelines, was $18, 528 (N2,927,464) per patient for Model A, $15, 159 (N2,395,070) per patient for Model B and $9, 425 (N1,489,080) per patient for Model C – all 2014 figures.
Although financing for care and prevention has increased over the last decade, there remains a funding gap – $2.3bn (£1.74bn) in 2017. The biggest donor, the Global Fund to fight Aids, TB and Malaria, allocates just 18 per cent of its resources to fight the disease.
Babawale Victor
Is Bedaquiline the next-best elixir?
There is no gainsaying the emergence of multi-drug resistant tuberculosis (MDR-TB) has threatened the progress made in TB control globally; MDR-TB is the resistance to Rifampicin and Isoniazid, the most effective first line anti-TB drugs, by the disease.
Els Torreele, executive director of Médecins Sans Frontières’ access campaign, said there has been a dearth of research and development (R&D) over many years for adequate tools for diagnosis and treatment.
In the last few years, however, Bedaquiline (a bacterial drug belonging to a new class of antibiotics) has been released to treat patients with drug-resistant TB.
“Before Bedaquiline, the last drug we developed was before we put a man on the moon,” said Aaron Oxley, executive director of Results UK. “Unfortunately in TB – or fortunately now – things are about to get more expensive because we’re getting tools that actually work.”
Bedaquiline (BDQ) has a novel mechanism of action. It binds to mycobacterium tuberculosis ATP synthase, an enzyme that is essential for the generation of energy in the pathogen. Inhibiting ATP synthesis results in bactericidal activity. The atpE gene product (subunit c, a proton pump) is the target of Bedaquiline in mycobacteria.
The distinct target and mode of action of Bedaquiline minimises the potential for cross-resistance with existing anti-TB drugs thus the buzz about its efficacy and potency as an anti-MDR-TB nullifier.
Tackling the MDR-TB conundrum
A major issue with TB in Nigeria is the low TB case finding for both adults and children. In 2017 only 104, 904 TB cases were detected out of an estimated 407, 000 of all TB cases.
This indicates a treatment coverage of just 25.8 per cent thus leaving a gap of 302,096 cases, which were either undetected or detected but the cases were not notified especially in non DOT sites.
A total of just 1,783 MDR-TB cases were notified out of an estimated 5, 200, according to the health minister, Prof. Isaac Adewole.
Nigeria currently has 6,753 Direct Observation Treatment (DOT) centres compared to 3,931 in 2010. The total number of microscopy centres has risen from 1,148 in 2010 to 2,650 in 2017. GeneXpert machines installed in the country have increased from 32 in 2012 to 390 in 2017.
Treatment centres for patients with MDR-TB expanded from 10 in 2013, to 27 in 2017, while the number of TB reference laboratories also increased from nine in 2013 to 10 in 2018. Over 90 per cent of the TB patients notified in 2016 have documented HIV test results compared to 79 per cent in 2010, according to Adewole.
The health minister disclosed, that, in addition to this, a shorter drug regimen for the treatment of MDR-TB was introduced in the country in 2017 to reduce the treatment duration for patients with MDR-TB and ensure better treatment outcomes.
•An x-ray of a lung damaged by TB
“To further strengthen TB notification in some challenged states, TB Surveillance officers have been recruited in 12 states (Rivers, Delta, Imo, Anambra, Lagos, Oyo, Benue, Niger, Kaduna, Kano, Bauchi and Taraba) to work with non-NTP facilities (private Health facilities, atent medicine vendors, community pharmacists), disease surveillance and notification officers, state epidemiologists and TB programme officers, to improve TB case notification, he explained.
In a bid to bolster Nigeria’s anti-TB campaign, the Federal Ministry of Health has also initiated an active case-finding campaign in key affected populations spanning people living with HIV, children, urban slum dwellers, prisoners, migrants, internally displaced people and facility based health care workers.
The result has been encouraging so far, with the detection of over 11,500 TB cases through active house to house case searching in 2017.
However, the number of TB cases detected represent a small fraction of the over 300,000 missing cases of TB in the country; that is, those that go undetected.
Recently, Nigeria signed a $71 million agreement to support efforts to control TB in the country over the next two years (2019-2020) thus signalling the government’s intention to prioritise TB efforts.
In the wake of the development, national TB program officials and health care practitioners converged in Lagos, as part of a training focused on building health systems’ capacity to tackle TB and multi drug-resistant TB (MDR-TB) at the national and sub-national levels.
Prof. Isaac Adewole
These, among other efforts, are certainly meant for the long haul. On the short-run, the government and partnering agencies would do right to increase sensitisation efforts. It’s the only way prevent an experience like the Davids.
Sometimes, when he shut his eyes, David, 36, remembers his deceased daughter’s smile, and the pitter-patter of her feet.
