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WHY is TB on the increase?Publish Date: Feb 06, 2014
WHY is TB on the increase?
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Tuberculosis bacteria
newvision

By Carol Natukunda

The cough is on; the bad cough. There is an increase in the number of Tuberculosis cases in Uganda. Statistics from the health ministry show that about 50,000 TB cases are reported annually, up from 37,000 in 2001.

Globally about 9 million people are diagnosed with TB every year and around 5,000 die every day.  According to the 2012 Global Report by the World Health Organization, Uganda is ranked 18 among the 22 high burden countries of the TB disease.

Of major concern to TB control is the resistance to first-line anti-tuberculosis drugs, according to health minister Dr. Ruhakana Rugunda

Rugunda noted that although TB is curable, more people are dying more than ever. before.

Causes


Rugunda attributed the increased cases of Multi-Resistant Tuberculosis to inadequate treatment, treatment interruptions caused by the patients, and failure to ensure availability of medicines to the TB patients.

Some patients cannot afford the cost of treatment. According to Rugunda, it requires about eight million Uganda Shillings to treat one patient in duration of about two years. 

Dr. Penelope Miremba, a medical officer at the tuberculosis unit at Mulago hospital decried that many patients were going tonto a relapse, for defaulting on treatment. Miremba said many patients do not complete their TB medication and, therefore, risk having a relapse or suffering from a drug-resistant strain of the disease.

“Usually, the patient is required to start the dose afresh, when they go into a relapse,” said in a recent interview with New Vision.

Miremba explained 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. According to a source at Mulago, 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,” explained 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.

Generally, however, the increase in tuberculosis infections is blamed on a several causes including the prevalence of HIV and AIDS. The prevalence rate of HIV in Uganda has increased from 6.4% in 2005 to 7.3% in 2011.

The 2012 World Health Organization Global Tuberculosis Report indicates that increasingly people living with HIV have low immunity hence easily suffer from Tuberculosis.

The report says at least one-third of the 34 million people living with HIV worldwide are infected with TB bacteria, although not yet ill with active TB. “People living with HIV and infected with TB are 21 to 34 times more likely to develop active TB disease than people without HIV,” the report adds.

Experts say this is a cause for worry. “Diseases like HIV/AIDS, cancer and malnutrition, weaken the body’s immunity. TB, like any other diseases attacks patients who already have low resistance,” notes Dr. Alfred Driwale, the district health Officer of Koboko Hospital.

However, experts point to the country's poor health infrastructure, limited laboratories and hospital coverage, a lack of awareness of the disease among the public, and poor sanitation in the slum areas of urban centers, where most cases are usually recorded.

Dorothy Namutamba, a Program Officer – International Community of Women Living with HIV- Eastern Africa says TB is not being given the priority it deserves in terms of resource allocation, community education, research and advocacy. 

“TB has been left in the laboratories and the health care providers,” she says, adding that there is need for community sensitization on hos TB is spread and why treatment is important.

Dr. Sheila Ndyanabangi, a mental health expert at the Ministry of Health points the high burden of the TB disease to smoking tobacco. “Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking,” she says.

Ndyanabangi regrets that tobacco smoking is not a craze among young people in the form of shisha smoking.
According to the health ministry estimates, the high burden of the TB disease is mainly in the urban centers, with Kampala accounting for 7,800 cases, Wakiso, 1,300 cases and other regional towns account for between 1,300 – 1,600 cases each. 

This has been mainly attributed to the overcrowding, yet TB can easily be spread through droplets, when someone coughs.

Implications and way forward

TB affects mostly adults in the economically productive age groups 24- 45 years, which means that Uganda’s productive age bracket is at stake.

Ndyanabangi calls for the need to sensitize communities about the dangers of tobacco and drug use.  She notes that drug use is already out of hand, and has infiltrated communities in the suburbs, schools and the working force.

“We want the general public to be well aware of the situation, take responsibility as everybody has an important role to play,” she explains.

Minister Rugunda says the government is going to ensure treatment of TB in all National and Referral hospitals in order to reduce on the increasing cases of resistant TB.

He says all hospitals are to scale up Multi Drug Resistant TB treatment to ensure that all patients within the different regions already diagnosed with are started on treatment.

FACT FILE Quick facts on TB

⦁    Tuberculosis, or TB, is an infectious bacterial disease, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

⦁    Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk.

⦁    People who are infected with HIV are 21 to 34 times more likely to become sick with TB .Risk of active TB is also greater in persons suffering from other conditions that impair the immune system.

⦁    More than 20% of TB cases worldwide are attributable to smoking.

⦁    Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) anti-TB drugs. The primary cause of MDR-TB is inappropriate treatment.

⦁    Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.

⦁    How it is diagnosed? Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. With three such tests, diagnosis can be made within a day, but this test does not detect numerous cases of less infectious forms of TB.

RELATED LINKS

TB: Will Uganda meet the 2015 target?


Uganda gets world class TB lab

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