Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis which is easily transmitted through the air when an infected person speaks, sneezes, laughs, sings or coughs.
Anyone can contract TB. It thrives mostly among people living in poverty-stricken communities and marginalised groups like refugee camps and migrants. Malnutrition, poor sanitation, and housing compounded with other factors like tobacco and alcohol use affect the vulnerability to TB.
“TB is an airborne disease that usually affects the lungs, and can also affect other body parts like the brain, lymph nodes, kidneys, and bones,” said Professor Soji Ige, a chest physician at the University College Hospital (UCH), Ibadan, Oyo State.
While most people exposed to the TB bacteria do not become infected, those who do will develop latent TB which is not infectious. But as they grow older, or when their immunity weakens, Professor Ige explained that the dormant bacteria becomes active, and they become infectious and suffer symptoms, which include a persistent cough, fever and chest pain.
Currently, Nigeria ranks fourth in global TB infections and the highest in Africa. Tuberculosis is the topmost infectious disease cause of death worldwide; there are estimated 10.4 million cases, 1.8 million deaths annually and representing the ninth leading cause of death globally.
Seven countries account for 64 per cent of the total number of cases of TB, with India leading, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa.
What is more, Nigerian Thoracic Society (NTS) said that at least 50 per cent of persons with tuberculosis (TB) in Nigeria are neglected and so will continue to transmit the disease in the community.
NTS’s President, Professor Peter Etete in a release said this treatment gap requires prompt attention to ensure the prevention and control of the disease.
This, he said, was particularly important considering that a new TB infection occurs every second and the disease is increasing rapidly in Africa, in parallel with the HIV/AIDS epidemic.
According to him, the problem of TB has been further compounded by the emergence of multi-drug resistance and even more recently the extensively drug-resistant TB.
He added: “Globally up to half a million people developed multidrug-resistant TB (MDR-TB), with extensively drug-resistant TB (XDR-TB) reported by 100 countries.
“TB affects the economically productive age group in the community, thereby affecting productivity. More worrisome is the fact that about one in three people with TB are never diagnosed and in Nigeria, the proportion of missed cases is as high as 50 per cent. This means they will not be treated and they will continue to transmit the disease in the community.
“Although 53 million lives have been saved through global efforts since 2000, actions and investments fall far short of those needed to end the TB epidemic. Countries need to move much faster to prevent, detect, and treat TB if they are to meet the global targets.”
Professor Etete said tackling the TB problem will, therefore, require multisectoral action across the Sustainable Development Goals (SDGs).
“The focus this year’s World Health Organisation (WHO) TB day comes in line with the Sustainable Development Goals set by the End TB Strategy and the Global Plan to End TB, 2016-2020. It challenges us to look at the fight against TB in an entirely new way: that every step we take should be a step that counts for people and will lead us towards TB elimination.”
Doctors Without Borders/Médecins Sans Frontières (MSF) has been fighting TB for more than 30 years and is among the biggest treatment providers. Dr Francis Varaine, leader of the MSF working group on tuberculosis, explains that the failure to make progress is, above all, a political issue.
Moreover, making progress on TB control, Professor Simeon Cadmus, at the Department of Veterinary Public Health and Preventive Medicine, University of Ibadan said also requires recognising the interdependence of the health of people, animals, and the environment.
According to Professor Cadmus, the synergy between human and animal health in tackling the menace of tuberculosis, also a zoonotic disease, in Nigeria had been neglected over the years.
”The human burden of zoonotic TB cannot be reduced without improvement of standards of food safety and the reduction of bovine tuberculosis in animals.
Pastoralists, livestock workers such as butchers, people who drink unpasteurised milk and milk produce, as well as those who consume improperly cooked meat and meat products are all at risk of bovine tuberculosis,” he declared.
The Minister of Health, Professor Isaac Adewole at the 2018 World Tuberculosis Day in Abuja said that the major drawback in the country’s tuberculosis programme is the low case findings for both adult and children.
Adewole said many tuberculosis cases were either not diagnosed or diagnosed, but not reported.
He said: “In 2017, the country notified only 109,904 out of the estimated 407,000 – all forms of TB cases (with treatment coverage of 25.8 per cent), leaving a gap of 302,096 comprising undetected or detected but not notified cases especially in non-DOTS sites.
“In the same year, the proportion of childhood TB was seven per cent of all forms of TB cases compared to 10 per cent recommended by the WHO. In addition, a total of 1783 DR-TB cases were notified out of the estimated 5200 DR-TB cases.”
Dr Matshidiso Moeti, World Health Organisation, WHO, Regional Director for Africa said that TB is an old disease that can be prevented and treated, but continues to afflict and kill many people.
According to her, governments are contributing only a quarter of the resources needed to provide adequate TB services, and 40 per cent of needs remain unfunded.
Dr Moeti further stated that although the African Region has made good progress in controlling TB, Africa still has the world’s highest levels of the disease, and only half of existing TB cases are being found by our health systems.
“We have the most patients infected with both HIV and TB, and are seeing alarming increases in the forms of TB that resist treatment with common medicines,” she added.
A TB-free world will only be achieved through leaders who champion efforts to end TB at the local level.
She stressed that leaders have a tremendous influence to build strong partnerships and commitment to ending the TB epidemic at every level.
The WHO Regional Director for Africa also called upon health workers, nongovernmental organisations and technicians to maximise the use of proven methods to diagnose and successfully treat all types of TB.
Dr Moeti added that community leaders, patient advocacy groups and people affected by TB should partner with government to ensure access to treatment for all.
She urged government at all levels to scale up domestic funding for TB control and take responsibility for essential medicines and laboratory supplies.
There are several ways one can prevent contracting or getting infected. They include:
- Go for early diagnosis and treatment: It is very important to seek early treatment to prevent deterioration and spreading of infection.
- Examination of close contacts: We live with people infected with TB. This can be through TB skin testing and x-ray examination.
- Lead a healthy life: People with poor health are more susceptible to get TB.
- Go for a BCG vaccination: Getting a Bacile Calmette Guerin (BCG) vaccination helps prevent the spread of TB.
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