In those moments, the world peels away and the bereaved father and TB patient, experiences fresh torment; heartbroken, he relives the screaming gleam in his daughter’s eyes just before the glimmer turned clay-like, the colour of burnt mud.
“I know she is in a better place. But I should have been more observant. My carelessness led to her death,” said David, in the tenor of a man for whom time and memory allows the gift of reflection. Until reality afflicts him with the plague of truth: Tanimola, his bubbly five-year-old daughter, lays dormant beneath cracked earth.
PHOTOS: William Daniels, Olatunji Ololade, Library
No fewer than 18 Nigerians die hourly from Tuberculosis (TB), the National Tuberculosis, Burulli Ulcer and Leprosy Control Programme ( NTBLCP ) , said on Friday in Lagos.
Mrs Itohowo Uko, the Deputy Directorof NTBLCP in the Federal Ministry of Health, disclosedd this at an integrated media parley organised by Breakthrough Action -Nigeria in collaboration with the Health Writers Association of Nigeria (HEWAN), in Lagos.
Uko, who is also a laboratory scientist, described tuberculosis as an airborne infectious disease caused by the germ, Mycobacterium Tuberculosis, which affects the lungs mainly but may affect any other part of the body.
”According to the World Health Organisation (WHO) 2017 global report, TB is one of the top 10 causes of death worldwide and Nigeria is classified among the 14 countries with high burden of TB.
”It is estimated that two out of every 1,000 Nigerians will have TB; 104,940 TB patients representing about 20 per cent of existing patients were notified to the authorities in 2017.
“ This means that there is a huge number of TB patients in communities that are not notified.
”No fewer than 18 Nigerians die every hour of TB and one case of untreated TB can infect between 10 and 15 persons per year.
”Nigeria has the sixth highest burden of TB patients globally and first in Africa; of the 104,904 patients notified in 2017, 63 per cent were aged between 15 and 44; the working age group is the most affected, ” she said.
Uko said that the statistics were scary and called on all stakeholders to show concern to ensure a Nigeria-free TB, reduce burden , as well as reach zero TB deaths.
On the dynamics of TB, she said that TB is spread through the air when the person with TB of the lungs coughs, sneezes, sings or talks.
According to her, TB is curable and the patient is not termed as infectious after few weeks of treatment.
”Persistent cough of two weeks or more duration may be due to TB and needs to be further investigated.
”Other signs of TB of the lungs include:
loss of weight when you are not trying to lose weight, drenching night sweats when others close by are not sweating like that and loss of appetite, ” she said.
Uko advised the public to avoiding overcrowded and poorly ventilated environments, observe cough hygiene by covering their mouths properly when coughing and sneezing.
She also advised them not to be spitting indiscriminately in public, as well as eating a balanced diet to avoid malnutrition.
She also called for prompt diagnosis of TB in patients and recommended treatment for six months to prevent spreading the germ to others.
”TB is completely curable if detected and treated early; the drugs and diagnostic tests are free of charge in Nigeria.
”The toll-free number to call is 08002255282 if you have any of the above signs or symptoms for further guidance.
”There is the urgent need to increase early TB case finding, notification and treatment,’’ she said.
Uko also urged the media to work with health agencies in the dissemination of health-promoting messages to the public.
In her remarks, Dr Bolatito Aiyenigba, Deputy Director, Malaria and Tuberculosis Project of Breakthrough Action-Nigeria, said the project focused on Integrated Health Social Behaviour Change in the country.
Aiyenigba highlighted maternal, neonatal , child health , as well as nutrition, family planning, malaria and tuberculosis as its areas of focus.
She also said that the project had helped to build media capacity in the reportage of malaria, family planning, nutrition and tuberculosis.
“Health is a general concern and the media has a role to play in educating and informing the public on the need to adopt healthy lifestyles and reduce the high prevalence of diseases in the country,’’ Aiyenigbe said.
A veteran Nigerian Artiste, Richard Mofe Damijo, popularly known as RMD, says Nigerian artistes will support the efforts to end the scourge of Tuberculosis (TB) in the country.
RMD spoke as part of a TB discussion group during the United Nations General Assembly (UNGA) first-ever high-level meeting on tuberculosis (TB) in New York.
The UNGA on TB on Sept. 26 gathered Heads of States in New York to accelerate efforts in ending TB and reach all affected people with prevention and care.
This is part of the activities of the 73rd UNGA, the biggest global meeting of heads of states.
The theme was: “United to End Tuberculosis: An Urgent Global Response to a Global Epidemic’’.
RMD said: “From the work we do as actors, all the time we get the attention of people.
“We grow being followed and because of that followership, it gives us various platforms to reach a lot more people.
