Tuberculosis (TB) remains a major public health concern in Uganda, with an annual incidence of 199 cases of all forms translating to about 91000 new cases every year. 

Identification of cases has remained an overwhelming challenge as health service providers deal with the stigma associated with the disease due to limited awareness of the disease and what role they play to reduce the burden. 

Although Uganda is steadily striving to achieve its goal in the fight against TB, the road ahead is dotted with challenges. 

Dr Stavia Turyahabwe, the assistant commissioner tuberculosis leprosy control at the ministry of Health. Photo by Umar Nsubuga

Dr Stavia Turyahabwe, the Assistant Commissioner, Tuberculosis Leprosy Control at the health ministry, says the public should be sensitised about TB so that they can detect the symptoms early and report to health facilities quickly for immediate attention. 

She notes with concern that patients do not comply with the treatment plan because it takes long. They need support from health service providers and the community.

According to Dr Turyahabwe, proper hygiene is important in alleviating TB. Once you are in a public place, such as a school, bank, church, mosque, market, bus/taxi etc and you have a cough, it is prudent to have your mask on. 

You can also have a handkerchief to cover your mouth and nose when you cough. Adequate ventilation is also important in the fight against TB. 

“Once in a taxi or any other enclosure, make sure you open the windows to allow proper circulation of air inside the enclosed place. There could be a person having TB and it spreads to other un-affected people,” Dr Turyahabwe says. 

According to her, TB can affect any part of the body but mostly attacks the lungs. All other parts of the body can get affected, including the neck, throat, bones, abdomen, spine and body organs.

Signs and symptoms

TB is classified as either primary TB or secondary TB. Primary TB refers to a form of disease in a person who has never suffered from it, while secondary TB arises in a person who has had TB before. 

Symptoms of TB include loss of appetite, weight loss, mild fever and cough with sputum (at first, the sputum is like pus and it may be stained with blood). 

Dr Turyahabwe explains that even though TB mainly attacks the lungs, it can spread to other body parts, such as the heart, spinal cord and brain, mainly through blood and the lymphatic system, causing extrapulmonary TB.

Dr Francis Kanyike, a medical doctor at the Joint Clinical Research and national TB trainer says the risk of getting TB is higher in children below five years and the elderly because their immunity is low. 

He adds that the risk is also high in people with immune suppressive diseases (diseases which weaken the body’s immunity, thus the ability to fight infections).

Such diseases include HIV/AIDS and diabetes mellitus (high blood sugar).

He says there is a need to strengthen the health care system so that people can be adequately diagnosed and if found infected can be treated to kill the organisms. This, too, comes with adequate supplies of drugs because stock-outs can lead to drug resistance.

Asymptomatic TB

Like with all bacterial infections, Kanyike says in some cases, people living with HIV/AIDS may have asymptomatic TB (without showing signs and symptoms)

Testing

According to Dr Kanyike, one of the methods of testing for TB is by doing a sputum analysis test. With this method, the sputum is analysed for organisms that cause the disease. There are also other more sophisticated methods.

Treatment

Kanyike says patients are treated with anti-mycobacterial drugs. For primary TB, treatment is given for six months and those with drug-resistant cases are treated for 10 and more months with alternative drugs.

Prevention

The spread of TB can be prevented through practicing prevention measures, including wearing masks/covering the nose and mouth at all times when you have a cough or flu, identifying patients early, taking preventive treatment if you have stayed with someone with the disease as advised by the health worker, vaccination at birth of all newborn babies and building houses with adequate ventilation.

He encourages parents to take their children below five years for immunisation against TB using the BCG vaccine. TB and HIV/AIDS affect the same body defence system (white blood cells) so when one is infected with HIV/AIDS, they become more vulnerable to TB and/or the latent TB in their body easily manifests.

TB does not cause HIV/AIDS because these are transmitted differently. However, it is advisable to know one’s sero-status so as to determine whether HIV/AIDS was the underlying cause and also ensure efficient management. 

“Stop stigmatising TB patients on treatment as they are less likely to transmit the disease to you. If the transmission occurred, it was when a diagnosis was not yet done. Support them to complete treatment. TB is curable and preventable,” Kanyike says.