TB control baffles scientists

Saturday March 24 was World Tuberculosis Day. On this day, 118 years ago, a great scientist named Robert Koch discovered the TB germ writes Charles Wendo More than a century later, TB is only becoming more deadly though there are effective drugs that can cure it. Dr Rose Odeke, the acting head of the National Leprosy and Tuberculosis Programme, says the number of people suffering from tuberculosis in Uganda has been growing by 10% every year for the last 10 years. A total of 30,349 cases were reported to health facilities in 1999. But this is only half the number of people who suffer from the disease. The other half of TB patients do not go to health facilities. Of those who go to health facilities, about 60% complete treatment. Thus only 30% of all TB patients get cured. The rest remain harbouring the TB germ in the communities. As long as they are not on treatment, TB patients release the germs into the air whenever they cough, laugh or talk. Other people get infected when they breath in the airborne germs. "The most effective means of preventing TB is to treat and cure the infectious cases. "If we want to reduce this disease, we have to reduce the sources of infection by finding as many cases and making sure they are treated and cured," says Odeke. The World Health Organisation (WHO) describe the continued growth of the TB epidemic as "totally unnecessary and completely avoidable." One of the main constraints has been the long duration of treatment. The TB patients have been staying in hospital for two months to complete the treatment. But many patients flee the hospital, due to boredom, before they complete treatment. In rural areas, some people are so poor that they cannot afford the cost of maintaining a patient in a hospital many miles away from home. Due to poverty, they keep away from the treatment. Odeke says for better TB treatment, they are introducing a treatment strategy that does not require the patients to stay in hospital. Neither would the health workers have to wait for patients to go to hospital. She says they are training community volunteers to detect people who might be suffering from TB and then refer them to health facilities. When confirmed, the patients return home with a package of tablets to swallow daily for a given period. To make sure they take it, the volunteers will supervise them daily. The strategy is called Directly Observed Therapy Short course (DOTS) and was selected by WHO as the theme for this year's World Tuberculosis Day. "In Kiboga before we started DOTS the number of patients defaulting was 20%. Now only 2% of the TB patients fail to complete treatment. We started it in Kiboga as a pilot project but we intend to cover the whole country in three years," says Odeke. The move comes at a time when WHO and the Global Partnership to Stop TB have announced a new initiative to provide TB drugs to the most affected countries. Ten million patients are expected to benefit from the initiative in the next five years. "It is shameful that many TB patients are still dying of the disease, and it is inexcusable that less than a quarter of them have access to effective TB treatment," says Dr Gro Harlem Brundtland, WHO director general. Ends