“Socially in Nigeria today and the world all over, it makes it easier to join forces with TB partners in order to be effective.
“I am sure that we will be able to do everything in our power to get the message out there and we have the artistes’ support, of course, and our government here today.’’
He added: “Another is to have as much information as possible from our partners because it is not enough to just say something once and then you stop at that.
“The depth of your knowledge in the campaign that you are trying to propagate is very important so as to have a good synergy between the partners and celebrities.
“We need the government, our leaders here to support us to get the messages across,’’ he said.
Also, President Muhammadu Buhari reaffirmed Nigeria’s commitment to eradicate tuberculosis as soon as possible.
According to him, the administration remains resolute in the efforts to address institutional and societal challenges, through the enhancement of strong multi-sectoral mechanisms.
According to the World Health Organisation (WHO), it is estimated that TB claims no fewer than 420 lives every day.
This makes Nigeria the 7th with the highest burden in the world and second highest in Africa.
TB is one of the top 10 causes of death worldwide; it is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs; it is curable and preventable.
TB is spread from person to person through the air; when people with lung TB cough, sneeze or spit, they propel the TB germs into the air,
A person needs to inhale only a few of these germs to become infected.
In 2017, an estimated 10 million people fell ill with TB and 1.6 million died from the disease (including 0.3 million among people with HIV); an estimated one million children became ill with TB and 230 000 children died of TB (including children with HIV associated TB).
Also in 2017, 87 per cent of new TB cases occurred in the 30 high TB burden countries; eight countries accounted for two thirds of the new TB cases and they include India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
The Global Fund is joining leaders who converge on New York to commit to speeding up global collaboration in the fight against TB, a preventable disease that killed 1.6 million people in 2017.
Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, is addressing the first-ever UN High-Level Meeting on Tuberculosis.
Leaders are expected to sign a Declaration that will commit them to bigger efforts and investments needed to achieve the Sustainable Development Goal target of ending the TB epidemic by 2030.
The World Health Organization (WHO) has called the meeting an “unprecedented step forward” by governments and partners in the fight against TB.
“The time has come for the world to reject the notion that a disease that is preventable and curable can continue to kill so many,” said Sands. “I call upon every country to muster the political will and invest the resources needed to meet the targets in the Declaration. We will need more international funding, but we will also need greater domestic resources.”
Since 2002, the Global Fund has invested more than US$6.2 billion in the fight against TB and now represents about 65 percent of the international response to TB. But to meet the targets in the Declaration, the world will need to invest more in programs that are working, and find new and better drugs and tools to fight TB.
Today’s meeting is expected to commit to closing the funding gap for the treatment and research of TB, estimated at $3.5 billion this year – an amount that may double by 2022. To reach millions of people who miss treatment every year, the leaders will also commit to finding and treating 40 million people with tuberculosis from 2018 to 2022.
“We need a step change in our approach to fighting TB,” said Sands. “The Declaration is the result of a generation of activists who are standing up to fight TB, global leaders committing funding and political will, and a new energy amongst the private sector and researchers to find innovative new solutions to end TB. We have a moral imperative to hold them accountable for making this happen, tracking progress against targets across every country.”
The leaders will commit to developing community-based health services to address human rights-related barriers to health and other challenges that block people from accessing the prevention, care and treatment they need to beat TB.
“Most of those that are ‘missed’ are the ones that are most vulnerable,” said Lucica Ditiu, Executive Director of the Stop TB Partnership, who was a driving force in the TB community to make today’s meeting a reality. “To succeed, TB services must be based on dialogue with people with TB. We have to look at the person living with TB as a full person, as a peer – with needs, with a family.”
President Muhammadu Buhari on Wednesday in New York restated Nigeria’s commitment towards the eradication of tuberculosis in the near future.
Addressing a High Level meeting on the theme, “United Against Tuberculosis: Global Action Against Global Threat” on the sidelines of the 73rd Session of the United Nations General Assembly, the President expressed delight that the landmark event was taking place “at a period when the pain of the disease, and its dire consequences on the health and socio-economic development of many developing countries, is on the rise.”
In a statement by the Special Adviser on Media and publicity, Femi Adesina, the President welcomed the adoption of what he termed “the all-important Political Declaration on: “United to End Tuberculosis: An Urgent Global Response to a Global Epidemic,”
He said that this was the first global forum with dedicated focus on worldwide tuberculosis pandemic.
Acknowledging that “TB has become a global challenge that requires consistent and an all-inclusive global strategy based on research and discovery of new drugs,” the Nigerian President stressed that “such efforts must also include mobilization of funds and global partnership of relevant stakeholders working together to frontally address the scourge.”
He noted that the task before world leaders “is to initiate a global response towards eradicating the disease especially in developing countries, where counter-measures are sometimes beyond the capacity of such nations.”
