Congestion accelerates tuberculosis in camps
Jul 16, 2007
FIVE months since she was started on the tuberculosis (TB) treatment, Regina Anyeko still cannot understand how she caught the pulmonary disease. “We have never had any cases of TB in our family. And all along I was a very healthy person,†wonders the 50-year-old housewife at Unyama camp for the
By Denis Ocwich
FIVE months since she was started on the tuberculosis (TB) treatment, Regina Anyeko still cannot understand how she caught the pulmonary disease. “We have never had any cases of TB in our family. And all along I was a very healthy person,†wonders the 50-year-old housewife at Unyama camp for the internally displaced people (IDP) in Gulu district.
Anyeko developed a virulent and incessant cough in 2005, while in the camp. “I coughed for over six months despite taking Septrin tablets and other medicine,†she recalls.
Her sputum was tested three times, but none of the tests showed she had the mycobacterium tuberculosis – the bacillus that causes TB.
“It was not until an X-ray was taken on my chest that I was found to have active TB,†she explains. “Maybe if I did not come to the camp, I would not be having TB,†laments Anyeko, who was displaced from Ato Hills, 15km away.
In Lira town, Richard Ogwal, 35, who is half-way the eight-month TB treatment course, also blames her health problem on the congested camps. He has been living at Erute IDP camp for the past three years.
Lying bare-chest on the floor of his tiny hut, he speaks meekly: “I came here without TB, but now I am sick and unable to do any hard labour. How will I sustain my family?â€
Although there has not been any systematic study on TB prevalence among IDPs in northern Uganda, health experts believe the living conditions in the camps are conducive for accelerating the development of active tuberculosis.
According to the Global Plan to Stop TB 2006 – 2015, a document prepared by the World Health Organisation (WHO), displaced people around the world are among the most vulnerable to TB and HIV/AIDS infections.
The report calls on TB-burdened countries, including Uganda, to “pay more attention and direct more resources (money and human) to vulnerable regions.
Northern Uganda has seen 20 years of insurgency orchestrated by the Lord’s Resistance Army rebels. The war has forced close to two million people into camps, with malnutrition, poor hygiene, overcrowding and poorly-ventilated shelters.
“Over the last four years, we have been recording increasing number of TB patients,†says Ben Okao-Abor, the TB/HIV focal person for Lira district.
“For every quarter of a year, we have been registering between 500 and 700 cases. “Before 2000, the quarterly TB cases registered were between 250 and 300,†Okao-Abor adds.
Lira’s case is not far from that of Gulu, which has over 80% of its population living in camps. According to John Opwonya, the district senior clinical officer and TB/Leprosy supervisor, Gulu has the highest incidence of HIV in the country – , 11% of the population.
Opwonya says the district recorded 1,065 cases of TB in 2005. This was slightly up from 1,009 in 2004. The data excludes that of Lacor Hospital, also in Gulu, which has had cases of multi-drug-resistant TB (MDR-TB), which occurs when the TB bacteria become resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
“So far, we have had five suspected cases of MDR-TB. One patient had undergone 14 months of treatment without success,†says Kenneth Oketayot, the senior clinical officer at Lacor.
All the suspected MDR-TB cases were referred to the Joint Clinical Research Centre in Kampala, which has better diagnosis and facilities. Last year, the number of TB cases recorded at Lacor went up to 1,545, from 1,396 in 2005. Some of the patients diagnosed came from neighbouring districts.
Lacor is the only health centre in the north providing test services for both pulmonary (of the lungs) and extra-pulmonary (outside the lungs) tuberculosis.
Most patients diagnosed with TB from Lacor, just like in major district hospitals, are referred to health units near their homes. At Gulu Regional Referral Hospital, an average of 250 TB patients are served per month. At the time of my visit, 21 of them were in-patients.
To manage TB in the camps, the district health officials have been relying on the Community-based Directly Observed Therapy, Short-course (CB-DOTS) strategy. Approved by WHO and adopted by the Ministry of Health as a national strategy, CB-DOTS involves, among others, health workers going to the villages and camps to sensitise people about TB. People are encouraged to go for tests whenever they get a bad cough for more than a week.
Under the strategy, there has been increased TB surveillance, diagnosis and treatment in the village health units.
DOTS expansion and enhancement is one of the components of the WHO-championed Stop TB Strategies, aimed at dramatically reducing the global burden of TB by 2015. This is in line with the Millennium Development Goals and Stop TB partnership targets. The Stop TB partnership was established in 2000 to eliminate TB as a public health problem and secure a world free of tuberculosis.
Tuberculosis kills an estimated two million people in the world every year and nine million new infections are recorded globally within the same time span. In Uganda, which is ranked 15th among the 22 high-burden countries with highest cases of tuberculosis, about 100,000 people develop the disease every year.
“With CB-DOTS, there is always a community volunteer to ensure that a TB patient takes his or her drugs promptly at the recommended time,†says Opwonya.
“We are changing TB management from hospital-based to community-based, but we need health workers and volunteers.â€
As people head to their homes in the wake of prevailing peace, there is need to take health services closer to the rural settings.
As with HIV/AIDS management, proper handling of TB in the north will require more funding, additional medical personnel and sensitisation.
The community-based surveillance and diagnosis of the airborne disease, as recommended by WHO, is the way to go. Creation of more diagnosis and treatment centres at the grassroots will boost case detection and treatment success rates.
Regina Anyeko no longer has to travel miles away to Gulu Referral Hospital for drugs. And she does not have to go to the health centre everyday. She gets her tablets once a week from the nearby Unyama Health Centre. Sometimes the drugs are collected by her son, Denis Ojara. Other times, the community health volunteer takes the medicine right up to her home. Her son’s duty is to keep reminding her to swallow her tablets once every evening at 9:00pm.
