National World TB day Commemoration 2013

INTRODUCTION

Every year on 24th of March, the world commemorates World Tuberculosis (TB) day. On this day the World commemorates the day when Dr Robert Koch identified the Germ that causes TB.

The World TB day was first commemorated as an initiative of The International UnionAgainst TB and Lung Disease (The Union) in Uganda World TB Day was first commemorated in 1997 and has since been used to educate, inform and appeal to all to get involved in the fight against TB.

On this Day the world population under one voice advocates for Tuberculosis Control. The Theme for this year is “CALL FOR A WORLD FREE OF TB” and the slogan “STOP TB IN MY LIFETIME”. This is the second year to run the same theme and slogan.

We are renewing our commitment until we have universal coverage to treatment and have zero deaths to TB and a world free of Tuberculosis.

The theme for this year: “Call for a world free of TB” is compatible with the vision of the Ministry of Health and the National TB/Leprosy Programme as included in the 2011/12- 14/15 Strategic Plan for a “Uganda free from Tuberculosis”.

The slogan “Stop TB in my life time” emphasizes the importance of commitment by every Ugandan (young and old, men and women) to the fight against TB. If each person does what is their part, we can get rid of TB in this generation and ensure that people in the next generation will live in a Uganda without (free from) TB.

I am, therefore, very happy to officiate on this occasion and hope that it will go a long way in inspiring all the people participating in the function to dedicate their efforts, time and other resources to the fight against TB in Uganda.

BASIC INFORMATION ABOUT TB

It has been mentioned several times that TB is caused by a germ that is spread through the air by people with TB disease that has not been treated.

We cannot regard it a source of pride but rather an issue of great concern that:

(i) Uganda remains on the list of high burden TB countries

(ii) Almost 50,000 new cases of TB are identified every year

(these being only a part of those estimated to be actually present ) in the country

(iii) Lower than acceptable proportions of the identified TB patients successfully complete the prescribed treatment.

Our first role as Ugandans is to help identify the undetected transmitters of the disease. This transmitter could be yourself, a member of your family, a friend or someone in your village; I wish to emphasize here the message of the health workers and the speakers before me that TB should be suspected in anyone with any cough lasting two weeks or more.

People with these suspect symptoms (regardless of who they are) must present to health facilities to be screened for TB.

Apart from cough, all of us (but especially members of Village Health Teams) should lookout for the other suspect symptoms of TB including: persistent evening fevers, night sweats, weight loss and loss of appetite.

Most health units are equipped with facilities and equipped with professional skills (clinical and laboratory) and the laboratory facilities to screen people with suspect symptoms for TB; those that do not have the facilities will at least be able to refer the patients to the nearest facility where diagnostic services are available.

TB AND HIV

While Uganda continues battling with the HIV-AIDS epidemic; it is noteworthy that the HIV-AIDS epidemic also fuels the TB problem; one of the explanations for the increasing TB problem in Uganda is HIV-AIDS.

50 to 70% of all TB patients are also HIV infected. It is opportune to urge the public and all health workers to be on the lookout for this combination as we already have in place the system for handling it.

HIV AND TB

TB is, on the other hand, the most important killer of people living with HIV AIDS; it goes without saying that good quality care programmes for HIV-AIDS must look out for TB and give priority to measures to effectively treat it. In the case of persons with HIV-AIDS any cough regardless of duration has to be screened for TB.

Other conditions which can catalyze the development of TB (other than HIV) are: malnutrition, living in overcrowded conditions, houses with inadequate ventilation and living in slum areas.

TREATMENT FOR TB

It is a fact that anti-TB medicines can cure TB completely even in patients that have both HIV and TB. The Government of Uganda has put in place mechanisms to ensure an uninterrupted supply of essential medicines this we shall continue to ensure and anti TB medicines are fully integrated in this mechanism.

Persons with TB disease should be suspected early tested and diagnosed. Once diagnosed they need to be treated fully to get cured.

TB is CURABLE. Once cured, their livelihood and economic productivity will improve and they will also stop spreading the disease to other people.

It is of crucial importance that all concerned people (those involved in planning, financial resource allocation, procurement and distribution of medicines, those responsible for management of medical supplies from the Central stores, at the district and health facilities ensure not only the constant availability of the medicines but also that the medicines get to the patients in need of them in time, in sufficient quantity and free of charge. It is very risky not to complete a recommended dose of treatment by health professionals.

The Ministry of Health- TB and Leprosy Control program and other stakeholders must be congratulated for the achievements recorded thus far in the treatment of TB (that last year about 77% of the patients started on treatment successfully and completed the treatment but they have to do more: the target proportion of those who successfully complete treatment should be at least 85%.

The wish of every TB patient in this country would actually be that 100% of them successfully complete the treatment.

NO ONE SHOULD DIE FROM TB.

The current TB treatment takes a long time; like in all other diseases needing prolonged treatment, patients need to be continuously educated by health care providers on the need to take their medicines daily until they are instructed to stop;

The patients must be educated about the disease, treatment duration, importance, benefits of completing treatment.

They also need to be encouraged and supported by their families and friends to stay on treatment; The consequences of not getting adequate treatment do, after all, impact on each and every one: the health workers, the patient and his family and friends and the entire community.

What are the implications of inadequate treatment? We have been told about the existence in Uganda of TB germs that do not respond to the most effective and readily available anti TB treatment (first line of treatment):

This resistant TB is called Multiple drug resistant TB. This type of TB, which is quite difficult and extremely expensive to manage, is preventable. In order to effect that prevention, we all need to respond to the plea made by the TB control program Manager, to support, persuade and encourage patients with TB to take their medicines daily for the mandatory 6-8 months till completion.