He also emphasized the “need to develop new strategies that connect national responses with international finance and technical partnership to stop the ravaging disease.”
He said “Nigeria welcomes the adoption of this Political Declaration, especially its relevant provisions which commit to provide diagnosis and treatment to 40 million people, including 3.5 million children between 2018 and 2022.
“The Declaration should also serve as a template for preventing TB for those most-at-risk, through rapid scale up of access to testing the infection, especially for the high-burdened countries,” he said.
The Nigerian leader expressed confidence “that other commitments made under this important document, including those on development of new vaccines, drugs and community-based health services, will further guarantee success in our collective fight against the disease.”
Nigeria’s national TB eradication strategy, he noted, had long been structured to provide tailored quality services in terms of diagnosis, treatment and prevention, adding that “since assuming office in May 2015, we consistently increased budget appropriation for the health sector.”
The budgetary increment, he stressed, was with “a view to ensuring that we promote the well-being of our people through access to qualitative health care services,” adding that, “we are investing in research and development in our various public and specialized institutions.”
The President said the national Action Plan on TB Eradication 2015-2020, which is being pursued with renewed vigour, is structured on five priorities namely: detection of TB in adults and children; improving treatment in specific geographic areas that are under-performing; integrating TB and HIV services; building capacity for diagnosing and treating drug resistant TB; and creating strong and sustainable systems to support these achievements.
Stressing that private sector engagement for TB is also being stridently pursued as a robust Public-Private Mix (PPM), President Buhari, said that the national “strategic plan is geared towards meeting the overall aims of providing Nigerians with universal access to high quality, patient-centred prevention, as well as diagnosis and treatment services for Tuberculosis, TB/HIV and drug-resistance TB by 2020.”
Furthermore, the Nigerian government, he said, is “exploring the possibility of establishing a financial institution dedicated to providing financial lifelines for free, comprehensive and qualitative medical treatments,” aimed at mitigating the “financial burden on victims and to also ensure that we continue to save lives and create favourable conditions for economic and social development.”
Pledging his country’s resolve to address “institutional and societal challenges through the enhancement of strong multi-sectoral mechanisms,” the Nigerian President called on the global community to demonstrate renewed commitment to the Political Declaration on the eradication of TB.
The World Health Organisation ( WHO ) has called for urgent global action to end Tuberculosis (TB), the world’s deadliest infectious disease which claims 4000 lives daily. The call was made at a press conference to launch the 2018 Global Tuberculosis report, held yesterday at the United Nations headquarters in New York.
The report provides a comprehensive assessment of the TB epidemic, with data on disease trends and response in 205 countries and territories. It also outlined a monitoring framework with data on SDG indicators and a graphic country profiles from the top 30 high-TB-burden countries.
According to the report, Nigeria’s TB treatment coverage stands at 24 percent with 155 000 deaths, including 35 000 deaths among people with HIV. Also, 24, 000 people fell ill with drug-resistant TB while 58, 000 people living with HIV fell ill with TB. The TB cases in Nigeria were attributed to five risks namely alcohol, smoking, diabetes, HIV and undernourishment.
The Director, Global TB Programme, WHO, Dr Tereza Kasaeve called for urgent actions to close the gaps and reach all people affected with TB worldwide with proper care. In a chat with The Nation, Dr Irene Koek, the Deputy Administrator for Global Health, US Agency for International Development (USAID) charged leaders from African countries to recognizeTB as an important issue that demands urgent attention with political commitment which invests in the needs of patients and health systems.
Heads of State are expected to meet at the first-ever United Nations General Assembly High-level Meeting on TB on 26 September in New York, to commit to accelerate the TB response.
Nigeria is the second country in Africa with the highest rate of Tuberculosis (TB), and seventh globally.
Last year, it had 104, 904 TB cases, 63 percent of which belonged to the ages 15 – 44 daily.
With these figures, the country is set to win the war against the disease by 2025, or 2030.
To this end, the Federal Government has engaged professionals in private sectors across medicine, laboratory/diagnosis, pharmacy, and the media.
The Minister of Health, Prof Isaac Adewole, said low awareness and limited capacities for picking up people with TB, especially for diagnosis and treatment, are some of the key factors driving the TB problem in Nigeria.
“The new diagnostic tool for TB called GeneXpert MTB/RIF machine is only available in 390 health facilities in the country; therefore, patients who required the GeneExpert test could not access it due to limited number and difficult sputum transportation system.’’
