Deadly Tuberculosis B hits Uganda

Apr 09, 2011

WHILE it is already too bad that 100,000 Ugandans are contracting tuberculosis (TB) every year, much worse news has set in: A type of TB that is resistant to standard treatment has been spreading in the country and the treatment will cost sh11million per patient, enough to pay university fees for th

WHILE it is already too bad that 100,000 Ugandans are contracting tuberculosis (TB) every year, much worse news has set in: A type of TB that is resistant to standard treatment has been spreading in the country and the treatment will cost sh11million per patient, enough to pay university fees for three years.

By vicky Wandawa

LIKE a common cold, TB starts with a cough, only that this cough cannot be treated by cough syrups and tablets bought over the counter.

“The cough usually lasts for more than two weeks and the patient produces sputum, sometimes laced with blood,” Henry Luzze, a medical officer at Mulago hospital’s TB unit explains. This could also be followed by excessive sweating at night and general body weakness.

Uganda is among the 22 countries in the world with the highest number of TB cases, with 100,000 new cases annually.
“These 22 countries carry about 80% of the world’s TB burden,” notes Dr. Joseph Kawuma, the executive secretary of Uganda Stop TB partnership.

Tuberculosis is caused by a species of bacteria known as Mycobacterium, which is spread mostly through the air, when an infected person coughs, spits, talks or even breathes around other people. There are other species spread through unboiled milk from infected cows.

Sadly, one cannot avoid the bacteria because they are everywhere. All that can be done to protect people from the virus is immunisation soon after birth. Even then, the immunization does not stop the TB germs from entering into your body. It only prevents the germs from making you sick.

According to the Ministry of Health, two thirds of all Ugandans have the TB germs in their lungs but they are not sick because they were immunised.
However, those with a weak body immunity are at risk of falling sick.

“In a lifetime, you have a 10% chance of contracting tuberculosis through inhalation but for one with HIV, the risk rises to 50%,” Luzze explains.

Meanwhile, Kawuma explains that 6 out of every 10 people with TB have HIV positive, and 3 out of 10 HIV patients have TB. The link between the two diseases is so strong that these days everyone with TB is advised to test for HIV and vise versa.

Besides HIV, Luzze explains that diabetes and malnourishment reduce one’s immunity, hence the risk of contracting tuberculosis is high. Poor ventilation and over exposure to the germs, also increases the chances of contracting TB.

Despite the risk, 10% of children born in Uganda do not receive the tuberculosis vaccine, BCG, which is supposed to be given free, immediately after birth.

Never the less, it is possible for a TB patient to heal completely. Luzze notes that TB requires a minimum of eight months treatment.

The first two months are referred to as the intensive phase of treatment. In Uganda, the treatment is free and can be accessed at all health centre IIIs, at the sub-county level.

However, even with the estimated 100,000 new cases annually, many miss out on the treatment. “There is evidence to show that we are treating barely half of these new cases,” Kawuma notes.

Many do not know they have TB, and do not go to hospital until it becomes worse. Even health workers sometimes take long to suspect that a patient has TB.

“Currently, there are numerous undetected cases of Tuberculosis in Uganda. Since the disease is airborne, wherever these patients breath, those around them are at a high risk of contracting the disease.” Kawuma says.

On average a TB patient can infect 10-15 other people in a year. The consolation is that once treatment has been started, patients cannot infect other people, if the medication is being taken as recommended.

An emerging challenge, however, is that the disease is becoming resistant to drugs. Doctors have noted a rise in the number of patients who do not heal when given the usual drugs.
In developed countries drug resistant TB (DR-TB) patients are being given drugs that are 15 times more expensive than the common ones. In Uganda, however, the drugs that treat DR-TB are not yet available.

The Ministry of Health has now created a coordination office to monitor the resistant strain of TB.

Dr. Samuel Kasozi, the coordinator for the DR-TB programme, says so far, 150 multi-drug resistant TB (MDR-TB) cases, have been detected from January 2008 to March 2011.

“The actual DR-TB burden in Uganda is not known but a survey to ascertain the burden is being carried out. MDR-TB occurs when the TB bacteria become resistant to the two most powerful first line anti-TB drugs,” Kasozi explains.

The emergence of Drug resistant TB is believed to be linked to poor adherence to prescribed TB treatment, social barriers such as stigma, discrimination, poverty, poor Direct Observation of Treatment (DOT) by treatment supporters and non compliance to the guidelines from prescribers partly due to drug stock-outs in some facilities.