MULTI-DRUG RESISTANT TB (MDR TB)

Some cases of drug resistant TB have already been recorded in Uganda. The government with its partners has responded to the need to care for the people with drug resistant TB by procuring the necessary medicines and putting in place treatment facilities. Government intends to further decentralize this service to all regions.

A special furnished 40 bed capacity National MDR TB ard was commissioned 2 days ago at Mulago National Referral Hospital to enable the hospital to take the expected lead in addressing the problem of MDR TB.

As I speak, other sites; Mbarara, Arua, Kitgum and Fort Portal have started offering this service and about 60 patients are benefitting from it. Other regional referral hospitals have been designated to handle these patients and a few partner-led sites could be allowed. It is the intention of the ministry to put all existing (known) patients with MDR TB on treatment within the next 3-4 months. Therefore information on confirmed MDR TB patients information should be sent to the national TB program as soon as possible by all those with information from districts.

Allow me remind all of you that supporting any known TB patient on treatment to complete TB treatment is one of the easiest way of stopping TB, stopping developing of drug resistant TB.

THE RESPONSE OF THE GOVERNMENT OF UGANDA TO THE CALL TO STOP TB CAN BE SUMMARIZED AS FOLLOWS:

THE GOVERNMENT:

• Recognizes TB as a one of the leading killer diseases. TB control is provided for in the Health Sector Strategic and Investment Plan (HSSIP 2011-14). The Ministry of Health Coordinates TB control activities through the National TB and Leprosy Control Program

• Has recruited health workers for Health Centres IV and III; these are expected to strengthen TB control among other roles at these levels. More health workers shall be recruited for general hospitals and regional hospitals

• Has procured and deployed equipment for TB testing, in 2011 about 200 BINOCULAR MICROSCOSCOPES were procured with support from the Global Fund and distributed.

• Has worked with partners to introduce some innovative diagnostics such as the GeneXpert machines and Fluorescent microscopes. There are so far about 20 sites with such Xpert machines and about 100 sites with highly sensitive fluorescent microscopes. More machines are expected for high caseload facilities such as Masaka which already has both the GeneXpert machine and a Fluorescent Microscope.

• My Ministry has acknowledged the continuing presence of challenges including those related to the strong association between HIV and TB, MDR TB, human resources for health, insufficient funding, lack of knowledge about TB among the general population and high population growth among others. Many of these are not peculiar to TB alone. We remain committed as a Ministry to do all we can to address these challenges.

MY SPECIAL APPEAL

On this occasion of World TB Day 2013, I wish in a special way to appeal to:

(i) Persons on TB treatment to adhere to the advice given to you by your health workers. Encourage one another to complete the prescribed treatment. You will get cured of TB. Encourage any other people who have symptoms like you had to come out and get tested now.

(ii) All Health Workers at all Levels of Care: Be on the lookout for patients with suspect TB symptoms (particularly the people with cough); if there is no capacity to handle the patients in your facility, refer them to the nearest one where appropriate care can be provided.

Remember that missing out on the essential actions could increase the risk for you, other health workers and the general public of contracting TB.

I cannot over emphasize the need to screen repeatedly all people attending HIV care settings for TB. You are also responsible to make sure that transmission of TB does not happen within health care settings whether to yourselves or to people attending health facilities for other reasons.

(iii) The Community and Families: to encourage everybody who has coughed for 2 weeks or more to report at the nearest health facility with laboratory services for TB testing and advice from qualified health workers .

The Village Health Team members (VHTs) you should champion this exercise. Do not segregate anyone found to have TB but rather support this person to adhere to the recommended treatment so as to get cured. Look out for other coughers assist them to get tested for TB.

Let us adopt more healthy behavior: cover the mouth when you cough, do not spit indiscriminately, work to improve the ventilation of our homes, take our children for immunization.

(iv) District Leadership: The leadership both political and technical needs to support activities of the health departments so that disease control activities and support supervision are regularly done. I appeal to Districts to allocate and spend funds on TB control as part of the integrated health service delivery for the good of the communities served. There is need to prioritize TB and to advocate for increased funding at all levels so that funds are available for provision of quality TB care.

Recording and reporting of disease control activities remains one of the biggest weaknesses observed in our health services. If this is not corrected it will become impossible to monitor disease trends and to design appropriate interventions for controlling diseases including TB.

ACKNOWLEDGEMENTS:

I extend sincere thanks to the various development partners who contributed generous towards the organization of this function and for coming to be present.

In a very special way, I wish to thank Masaka District Local Government, the National TB/Leprosy Programme, the national and district organizing committees for the excellent preparation.

I thank everyone that has attended this function for your patience and active participation.

CLOSING REMARKS

It is my hope and prayer that together we shall move forwards determined to act and to do all it takes to STOP TB in our life time so that future generations will be free from this disease.

I FOR ONE, DO PLEDGE TO DO MY BEST TO STOP TB IN MY LIFETIME

I salute you all. God bless you abundantly.

FOR GOD AND MY COUNTRY.

MESSAGE OF THE REGIONAL DIRECTOR ON THE OCCASION OF WORLD TUBERCULOSIS DAY 2013 24 March 2013

Today, 24th of March 2013, is World Tuberculosis Day. It is a day when the whole world is reminded about the suffering that Tuberculosis (TB) continues to exert on people although effective control measures are available.

This year’s slogan for World TB Day is “Stop TB in my lifetime” TB remains a major public health problem in the African region which accounted for over 26% of notified TB cases globally in 2011.

It is estimated that, TB killed over half a million people in the African Region and only 62% of existing TB cases were detected in that year.

The situation is further worsened by the threat of drug-resistant TB and multidrug resistant TB which continue to be serious problems complicating TB treatment. Click for more