That is why the government is engaging professionals across the country in a new initiative- Public Private Mix (PPM) for TB Control, “in collaboration with the Lagos State Ministry of Health Association of General and Private Medical Practitioners of Nigeria (AGPMPN) is the umbrella organisation for all medical and dental doctors in private practice either as owners or employees to ensure patients that get to them, who has coughed for more than two weeks get screened, and if diagnosis is positive gets a free treatment. The huge number of missing TB people remain the source of continuous TB in community.”
Also, the Federal Government has engaged medical laboratory scientists and their umbrella body; pharmacists, especially community pharmacists, and other stakeholders, so there will be no missed person with TB again.
The minister said: “We have deployed cutting-edge technology to enhance TB diagnosis in the country. A total of 391 GeneXpert machines have so far been installed at 310 sites across the country for this purpose. To ensure universal access, the government is targeting at least one machine per LGA. In addition, a total of 2,650 microscopy centres exist to support treatment monitoring.The number of TB reference laboratories has also increased from eight in 2013 to 10 in 2018 to support the management of drug resistance TB. In furtherance of the desire of the FMoH to improve access of all presumptive TB cases to Xpert MTB/RIF essay, specimen transport is being fashioned in a hub and spoke model. We have also expanded the capacities in-country to adequately manage drug resistant TB, with over 2,000 drug resistant TB cases diagnosed in 2017.
“Last year, at the National Council on Health, a resolution was passed, which mandates notification of TB cases by all providers, including private health care practitioners. This is a bold step taken by the country to address its TB burden and increase TB notification in the country. We are working with the relevant government agencies and organisations to enhance the implementation of the NCH resolution. Furthermore, to ensure active private sector participation in financing TB service provision and demand creation, the FMoH has created this platform to engage the private sector.
“Every year, 302, 000 TB cases are not diagnosed and are not properly treated and are therefore missed. The pool of missed TB patients serves as a reservoir for continuous transmission of TB. One infectious TB case can infect 10 to 15 persons annually. Every Nigerian is, therefore, at risk of being infected with TB, because TB being an airborne disease can be spread when there is a close contact with an infectious TB case in our various homes, in the market, at the various places of worships, schools, social gatherings and workplace. Nigeria notified 104, 904 TB cases last year, 63 percent of which belonged to the age group 15-44 years,” said Adewole.
He said about 17 Nigerians die every hour from TB. “Every year, about 100, 000 Nigerians die from TB. These deaths can be prevented if people with TB are diagnosed early, and are promptly treated with the right medicines. These are absolutely free now, both in the public and private facilities.
“Finding the missing TB people is the great challenge we are tackling now. The sub-optimal resources available for TB control in Nigeria have impeded efforts at finding the missing people with TB. Last year alone, over 300, 000 were missed and not detected. Children are not left out, as seven children get TB every hour. War against TB is winnable if detected early and treated properly. Stigma is driving TB under. Proportion is higher in children because they have low immune, hence low resistance to TB.
Adewole explained that as part of efforts to control TB in Nigeria, the mnistry established the National TB Control Programme, which developed the National TB Strategy 2015-2020 framework to address the country’s TB burden. The framework is consistent with the End TB Strategy and incorporates the most recent internationally recommended diagnostic and treatment strategies, adding: “The ministry in collaboration with a broad coalition of partners namely: USAID and the US Centers for Disease Control and Prevention (CDC), the KNCV Tuberculosis Foundation (KNCV)/Challenge TB (CTB), the Department of Defence (DOD), the Global Fund, the International Federation of Leprosy Associations (ILEP), the Stop TB partnership, Association of Reproductive and family Health (ARFH), Institute of Human Virology (IHVN) and the Civil Societies among others, is providing free TB services in over 7,000 health facilities in the country, where over 100,000 TB cases were notified and treated in last year.
“The TB cases notified in 2017 only represent about 25 per cent of the estimated TB cases in the country. The remaining 75percent of the estimated TB cases that are undetected (missing TB cases) remain in the community, leaving a high probability of transmission of the disease to other people. The infectious sources could be our close associates, workers, drivers, teachers etc., thereby putting all of us, including our children at risk, and hence the need for all of us to work together to make Nigeria free of TB.
“We are working hard to address the menace. The country delivers TB treatment and care through a network of over 7,000 health facilities accredited by the National TB and Leprosy Control Programme (NTBLCP) up from 3931 in 2010. Similarly, the number of Drug resistant TB (DR-TB) treatment centres has been progressively increased from 10 in 2013 to 28 last year,” said Prof Adewole.
Chairman, Association of General and Private Medical Practitioners of Nigeria (AGPMPN), Lagos State Dr Tunji Akintade, assured that before the partnership with the state, his colleagues in private practice avoided treating TB, “because of the stigma it brings to their hospitals. But with this partnership with AGPMPN, we are already to win the war against TB”.
