Every year, on March 24, the world celebrates TB Day. The day is set aside to create awareness about the epidemic and organise efforts to wipe the epidemic out of Uganda. This year’s theme is calling for a world free of TB, under Millennium Development Goal Six, whose aim is to combat major killer diseases, including TB, by 2015. Joyce Nyakato and Shamim Saad, write:

TB: Will Uganda meet the 2015 target?

“It started as a mild cough. But after two weeks, the cough worsened. It became hard to ignore. I felt so much pain piercing through my back,” says Jane Nanyange. “I couldn’t breathe well, so I went to hospital, where my spit was tested. I was diagnosed with tuberculosis. I was worried because I had been told that tuberculosis drugs were expensive,” Nanyange, whose is now admitted at the Mulago Hospital TB ward, narrates.

However, given that Nanyange is living with HIV, it did not surprise her that she had developed TB. She was admitted in May last year and discharged in July this year, though she was recently re-admitted because she did not respond to the medication.

When she was discharged in July, she was given drugs to take home and advised to keep reporting to the outpatient department for close monitoring. However, three months later, she still complains of the same symptoms that she presented with the first time she sought treatment.

TB relapse

According to Dr. Penelope Miremba, a medical officer at the tuberculosis unit, Nanyange is one of the many relapse cases that result from patients defaulting on treatment. Usually, the patient is required to start the dose afresh.

Miremba says many patients do not complete their TB medication and, therefore, risk having a relapse or suffering from a drug-resistant strain of the disease.

That is why Dr. Abel Nkolo, the country representative of TB CARE I Uganda, stresses the importance of patients completing the dose. However, for them to do it, they need to be directly monitored by a treatment supporter in their localities.

Miremba explains that when patients miss their dose, the bacteria are not completely eradicated, so they become resistant to the disease, posing a great challenge. Patients have to be put on second line treatment, which even takes much longer.

Tuberculosis treatment is often a success, but it is a long process that usually takes about six to nine months. However, the multi-drug resistant infections need up to two years to treat and are much more expensive.

Defaulting on treatment usually happens after two weeks of taking the medicine because this is when the effects and symptoms begin to disappear.

“Patients often think that they have cured and, therefore, stop taking their medicine,” explains Miremba.

Usually, after a couple of weeks of taking the medicine, most people are no longer capable of transmitting infection and they begin to feel better. But that does not mean all the bacteria are killed. One has to take the full dose.

Who is prone to infection?

According to Dr. Mugabe Rwabinumi, the acting programme manager of National Tuberculosis and Leprosy Centre, conditions that facilitate the transmission of TB include living in crowded environments such as prisons, boarding schools, slums and camps. People living with HIV/AIDS are also prone to TB because the virus weakens their immunity.

According to Miremba, the number of students is increasing in boarding schools are developing the disease. Dr. Joseph Imoko, the World Health Organisation national professional officer of TB, adds: “This is because of the overcrowding of the dormitories in the school environments.”

He advises that there is a need for parents to screen children with symptoms of TB to prevent them from transmitting the bacteria to other students.

When a person with tuberculosis is left untreated, he may spread the bacteria to about 10-15 other people in a year. Most people have been exposed to TB infection, however, the body has a mechanism of dealing with it. While it clears for some, for others, it remains dormant in the body.

However, when the immune system deteriorates from different causes like HIV/AIDS, cancer and malnutrition, it fails to control the infection, which activates the disease as the bacteria multiply and cause damage in the body. In fact, the disease is said to kill the majority of people with HIV/AIDS if untreated.

It commonly affects the lungs because that is the part of the body, which tries to contain the infection. However, when the disease breaks out, it can spread to other body parts through blood or the lymphatic system. With treatment, TB can successfully be controlled and cured, no matter where the infection may be.

Unfortunately, people are still ignorant of the symptoms of TB, while others still peg it to witchcraft, which has made the fight against the disease hard.

Symptoms

TB manifests as a persistent cough for two weeks or more. This is a type of cough that does not go away with over-the-counter medicine. Chest pains, night sweats and loss of weight also accompany TB.

Way forward

Attention is shifting to the communities and the area, where people live. Miremba believes that if the communities know the tell-tale symptoms of the TB, they are able to report these cases to the health centres in time for them to get early treatment and reduce chances of infecting others.

She stresses the reinforcement of TB volunteers in the communities to do follow-ups on treatment and advise the community on best practices that reduce the spread of TB. While some communities have the voluntary workers, the majority do not.

According to the country is planning a National TB prevalence survey to determine the burden of TB in its population, slated to start by the end of June this year.

However, the world Health Organisation TB 2012 report,using estimates, still ranks Uganda as one of the countries with a high TB burden.

Estimates show that Uganda seems to be on track in meeting targets in the reduction of the TB mortality rate. However we seem to be stalling when it comes to detection because some cases still go unreported.