The ordinary TB tests available at health centre IIIs cannot tell whether the infection is drug resistant or not. To detect drug resistance, sputum samples have to be tested from the national referral laboratory in Wandegeya, Kampala.

To do this, medics at the health centres seal a patients sputum in a box and send it to Kampala by post. The process is facilitated by the Centre for Disease Control.

What is Tuberculosis?

How it spreads

If not treated, each person with active TB can infect on average 10 - 15 people a year. The infection usually spreads from people who are not receiving treatment. Once the patient starts taking their daily dose as required, they stop spreading the germs.

Statistics

More than 100,000 Ugandans get TB every year. That is, nearly 2,000 every week, or about 270 everyday. Globally, 1.7 million people died of TB in 2009, equal to about 4700 deaths a day.

How do I know I have it?

Symptoms include a prolonged cough that does not heal when you take the common treatments. Sometimes the sputum has blood.

The patient may also sweat alot at night and have general body weakness. Everyone who has cough lasting more than four weeks should take a TB test. The test can be done at Health Centre III facilities at sub-county level.

Treatment

A combination of antibiotics taken daily for at least eight months will cure the disease. The treatment is free of charge. Some patients, however, have multidrug-resistant TB (MDR-TB), which does not respond to the standard treatments.

Handling TB infection

If you have TB or are looking after a person with the disease, avoid over crowded, enclosed and unventilated spaces. Closed places with air conditioning are dangerous. The bacilli are killed by sunlight. Air and wind also disperse it. Open the patient’s room for sun rays and wind to enter. Also cover your mouth when you cough. Do not spit everywhere. Flush or cover sputum with soil.

If you test positive for TB, test all other family members. All those who test positive must also check for HIV before taking TB drugs to avoid reaction.

Take all drugs in the right doses as prescribed by a physician. TB drugs are free in Uganda. If you do not treat TB, you spread the disease, it may become resistant to the drugs and you will die.

Prevention

The BCG vaccine given to babies immediately after birth makes us immune to TB. Adequate ventilation helps to prevent the spread of TB from person to person.

Family members should support the patients to start treatment immediately so they do not infect others. The treatment is free; all you need is to take the patient to hospital.

SOLUTIONS

Although MDR-TB cases have been diagnosed in Uganda, treatment is not yet available.

But plans are underway to ensure that by the end of this year drug resistant TB can be treated here.
Medical workers at Mulago Hospital have been trained on the management MDR-TB. Initially drug resistant TB will be treated at the TB unit in Mulago Hospital but later treatment will be expanded to other regional hospitals.

Funds are being lobbied for from the Government and other partners to renovate Mulago’s TB unit to accommodate at least thirty patients. Because drugs for MDR-TB are associated with a number of side effects, plans are also underway to purchase drugs to treat these side effects.

It is estimated that the cost of treating each MDR-TB patient will be $4,668 (Ush11.2m), including drug costs laboratory tests and personal protective gears such as masks and respirators.

In total, for the MDR-TB treatment project to start, the Government requires approximately sh40.5b.

Real life experience: Segane’s battle with TB

Peer pressure made me start smoking at the tender age of 16. Two years later, I developed a cough. My parents thought it was an ordinary cough but they were wrong.
We went to four different clinics but none of the drugs I was given worked.

One of the doctors then suspected that I had tuberculosis (TB). He advised my parents to take me to Entebbe Hospital. There, an X-ray revealed that my left lung had been badly damaged by TB.

I was told that I would go on treatment for six months, the first two of which I would be admitted at hospital.

During the two months, I took the medication but it was too strong and made me weak. I had to drink lots of fluids and spent the whole day in bed.

Unfortunately, even after the first two months when I was admitted, I was not discharged because I was not responding to the medication.

I was being given eight tablets and an injection daily and stayed at hospital for two more months.
I was eventually discharged and told to continue taking my medication religiously. The doctor warned me that if I missed a dose I would not get well.

While I was in hospital many patients died because once they were discharged, they would not follow the doctors instructions to continue with medication. Some would take alcohol and yet we had been told that taking alcohol while on TB treatment was equivalent to making poison for the body.

The TB eventually healed and now, 10 years later, I feel perfectly fine except for the little pain in the left lung whenever I get a cold.


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