GIRD your loins … tuberculosis is sweeping through the land, killing as many as 400 Nigerians every day, and roaming, inactive, in the bodies of more than 300,000 people it is yet to hack down. The government requires billions of Naira in this tight economy to contain the upsurge and spread of tuberculosis. As the money is not easily forthcoming, traditional medicine and alternative medicine will be the last resort of many sufferers and those who will be seeking protection against infection. There is, indeed, hope for such health seekers.
I am on standby inside me these days whenever anyone around me is coughing. The possibility of infection is enormous in buses. Many people do not cover their mouths. Many others are not brought up at home or trained at school in the culture of handkerchief. So, shaking hands with an infected person, who covered his/her mouth with his/her hand while coughing can easily cause peril to other people, who come in contact with this hand. Not only that, dropplets of saliva which bear the mycobacterium tuberculosis, the germ which causes tuberculosis, may fall on another person’s clothes or skin. Back home, these germs may find their ways into the bodies of many people through food or contact.
There have been cases where tuberculosis is spread or contracted by humans from cats, some fish and even red meat. I suspect that cow meat may be a major vector in Nigeria. Cows are headed through forests day and night under very stressful conditions, which deplete their immunity by the time they arrive at the abattoir for slaughter. In Lagos alone, about 10,000 cows are slaughtered every day. This is a lucrative business, which balloons every year. So, it may not be out of place to assume that, today, the Lagos abattoir may be dealing with about 15,000 cows every day. At about N150, 000 for a cow, the arithmetic should add up to N2, 250,000,000(two billion, two hundred and fifty million naira only) every day. This may be worth more than the value of petroleum products consumed in the city of Lagos every day, and suggests why cow herding through farms have become such a huge political question, which the herders protect with AK 47 guns. That is an aside, really. Where we are heading is that cows are required by law to be certified fit for human consumption before they are slaughtered at the abattoir and sold there or anywhere. The certification is to be done by veterinary doctors. To carry out this job efficiently, there must be enough veterinary doctors on stand-by.
I imagine this would involve elaborate checks, including blood tests e.t.c. For 15,000 cows to be tested every day, the Lagos abattoir would require 150 veterinary doctors and their assistants, each working on about 100 cows. But is it possible for one vet doctor or one vet assistant to attend efficiently to 150 cows in one day? Your guess is as good as mine. Some infected cows would pass through the eye of the needle! And this may be one reason tuberculosis has again become a big deal in Nigeria, especially in the urban areas where cow meat is not properly cooked in food canteens. When I was a boy, women always boiled meat and then fried it before they cooked it in stew or sauce. In today’s canteens, the cook avoids this long process to prevent the beef from shrinking and losing economic value. Do not get me wrong. I am not, by this, advocating frying, because when proteins are overheated, they transform into nitrosomes, which can cause cancer. It is possible that the diet of those days gave rise to the wide range of cancer occurrences exhibited in the elderly of this generation.
The Signs
The symptoms of tuberculosis are not too difficult to know. Persistent coughing is, most likely, the primus inter pares. The cough type has the capacity to defy many fist-line pharmaceutical cough remedies. A second symptom is a streak or specs of blood in the sputum. Again, persistent night sweats may be observed. Then, there is a gradual weight loss, which the infected person or persons around him/her may mistaken for stress or poor diet. On top of these, serious damage to tissue may be going on inside the body. There is a mistaken notion that tuberculosis is, strictly, a lung disease. True, it predominantly features in the lungs. But it affects other organs as well. In earlier commentaries in this column, I explained how two of my male cousins from the same mother died of tuberculosis of the spinal bones, which eventually ate up parts of their livers, before it was discovered that the fever presented in those cases was not due to back pain alone. Tuberculosis may unleash some serious havoc, also in the adrenal glands, chest cavity, bones, throat, kidneys, eyes and even the sex organs.
Mycobacterium Tuberculosis
When the bacterium is “shelled” out of the mouth through amplest of saliva into the air or by coughing and spitting out the sputum, it mixes with dust. If this occurs in dry, hot weather, which threatens its existence, the germ would form a protective chiteneous material around itself to prevent dehydration and death. The snail, too, does this. The germ awaits the good day or time when wind would rouse the dust and some unfortunate person would inhale it. How many of us do not inhale dust? If the dust is infected, the germs get into us. We would be lucky if our immune systems, defenders of our bodies, would knock them out. This job falls largely on the macrophages, the large white blood corpuscles, which engulf and eat up germs, and are then killed themselves. If the macrophages are healthy and many and the immune system can produce as many of them as are needed during such an emergency as this, the battle is won without the infected person knowing that anything is going on inside his/her body. But if the macrophages die, and the bacteria they engulf survive them for no reason or another, these germs travels through the blood circulation to safe havens, which they then colonise and damage inadvertently in the poisonous waste products of their metabolism and other activities. Sometimes, the body may have successfully boxed them up in cages, so to say, in which they are inactive, but the day stress overtakes the body and the immune system cannot keep an eagle watch, as during an HIV infection, the “cages” are thrown open in a sort of jail break, and the tuberculosis germ, once again, becomes ambulatory, that is free moving and infective.