“If they could improve on CB-DOTS, then TB management will become easier and the disease will be wiped out from the north like they did with Guinea worm,†says Anyeko.
FIVE months since she was started on the tuberculosis (TB) treatment, Regina Anyeko still cannot understand how she caught the pulmonary disease. “We have never had any cases of TB in our family. And all along I was a very healthy person,†wonders the 50-year-old housewife at Unyama camp for the internally displaced people (IDP) in Gulu district.
Anyeko developed a virulent and incessant cough in 2005, while in the camp. “I coughed for over six months despite taking Septrin tablets and other medicine,†she recalls.
Her sputum was tested three times, but none of the tests showed she had the mycobacterium tuberculosis – the bacillus that causes TB.
“It was not until an X-ray was taken on my chest that I was found to have active TB,†she explains. “Maybe if I did not come to the camp, I would not be having TB,†laments Anyeko, who was displaced from Ato Hills, 15km away.
In Lira town, Richard Ogwal, 35, who is half-way the eight-month TB treatment course, also blames her health problem on the congested camps. He has been living at Erute IDP camp for the past three years.
Lying bare-chest on the floor of his tiny hut, he speaks meekly: “I came here without TB, but now I am sick and unable to do any hard labour. How will I sustain my family?â€
Although there has not been any systematic study on TB prevalence among IDPs in northern Uganda, health experts believe the living conditions in the camps are conducive for accelerating the development of active tuberculosis.
According to the Global Plan to Stop TB 2006 – 2015, a document prepared by the World Health Organisation (WHO), displaced people around the world are among the most vulnerable to TB and HIV/AIDS infections.
The report calls on TB-burdened countries, including Uganda, to “pay more attention and direct more resources (money and human) to vulnerable regions.
Northern Uganda has seen 20 years of insurgency orchestrated by the Lord’s Resistance Army rebels. The war has forced close to two million people into camps, with malnutrition, poor hygiene, overcrowding and poorly-ventilated shelters.
“Over the last four years, we have been recording increasing number of TB patients,†says Ben Okao-Abor, the TB/HIV focal person for Lira district.
“For every quarter of a year, we have been registering between 500 and 700 cases. “Before 2000, the quarterly TB cases registered were between 250 and 300,†Okao-Abor adds.
Lira’s case is not far from that of Gulu, which has over 80% of its population living in camps. According to John Opwonya, the district senior clinical officer and TB/Leprosy supervisor, Gulu has the highest incidence of HIV in the country – , 11% of the population.
Opwonya says the district recorded 1,065 cases of TB in 2005. This was slightly up from 1,009 in 2004. The data excludes that of Lacor Hospital, also in Gulu, which has had cases of multi-drug-resistant TB (MDR-TB), which occurs when the TB bacteria become resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
“So far, we have had five suspected cases of MDR-TB. One patient had undergone 14 months of treatment without success,†says Kenneth Oketayot, the senior clinical officer at Lacor.
All the suspected MDR-TB cases were referred to the Joint Clinical Research Centre in Kampala, which has better diagnosis and facilities. Last year, the number of TB cases recorded at Lacor went up to 1,545, from 1,396 in 2005. Some of the patients diagnosed came from neighbouring districts.
Lacor is the only health centre in the north providing test services for both pulmonary (of the lungs) and extra-pulmonary (outside the lungs) tuberculosis.
Most patients diagnosed with TB from Lacor, just like in major district hospitals, are referred to health units near their homes. At Gulu Regional Referral Hospital, an average of 250 TB patients are served per month. At the time of my visit, 21 of them were in-patients.
To manage TB in the camps, the district health officials have been relying on the Community-based Directly Observed Therapy, Short-course (CB-DOTS) strategy. Approved by WHO and adopted by the Ministry of Health as a national strategy, CB-DOTS involves, among others, health workers going to the villages and camps to sensitise people about TB. People are encouraged to go for tests whenever they get a bad cough for more than a week.
Under the strategy, there has been increased TB surveillance, diagnosis and treatment in the village health units.
DOTS expansion and enhancement is one of the components of the WHO-championed Stop TB Strategies, aimed at dramatically reducing the global burden of TB by 2015. This is in line with the Millennium Development Goals and Stop TB partnership targets. The Stop TB partnership was established in 2000 to eliminate TB as a public health problem and secure a world free of tuberculosis.
Tuberculosis kills an estimated two million people in the world every year and nine million new infections are recorded globally within the same time span. In Uganda, which is ranked 15th among the 22 high-burden countries with highest cases of tuberculosis, about 100,000 people develop the disease every year.
“With CB-DOTS, there is always a community volunteer to ensure that a TB patient takes his or her drugs promptly at the recommended time,†says Opwonya.
“We are changing TB management from hospital-based to community-based, but we need health workers and volunteers.â€
As people head to their homes in the wake of prevailing peace, there is need to take health services closer to the rural settings.
As with HIV/AIDS management, proper handling of TB in the north will require more funding, additional medical personnel and sensitisation.
The community-based surveillance and diagnosis of the airborne disease, as recommended by WHO, is the way to go. Creation of more diagnosis and treatment centres at the grassroots will boost case detection and treatment success rates.
Regina Anyeko no longer has to travel miles away to Gulu Referral Hospital for drugs. And she does not have to go to the health centre everyday. She gets her tablets once a week from the nearby Unyama Health Centre. Sometimes the drugs are collected by her son, Denis Ojara. Other times, the community health volunteer takes the medicine right up to her home. Her son’s duty is to keep reminding her to swallow her tablets once every evening at 9:00pm.
“If they could improve on CB-DOTS, then TB management will become easier and the disease will be wiped out from the north like they did with Guinea worm,†says Anyeko.