Tuberculosis, an increasing public health threat to Uganda

By Richardson Mafigiri

Although tuberculosis (TB) is curable and drugs are accessible free of charge, there are many cases which still go untreated amongst the population. In Uganda, TB and HIV dual epidemic has been observed overtime, with resultant catastrophic public health consequences and economic loses.

Tuberculosis is the most serious opportunistic infectious disease that normally affects persons with deteriorated immune system.  The disease is caused by an organism known as mycobacterium tuberculosis (MTB) which lead to infection of the lungs (pulmonary tuberculosis) and other parts of the body known as extra-pulmonary tuberculosis.

Reports by WHO over time, indicates that one third (about 2 billion) of the world’s population is infected with non-active (latent) tuberculosis and approximately 9 million incidence cases occur each year. Eleven (11) million people are currently infected with tuberculosis disease around the world and of these, 1.3 million people die each year from it. Of the 11 million TB patients in the world, 98% occurs in the developing countries.

HIV/AIDS epidemic in Africa has fueled the rise of TB with resultant multidrug resistant cases being reported. Worst hit countries include China, India and many sub-Saharan African countries such as Nigeria and others. Uganda holds 16th position from 18th position in 1999 among the most 22 TB worst hit countries in the world. Uganda’s latest TB incidence estimate (2013) by World Bank is 166/100,000 persons.

Apparently, Uganda Ministry of Health reports between 44,300 and 50,000 TB cases every year. The most common symptom of tuberculosis is persistent cough that lasts for two weeks or more.  Other symptoms include night sweats, loss of weight, and loss of appetite. Tuberculosis affects all age groups, however in children below 5 years, sometimes there is a low index of suspicion because it may only present with poor weight gain and low grade fever.

Lack of knowledge of symptoms of tuberculosis disease coupled with poor health service seeking behaviors and belief in witchcraft pose a danger of continued spread of TB in community.

Tuberculosis is an airborne disease which means if a person suffering from infectious TB coughs, sneezes or even speaks, s/he shades particles containing Mycobacterium tuberculosis that may be inhaled by another person leading to infection.

A patient with TB experiences severe economic set back due to inability to participate in income generating activities, sometimes even isolation from social gatherings with others, once people know that one is a TB patient, no one would want to be very close to an infected individual.

This stigma cause psychological torture among those suffering from it. Even when the patient is treated and cured, sometimes this stigma continues, it takes long for one to be accepted in community. Therefore, TB disease requires more community education, early detection and treatment, increased contact tracing and intensified screening of patients with HIV.

The writer is a Fellow MakSPH-CDC-MoH PHFP-FET