Treatment
Doctors and pharmacists have struggled for hundreds of years to find a cure for tuberculosis and to even eliminate the germ. But many factors make this dream illusory. The victims are largely poor people, who live in overcrowded conditions in which the air content of oxygen is depleted. They do not eat well enough to give their body the protein it requires to form a formidable immune system. They over work to earn meager incomes, thereby stressing themselves. I encounter a big picture of the air pollution at Oshodi bus terminal everyday on my way home to Abule-egba by LAG BUS. The mini buses charge between 400 and 500 in place of 100 or 150 because heavy traffic has held down the big buses. Hundreds, if not thousands of commuters stand on their feet, all stressed up, for more than one hour, waiting for the traffic to move and for the big buses to come. Everyone, whether at the terminus platforms or in the stuck buses, is inhaling carbon monoxide instead of oxygen, ignorant that this would de-oxygenate their blood and that de-oxygenated blood does not support healthy immune system. They finish off their immune systems all the more when they arrive home and eat junk food and spray their bedrooms with dangerous anti-mosquito insecticides. what could be more disheartening in this regard than a story I heard on radio this morning (8 June 2018). A man and his wife who had just built a home in Shagamu, Ogun State, died in his house on their first night there. There were seven of them in one room. When their neighbour’s smelled stench coming from the house, they called the police, the police broke through the room and found seven decomposed bodies. It was speculated that they would have tried to clear rodents from the property with a powerful insecticide. Among poor Nigerians, SNIPER is widely used for the purpose despite many warnings to the contrary. Even in their single-bed apartments in face-me, I slap you, or face to face (apartment) single-bed houses, some cook in their rooms, or inhale petrol fumes when their neighbours refill the tanks of their “I better pass my neighbour” electricity generating sets. All these factors and more pre-dispose many people to tuberculosis infections and attacks and to the failure, sometimes, of pharmaceutical drugs. Accordingly, and especially because some strains of tuberculosis are becoming resistant to these drugs, some doctors now prefer to add chemotherapy to their treatment regimen. Even this has many side effects, which are now well known. To the doctors’ prescriptions, traditional medicines and alternative medicine protocol may be used as adjunct to conventional treatment or for prophylactic (prevention) purposes. The recipes, which I will mention hereafter have been used by some orthodox doctors either alone or as adjunct medication, with successful result. They have been found useful, also, in other pulmonary (lung) or breathing problem such as asthma, congestive obstructive pulmonary disease (COPD) and emphysema, to mention a few of them. The therapeutic goals in employing them revolve around, as usual, detoxification, alkalisation, mineralisation, oxygenation, parasite killing and immune boosting, among other objectives. An acidic system weakens the immune system and disorient it, whereas an alkaline system does the opposite, there are herbs, which stimulates the excretory organs (the lungs, liver, kidneys, skin and the bowels) to empty their toxic wastes for evacuation, and there are anti-oxidant, and there are anti-oxidant herbs, which destroy free radicals in the toxins, to prevent their overload in the blood during detoxification from mauling the system.
I would like to begin with Astragalus, which has demonstrated the capacity to help the body produce more macrophages. Zinc is useful in more than 250 ways for equilibrium the body biochemical processes. Women know it is good for hair, skin and nails, robust breasts, fertility and all that. Many men, too, have found it helpful to combat prostate gland challenges and improve sperm count and sperm health. Without zinc, there is little vitamin A can do for healthy vision. In its immune system function, zinc helps the Thymus Gland to maintain its size and efficiency. It is inside this gland that T-Cells or fighter cells mature. It is like their finishing defense academy.
I doff my heart for Golden Seal Root, one of nature’s most dependable antibiotic, antiviral and antifungal herbs. Maria Treben, that great Austrian herbalist of blessed memory, eulogised Calamus root for practically all health needs, including tuberculosis in her HEALTH THROUGH GOD’S PHARMACY Mark Treben says: “A year ago, a man 1.8 meters tall in his late fifties had become a skeleton without knowing the reason for his illness. Weighing only 45 kilos, he in company of a nurse stepped into the surgery of his doctor, who was telephoning another doctor and heard: I am sending you my most hopeless-patient … cancer of the lungs: so unwittingly the man learnt the diagnosis of his illness”. Afterwards, someone advised him to chew Calamus root to break his smoking habit and to drink yarrow tea mornings and evenings. Slowly, his weight increased, and since he felt better, he did not return to the doctor. About half a year later, he again went to the surgery of the doctor, who was most taken aback since he had thought this man dead. What did you do?, was all he could say. “Chewed Calamus root and drank yarrow tea”, replied the man. ‘ Calamus root? . Where did you find them? They are sold in herbal shops for a few shillings’. The man at this time reached his normal weight of 86 kilos and it was half a year later that he undertook a mountain hike, carrying a full laden back pack when I met him.’
The book, which I recommend for your health library, tells, also, the story of a man aged 36 years, who literally lost his balance after surgery to free the liver of a tumor. He was thin and went to develop tuberculosis in the intestine. Calamus root helped these conditions as well, reported Maria Treben. There are other startling cures achieved in the stomach and intestinal disturbances, including cancers. To Calamus and Yarrow we may add her suggestion of Horse Tail. I guess this is because of the high Silica content of this herb. Silica, called the homeopathic surgeon because it breaks up growths, is now available in 100 per cent biochemist tissue or cell salt No 12 and 96 per cent in Diatomaceous Earth (DE) or Diatom. Stinging Nettle has small amount of it.
We cannot address all useful remedies. Before I move on to Dr. Robert Atkens, one of those conventional doctors, who made the United States adopt nutritional food supplements. I would quickly like to add to the list Grape Seed Extract (GSE), which is highly antioxidant and one of those few supplements substances, which easily cross through Brain Blood Barrier. Dr. Raymond Strand reports that a man, who declined chemotherapy and opted instead for dietary supplements, especially GSE, normalise his Anti-Nuclear-Antibody (ANA) results within one year. His ANA had risen well over 1,000 per cent of normal. Dr. Strand mentioned this case in his “What Your Doctor Does Not Know About Nutrition May Be Killing You.”
Let’s hurry to Dr. Robert Atkins. Among his suggestions for all lung diseases is vitamin A. But, like all doctors, this mega-dosage physicians will not touch regular (i.e. oil soluble) Vitamin A with a long pole. Not more than 5000 I.U of it every day is often suggested, to prevent liver discomfort or damage, and birth defects. Dr. Atkins, like many physicians, prefer the water soluble variant of Vitamin A. which is often mentioned in this column as solubilised or water soluble Vitamin A. Dr. Atkins calls it by its other name.
Mycellized Vitamin A, saying: “If your body’s Vitamin A stores must be replenished in a hurry, as would be necessary at the outset of an acute respiratory infection, use the mycellized version, which by-passes the liver and is absorbed easily, thus reducing the likelihood of a toxic accumulation. Even in amounts of 100,000 I.U a day, for months at a time, mycellized Vitamin A has never caused any documented side effect. This safety record does not mean, however, that therapeutic dosages need not be mentioned by a doctor. Mycellized A performs impressively against sinus and other acute infections, especially when combined with mycellized Vitamin E.’’ Dr. Atkins suggests carotenoids, not just Beta Carotene, a mere member of the 600-member plus family, which is offered today for even cancer prevention and cure, except lung cancer caused by smoking, which at least, one study has shown is worsened by it. It warns against synthetic Beta Carotene in particular, saying it has been found to lower the blood presence of other caroteneoids. One of such affected caroteneoids is Lutein, which is needed for healthy eyes and crucial in “glaucoma” management. He salutes “natural” beta carotene, a deficiency of which he says has been linked to many cancers, including that of the lungs, and says it works best when it is combined with, say, mycellized Vitamin A and other natural carotenoids.
Maria Treben has an interesting handle on emphysema as well as cardiac asthma and disorders of the thyroid gland with their shortness of breath and is caused largely through liver trouble. The upward pressure of the liver contributes to the swelling and enlargement of the bronchial tubes, lungs and the heart. The constant pressure on the sensitive thyroid gland causes abnormal changes. In such a case, one cup of common club moss tea is drank in the morning and swedish bitters is applied as a compress for four hours during the day. I will round off with Dr. Atkins. The lungs and bronchial airways of the body are amazing, but delicate tissues. They are assaulted daily with both outdoor and indoor pollution, not to mention cigarette smoke and the toxic chemical found throughout our environment. Compound this inflammatory insult with lack of anti-inflammatory nutrients such as fish oil and anti-oxidants in our diets and you will understand why asthma and other pulmonary problems are continually on the rise. Food allergies can also be involved.
The bottom line approach for inflammation of the bronchial passage is to relax them with magnesium, protect them with anti-oxidants and reduce their exposure to environmental insults. He suggests Vitamin C, Vitamin A, essential oils formula, N-Acetyl cysteine, magnesium, Beta carotene, quercitine, selenium, taurine, Vitamin E and Co Q10.
